Journal Article

Who Should Be Screened for Postpartum Anemia? An Evaluation of Current Recommendations

Lisa M. Bodnar, Anna Maria Siega-Riz, William C. Miller, Mary E. Cogswell and Thad McDonald

in American Journal of Epidemiology

Published on behalf of Johns Hopkins Bloomberg School of Public Health

Volume 156, issue 10, pages 903-912
Published in print November 2002 | ISSN: 0002-9262
Published online November 2002 | e-ISSN: 1476-6256 | DOI:
Who Should Be Screened for Postpartum Anemia? An Evaluation of Current Recommendations

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The authors evaluated the utility of selective screening criteria for postpartum anemia developed by the Centers for Disease Control and Prevention (CDC) versus criteria developed among low-income women using prevalence-based screening principles. Pregnant women in Raleigh, North Carolina, were followed up to the postpartum visit in 1997–1999 (n = 345). Prevalence of postpartum anemia was 19.1%. Independent risk markers, arrived at through multivariate logistic regression, were multiparity (odds ratio (OR) = 1.5, 95% confidence interval (CI): 0.8, 2.9), obesity (OR = 3.0, 95% CI: 1.6, 5.5), anemia at 24–29 weeks’ gestation (OR = 2.3, 95% CI: 1.2, 4.4), anemia before delivery (OR = 3.4, 95% CI: 1.8, 6.7), and not exclusively breastfeeding (OR = 2.8, 95% CI: 1.0, 7.7). Risk scores were calculated by counting risk markers present. Likelihood ratios were determined for all possible risk scores of our algorithm and CDC’s algorithm. Anemia screening decisions differed depending on clinic anemia prevalence. For example, if low test thresholds are assumed, when clinic prevalence is 10%, women with risk scores >3 on the authors’ algorithm and >0 on CDC’s algorithm should be screened. The authors’ algorithm, in combination with prevalence information, can save clinics more money than CDC’s current algorithm because a broader range of likelihood ratios was obtained, indicating a better ability to distinguish high- from low-risk women. However, if resources are available, universal screening should be considered in high-prevalence settings.

Keywords: anemia; Bayes theorem; hemoglobins; iron; mass screening; puerperium; risk assessment; sensitivity and specificity; Abbreviations: CDC, Centers for Disease Control and Prevention; CI, confidence interval; LR, likelihood ratio; LR+, positive likelihood ratio; LR–, negative likelihood ratio.

Journal Article.  5897 words.  Illustrated.

Subjects: Public Health and Epidemiology

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