title: Women who experience obstetric haemorrhage are at higher risk of anaemia, in both rich and poor countries.
abstract: OBJECTIVE
  Anaemia is a potential long-term sequel of obstetric blood loss, but the increased risk of anaemia in women who experience a haemorrhage compared to those who do not has not been quantified. We sought to quantify this risk and explore the duration of increased risk for these women.
  
  
  METHODS
  Systematic review of articles published between 1990 and 2009. Data were analysed by high- and low-income country groupings. Prevalence and incidence ratios, and mean haemoglobin levels were compared.
  
  
  RESULTS
  Eleven of 822 studies screened were included in the analysis. Most studies showed a higher prevalence or incidence of anaemia in women who had experienced haemorrhage than in those who did not, irrespective of the timing of measurement post-partum. In high-income countries, women who had a haemorrhage were at 5.68 (95% CI 5.04-6.40) times higher risk of post-partum anaemia than women who did not. In low-income countries, the prevalence of anaemia was 1.58 (95% CI 0.96-2.60) times higher in women who had a haemorrhage than in women who did not, although this ratio was greater when the study including mild anaemia in its definition of anaemia was excluded (1.93, 95% CI 1.42-2.62). Population-attributable fractions ranged from 14.9% to 39.6%. Several methodological issues, such as definitions, exclusion criteria and timing of measurements, hindered the comparability of study results.
  
  
  CONCLUSIONS
  Women who experience haemorrhage appear to be at increased risk of anaemia for many months after delivery. This important finding could have serious implications for their health care and management.
authors.affiliation: London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: K S
authors.initials: KS
authors.lastname: Wagner
authors.forename: C
authors.initials: C
authors.lastname: Ronsmans
authors.forename: S L
authors.initials: SL
authors.lastname: Thomas
authors.forename: C
authors.initials: C
authors.lastname: Calvert
authors.forename: A
authors.initials: A
authors.lastname: Adler
authors.forename: R
authors.initials: R
authors.lastname: Ganaba
authors.forename: S
authors.initials: S
authors.lastname: Goufodji
authors.forename: V
authors.initials: V
authors.lastname: Filippi
mesh_terms: D000740:Anemia / Q000453:epidemiology / Q000209:etiology*; D036861:Delivery, Obstetric; D019049:Developed Countries; D003906:Developing Countries; D005260:Female; D006470:Hemorrhage / Q000150:complications*; D006801:Humans; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000453:epidemiology; D011644:Puerperal Disorders / Q000097:blood / Q000453:epidemiology / Q000209:etiology*; D012016:Reference Values; D012306:Risk