産後の鉄欠乏性貧血予防 (PRIORITY)
出産後の鉄欠乏性貧血の予防 (PRIORITY 試験): 女性と子供の健康研究のためのグローバル ネットワークのランダム化比較試験
調査の概要
状態
条件
詳細な説明
研究の種類
入学 (実際)
段階
- フェーズ 3
連絡先と場所
研究場所
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India
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Nagpur、India、インド
- Lata Medical Research Foundation
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Karnataka
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Belagavi、Karnataka、インド、590 010
- KLE Society's Jawaharlal Nehru Medical College
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Guatemala City、グアテマラ
- INCAP
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Eldoret、ケニア、30100
- Moi University School of Medicine
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Kinshasa、コンゴ民主共和国
- Kinshasa School of Public Health
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Lusaka、ザンビア
- University Teaching Hospital
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Dhaka、バングラデシュ、1212
- Icddrb
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Pakistan
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Karachi、Pakistan、パキスタン、74800
- The Aga Khan University
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参加基準
適格基準
就学可能な年齢
健康ボランティアの受け入れ
説明
包含基準:
- -LMPおよび/または臨床評価および/またはUSGによる妊娠20週を超える妊娠の確立
- 年齢:15歳(または対象年齢の下限※)~49歳
- 中等度の貧血が確認されている (Hb 7.0 ~ 9.9 g/dL、Hemocue® の静脈血サンプルに基づく分娩後 6 ~ 48 時間)
- 研究に参加している病院または医療施設で出産する
- インフォームドコンセントを提供できる
- -研究期間中、研究地域に留まる計画
除外基準:
- 過去 3 週間に受けた IV 鉄注入
- 鉄分補給の禁忌(一部の例には、溶血性貧血、アレルギー、重度の感染症が含まれる場合があります)
- 現在の入院中にすでに輸血を受けたか、予定されている輸血
- -既存のうつ病または他の精神疾患の既知の診断
- 無作為化前の死産、重大な先天異常、または新生児喪失
- マラリア陽性で未治療の女性
- 呼吸困難または疲労を伴う症候性貧血を呈し、直ちに是正する必要がある
- 既知のヘモグロビン症(鎌状赤血球症またはサラセミア)の女性
- 重度の喘息や既知の薬物アレルギーなどの重度のアレルギー状態の存在
- -医師の評価による緊急の医療を必要とする病気/状態を呈している女性
研究計画
研究はどのように設計されていますか?
デザインの詳細
- 主な目的:処理
- 割り当て:ランダム化
- 介入モデル:単一グループの割り当て
- マスキング:なし(オープンラベル)
武器と介入
参加者グループ / アーム |
介入・治療 |
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実験的:IV iron infusion
Participants randomized to the IV iron arm will receive a single-dose infusion of IV FCM, to be initiated between 6-48 hours after delivery.
All randomized participants will receive 400 mcg of folic acid daily for 6 months postpartum.
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FCM 50 mg iron/mL will be in a solution of 20 mL vials for infusion, using a dosage of 20 mg elemental iron per kg body weight, up to a maximum of 1 g, in a single IV infusion over 20-30 minutes.
400 mcg of folic acid daily to 6 months.
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アクティブコンパレータ:Oral iron tablets
Participants randomized to the oral iron arm will receive 60 mg elemental iron twice daily.
Treatment will be initiated between 6-48 hours after delivery and prior to discharge from the facility.
After discharge, each participant will take a treatment dose of twice daily for 6 weeks postpartum.
At 6 weeks postpartum, serum Hb will be assessed and participants with Hb < 7.0 g/dL will stop treatment, participants with Hb 7.0-11.9
g/dL will continue taking 60 mg elemental iron twice daily and participants with Hb > 11.9 g/dL will take 60 mg elemental iron once daily.
All randomized participants will receive 400 mcg of folic acid daily for 6 months postpartum.
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60 mg elemental iron twice daily to 6-weeks with then once or twice daily (based on Hb at 6-weeks) to 6-months.
400 mcg of folic acid daily to 6 months.
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この研究は何を測定していますか?
主要な結果の測定
結果測定 |
時間枠 |
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Maternal non-anemic state (Hb ≥11 g/dL)
時間枠:6 weeks post-delivery
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6 weeks post-delivery
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二次結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
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Change from baseline in serum Hb concentration at 6-weeks postpartum
時間枠:6 weeks post-delivery
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Serum Hb at baseline subtracted from serum Hb at 6 weeks.
Key secondary outcome.
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6 weeks post-delivery
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Maternal depression at 6-weeks postpartum
時間枠:6 weeks post-delivery
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Measured by Edinburgh Postnatal Depression Scale score > 10.
A score greater than 10 indicates a higher likelihood of depression.
Key secondary outcome.
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6 weeks post-delivery
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Change from baseline in serum Hb concentration at 6-months postpartum
時間枠:6 months post-delivery
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Serum Hb at baseline subtracted from serum Hb at 6 months.
Key secondary outcome.
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6 months post-delivery
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Maternal depression at 6-months postpartum
時間枠:6 months post-delivery
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Measured by Edinburgh Postnatal Depression (EPDS) Scale score > 10.
A score greater than 10 indicates a higher likelihood of depression.
Key secondary outcome.
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6 months post-delivery
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Maternal Fatigue Severity Scale Score > 4
時間枠:6 weeks and 6 months post-delivery
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Measured by the Maternal Fatigue Severity Scale (FSS-5R) > 4. A score > 4 indicates maternal fatigue.
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6 weeks and 6 months post-delivery
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Mother-to-Infant Bonding Scale Score ≥ 4
時間枠:6 weeks post-delivery
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Measured by the Mother-to-Infant Bonding Scale (MIBS) ≥ 4. A score ≥ 4 indicates worse mother to infant bonding.
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6 weeks post-delivery
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WHOQOL-BREF Overall Perception of Quality of Life score
時間枠:6 weeks and 6 months post-delivery
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The WHOQOL-BREF overall perception of quality of life score is the response to question 1 from the WHOQOL-BREF survey.
How would you rate your quality of life?
(Very poor=1; Poor=2; Neither poor nor good=3; Good=4; Very good=5)
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6 weeks and 6 months post-delivery
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WHOQOL-BREF Overall Perception of Health score
時間枠:6 weeks and 6 months post-delivery
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The WHOQOL-BREF overall perception of heath score is the response to question 2 from the WHOQOL-BREF survey.
How satisfied are you with your health?
(Very poor=1; Poor=2; Neither poor nor good=3; Good=4; Very good=5)
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6 weeks and 6 months post-delivery
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WHOQOL-BREF Physical Domain Score
時間枠:6 weeks and 6 months post-delivery
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The WHOQOL-BREF physical domain score is calculated as: ((6-Q3) + (6-Q4) + Q10 + Q15 + Q16 + Q17 + Q18)/7 x 4. If a participant is missing 2 or more questions in the physical domain or 6 or more questions in the WHOQOL-BREF assessment, then the WHOQOL-BREF physical domain score is set to missing. In the case where up to two items are missing, the mean of other items in the domain is substituted for the missing question. The score is transformed to a 0-100 scale by applying the following formula: (Score-4)*(100/16). |
6 weeks and 6 months post-delivery
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WHOQOL-BREF Psychological Domain Score
時間枠:6 weeks and 6 months post-delivery
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The WHOQOL-BREF psychological domain score is calculated as: (Q5 + Q6 + Q7 + Q11 + Q19 + (6-Q26))/6 x 4. If a participant is missing 2 or more questions in the psychological domain or 6 or more questions in the WHOQOL-BREF assessment, then the WHOQOL-BREF psychological domain score is set to missing. In the case where up to two items are missing, the mean of other items in the domain is substituted for the missing question. The score is transformed to a 0-100 scale by applying the following formula: (Score-4)*(100/16). |
6 weeks and 6 months post-delivery
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WHOQOL-BREF Social Relationships Domain Score
時間枠:6 weeks and 6 months post-delivery
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The WHOQOL-BREF social relationships domain score is calculated as: (Q20 + Q21 + Q22)/3 x 4. If a participant is missing 2 or more questions in the social relationships domain or 6 or more questions in the WHOQOL-BREF assessment, then the WHOQOL-BREF social relationships domain score is set to missing. In the case where one item is missing, the mean of other items in the domain is substituted for the missing question. The score is transformed to a 0-100 scale by applying the following formula: (Score-4)*(100/16). |
6 weeks and 6 months post-delivery
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WHOQOL-BREF Environment Domain Score
時間枠:6 weeks and 6 months post-delivery
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The WHOQOL-BREF environment domain score is calculated as: (Q8 + Q9 + Q12 + Q13 + Q14 + Q23 + Q24 + Q25)/8 x 4. If a participant is missing 3 or more questions in the environment domain or 6 or more questions in the WHOQOL-BREF assessment, then the WHOQOL-BREF environment domain score is set to missing. In the case where up to two items are missing, the mean of other items in the domain is substituted for the missing questions. The score is transformed to a 0-100 scale by applying the following formula: (Score-4)*(100/16). |
6 weeks and 6 months post-delivery
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Change from baseline in serum ferritin concentration
時間枠:6 weeks and 6 months post-delivery
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Serum ferritin concentration at baseline subtracted from serum ferritin concentration at 6 weeks and 6 months.
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6 weeks and 6 months post-delivery
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Change from baseline in serum soluble transferrin receptor concentration
時間枠:6 weeks and 6 months post-delivery
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Serum soluble transferrin receptor at baseline subtracted from serum soluble transferrin receptor at 6 weeks and 6 months.
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6 weeks and 6 months post-delivery
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Maternal non-anemic state (Hb ≥11.5 g/dL)
時間枠:6 weeks and 6 months post-delivery
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6 weeks and 6 months post-delivery
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Maternal non-anemic state (Hb ≥12.0 g/dL)
時間枠:6 weeks and 6 months post-delivery
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6 weeks and 6 months post-delivery
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Anemic state
時間枠:6 weeks and 6 months post-delivery
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Anemic state at 6 weeks postpartum defined as no anemia for Hb ≥ 11.0 g/dL, mild anemia for Hb 10.0-10.9
g/dL, moderate anemia for 7.0-9.9
g/dL and severe anemia for Hb < 7.0 g/dL.
Anemic state at 6 months postpartum defined as no anemia for Hb ≥ 12.0 g/dL, mild anemia for Hb 10.0-11.9
g/dL, moderate anemia for 7.0-9.9
g/dL and severe anemia for Hb < 7.0 g/dL.
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6 weeks and 6 months post-delivery
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Change from baseline in anemic state
時間枠:6 weeks and 6 months post-delivery
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Defined as 'Better' if the participant's Hb measurement is > 9.9 g/dL, 'No change' if the participant's Hb measurement is 7.0-9.9
g/dL, and 'Worse' if the participant's Hb measurement is < 7.0 g/dL.
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6 weeks and 6 months post-delivery
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Maternal mortality
時間枠:randomization to 6 months post-delivery
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Maternal death from any cause
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randomization to 6 months post-delivery
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Post-discharge blood transfusion
時間枠:discharge from delivery facility to 6 months post-delivery
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Blood transfusion given to mother after delivery facility discharge
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discharge from delivery facility to 6 months post-delivery
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Postpartum hemorrhage requiring blood transfusion or major surgery
時間枠:randomization to 6 weeks post-delivery
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randomization to 6 weeks post-delivery
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Post-discharge maternal hospitalization
時間枠:discharge from delivery facility to 6 months post-delivery
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Maternal admission to facility after delivery facility discharge
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discharge from delivery facility to 6 months post-delivery
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Neonatal/infant mortality
時間枠:randomization to 6 months
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Neonatal/infant death from any cause
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randomization to 6 months
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Post-discharge neonatal/infant hospitalization
時間枠:discharge from delivery facility to 6 months post-delivery
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Neonatal/infant admission to facility after delivery facility discharge
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discharge from delivery facility to 6 months post-delivery
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Exclusive breastfeeding
時間枠:6 weeks, 3 months and 6 months post-delivery
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Based on WHO/UNICEF definition that measures exclusive feeding with breast milk during the previous day.
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6 weeks, 3 months and 6 months post-delivery
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Hypophosphatemia at 6-weeks postpartum
時間枠:6 weeks post-delivery
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Measured by serum phosphate concentration < 2.5 mg/dL.
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6 weeks post-delivery
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Hypophosphatemia at 6-months postpartum
時間枠:6 months post-delivery
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Measured by serum phosphate concentration < 2.5 mg/dL at 6 months among participants with hypophosphatemia at 6 weeks.
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6 months post-delivery
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Short-term safety outcomes
時間枠:randomization to 6 weeks post-delivery
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Measured by at least one serious adverse event reported.
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randomization to 6 weeks post-delivery
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All Safety outcomes
時間枠:randomization to 6 months post-delivery
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Measured by at least one serious adverse event reported.
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randomization to 6 months post-delivery
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協力者と研究者
協力者
捜査官
- 主任研究者:Richard J Derman, MD, MPH、Thomas Jefferson University, Philadelphia, PA
出版物と役立つリンク
一般刊行物
- Tolkien Z, Stecher L, Mander AP, Pereira DI, Powell JJ. Ferrous sulfate supplementation causes significant gastrointestinal side-effects in adults: a systematic review and meta-analysis. PLoS One. 2015 Feb 20;10(2):e0117383. doi: 10.1371/journal.pone.0117383. eCollection 2015.
- Say L, Chou D, Gemmill A, Tuncalp O, Moller AB, Daniels J, Gulmezoglu AM, Temmerman M, Alkema L. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. 2014 Jun;2(6):e323-33. doi: 10.1016/S2214-109X(14)70227-X. Epub 2014 May 5.
- Parks S, Hoffman MK, Goudar SS, Patel A, Saleem S, Ali SA, Goldenberg RL, Hibberd PL, Moore J, Wallace D, McClure EM, Derman RJ. Maternal anaemia and maternal, fetal, and neonatal outcomes in a prospective cohort study in India and Pakistan. BJOG. 2019 May;126(6):737-743. doi: 10.1111/1471-0528.15585. Epub 2019 Jan 24.
- Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry. 1987 Jun;150:782-6. doi: 10.1192/bjp.150.6.782.
- Sultan P, Bampoe S, Shah R, Guo N, Estes J, Stave C, Goodnough LT, Halpern S, Butwick AJ. Oral vs intravenous iron therapy for postpartum anemia: a systematic review and meta-analysis. Am J Obstet Gynecol. 2019 Jul;221(1):19-29.e3. doi: 10.1016/j.ajog.2018.12.016. Epub 2018 Dec 19.
- Matsunaga A, Ohashi Y, Sakanashi K, Kitamura T. Factor structure of the Postpartum Bonding Questionnaire: Configural invariance and measurement invariance across postpartum time periods. J Psychiatr Res. 2021 Mar;135:1-7. doi: 10.1016/j.jpsychires.2020.11.017. Epub 2020 Nov 9.
- Taylor A, Atkins R, Kumar R, Adams D, Glover V. A new Mother-to-Infant Bonding Scale: links with early maternal mood. Arch Womens Ment Health. 2005 May;8(1):45-51. doi: 10.1007/s00737-005-0074-z. Epub 2005 May 4.
- Fellmeth G, Harrison S, Opondo C, Nair M, Kurinczuk JJ, Alderdice F. Validated screening tools to identify common mental disorders in perinatal and postpartum women in India: a systematic review and meta-analysis. BMC Psychiatry. 2021 Apr 20;21(1):200. doi: 10.1186/s12888-021-03190-6.
- Shrestha SD, Pradhan R, Tran TD, Gualano RC, Fisher JR. Reliability and validity of the Edinburgh Postnatal Depression Scale (EPDS) for detecting perinatal common mental disorders (PCMDs) among women in low-and lower-middle-income countries: a systematic review. BMC Pregnancy Childbirth. 2016 Apr 4;16:72. doi: 10.1186/s12884-016-0859-2.
- Ali SA, Tikmani SS, Saleem S, Patel AB, Hibberd PL, Goudar SS, Dhaded S, Derman RJ, Moore JL, McClure EM, Goldenberg RL. Hemoglobin concentrations and adverse birth outcomes in South Asian pregnant women: findings from a prospective Maternal and Neonatal Health Registry. Reprod Health. 2020 Nov 30;17(Suppl 2):154. doi: 10.1186/s12978-020-01006-6.
- Jessani S, Saleem S, Hoffman MK, Goudar SS, Derman RJ, Moore JL, Garces A, Figueroa L, Krebs NF, Okitawutshu J, Tshefu A, Bose CL, Mwenechanya M, Chomba E, Carlo WA, Das PK, Patel A, Hibberd PL, Esamai F, Liechty EA, Bucher S, Nolen TL, Koso-Thomas M, Miodovnik M, McClure EM, Goldenberg RL. Association of haemoglobin levels in the first trimester and at 26-30 weeks with fetal and neonatal outcomes: a secondary analysis of the Global Network for Women's and Children's Health's ASPIRIN Trial. BJOG. 2021 Aug;128(9):1487-1496. doi: 10.1111/1471-0528.16676. Epub 2021 Apr 12.
- Patel A, Prakash AA, Das PK, Gupta S, Pusdekar YV, Hibberd PL. Maternal anemia and underweight as determinants of pregnancy outcomes: cohort study in eastern rural Maharashtra, India. BMJ Open. 2018 Aug 8;8(8):e021623. doi: 10.1136/bmjopen-2018-021623.
- Rioux FM, Savoie N, Allard J. Is there a link between postpartum anemia and discontinuation of breastfeeding? Can J Diet Pract Res. 2006 Summer;67(2):72-6. doi: 10.3148/67.2.2006.72.
- Babu GR, Murthy GVS, Singh N, Nath A, Rathnaiah M, Saldanha N, Deepa R, Kinra S. Sociodemographic and Medical Risk Factors Associated With Antepartum Depression. Front Public Health. 2018 May 2;6:127. doi: 10.3389/fpubh.2018.00127. eCollection 2018.
- Tsai AC, Scott JA, Hung KJ, Zhu JQ, Matthews LT, Psaros C, Tomlinson M. Reliability and validity of instruments for assessing perinatal depression in African settings: systematic review and meta-analysis. PLoS One. 2013 Dec 10;8(12):e82521. doi: 10.1371/journal.pone.0082521. eCollection 2013.
- Khaskheli MN, Baloch S, Sheeba A, Baloch S, Khaskheli FK. Iron deficiency anaemia is still a major killer of pregnant women. Pak J Med Sci. 2016 May-Jun;32(3):630-4. doi: 10.12669/pjms.323.9557.
- Kramer MS, Dahhou M, Vallerand D, Liston R, Joseph KS. Risk factors for postpartum hemorrhage: can we explain the recent temporal increase? J Obstet Gynaecol Can. 2011 Aug;33(8):810-819. doi: 10.1016/S1701-2163(16)34984-2.
- Markova V, Norgaard A, Jorgensen KJ, Langhoff-Roos J. Treatment for women with postpartum iron deficiency anaemia. Cochrane Database Syst Rev. 2015 Aug 13;2015(8):CD010861. doi: 10.1002/14651858.CD010861.pub2.
- Vanobberghen F, Lweno O, Kuemmerle A, Mwebi KD, Asilia P, Issa A, Simon B, Mswata S, Schmidlin S, Glass TR, Abdulla S, Daubenberger C, Tanner M, Meyer-Monard S. Efficacy and safety of intravenous ferric carboxymaltose compared with oral iron for the treatment of iron deficiency anaemia in women after childbirth in Tanzania: a parallel-group, open-label, randomised controlled phase 3 trial. Lancet Glob Health. 2021 Feb;9(2):e189-e198. doi: 10.1016/S2214-109X(20)30448-4. Epub 2020 Nov 24.
- Skevington SM. Measuring quality of life in Britain: introducing the WHOQOL-100. J Psychosom Res. 1999 Nov;47(5):449-59. doi: 10.1016/s0022-3999(99)00051-3.
- Auerbach M, Macdougall I. The available intravenous iron formulations: History, efficacy, and toxicology. Hemodial Int. 2017 Jun;21 Suppl 1:S83-S92. doi: 10.1111/hdi.12560. Epub 2017 Mar 29.
- Chertow GM, Mason PD, Vaage-Nilsen O, Ahlmen J. Update on adverse drug events associated with parenteral iron. Nephrol Dial Transplant. 2006 Feb;21(2):378-82. doi: 10.1093/ndt/gfi253. Epub 2005 Nov 11.
- Gomez-Ramirez S, Shander A, Spahn DR, Auerbach M, Liumbruno GM, Vaglio S, Munoz M. Prevention and management of acute reactions to intravenous iron in surgical patients. Blood Transfus. 2019 Mar;17(2):137-145. doi: 10.2450/2018.0156-18. Epub 2018 Oct 16.
- Rampton D, Folkersen J, Fishbane S, Hedenus M, Howaldt S, Locatelli F, Patni S, Szebeni J, Weiss G. Hypersensitivity reactions to intravenous iron: guidance for risk minimization and management. Haematologica. 2014 Nov;99(11):1671-6. doi: 10.3324/haematol.2014.111492.
- Auerbach M, Macdougall IC. Safety of intravenous iron formulations: facts and folklore. Blood Transfus. 2014 Jul;12(3):296-300. doi: 10.2450/2014.0094-14. No abstract available.
- Rebecca Giallo, Catherine Wade & Mandy Kienhuis (2014) Fatigue in mothers of infants and young children: factor structure of the fatigue assessment scale, Fatigue: Biomedicine, Health & Behavior, 2:3, 119-131, DOI: 10.1080/21641846.2014.925326
- Young CA, Mills R, Al-Chalabi A, Burke G, Chandran S, Dick DJ, Ealing J, Hanemann CO, Harrower T, Mcdermott CJ, Majeed T, Pinto A, Talbot K, Walsh J, Williams TL, Tennant A; TONiC study group. Measuring quality of life in ALS/MND: validation of the WHOQOL-BREF. Amyotroph Lateral Scler Frontotemporal Degener. 2020 Jun 27;21(5-6):364-372. doi: 10.1080/21678421.2020.1752244.
便利なリンク
- Sison G. The Morisky Medication Adherence Scale: An Overview. 2018
- Auerbach M. Treatment of iron deficiency anemia in adults. 2020
- Electronic Medicines Compendium (eMC). Monofer 100mg/ml solution for injection/infusion.
- Electronic Medicines Compendium (eMC). Ferinject (ferric carboxymaltose).
- World Health Organization. Anemia
- World Health Organization. Maternal health
- Number of non-pregnant women (aged 15-49 years) with anaemia (thousands)
- World Health Organization. Prevalence of anaemia in pregnant women (aged 15-49) (%).
- World Health Organization. Prevalence of anaemia in women of reproductive age (aged 15-49) (%)
- World Health Organization. The World Health Organization Quality of Life (WHOQOL). 2012.
- World Health Organization. WHA65.6. Comprehensive implementation plan on maternal, infant and young child nutrition as passed by the World Health Assembly at the Sixty-fifth World Health Assembly meeting.2012.
研究記録日
主要日程の研究
研究開始 (実際)
一次修了 (実際)
研究の完了 (実際)
試験登録日
最初に提出
QC基準を満たした最初の提出物
最初の投稿 (実際)
学習記録の更新
投稿された最後の更新 (実際)
QC基準を満たした最後の更新が送信されました
最終確認日
詳しくは
本研究に関する用語
追加の関連 MeSH 用語
その他の研究ID番号
- CP PRIORITY
個々の参加者データ (IPD) の計画
個々の参加者データ (IPD) を共有する予定はありますか?
医薬品およびデバイス情報、研究文書
米国FDA規制医薬品の研究
米国FDA規制機器製品の研究
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