Prevalence of Anemia, Iron Deficiency Anemia and its Socio-Demographic Factors among Pregnant Women in Garmian Province, Kurdistan region of Iraq
Abstract
Anemia is the most common hematologic abnormality in pregnancy. Maternal anemia is associated with adverse fetal, neonatal, and childhood outcomes. This study aims to determine the prevalence of anemia, and iron deficiency anemia (IDA), the severity of the condition, and study the effect of some socio-demographic factors on pregnant women in Garmian province. The study was conducted among 157 pregnant women in Garmian province between 17 and 49 years old. Participants completed a questionnaire that included sociodemographic characteristics, disease, and gestational age. A hematological evaluation, including a complete blood count (CBC) and serum for ferritin testing. Results of this study have shown that the prevalence of anemia and IDA were 34.4% and 15.3%, respectively. Almost three-quarters of the pregnant women had mild anemia, while 31 % of the subjects had moderate anemia, and about 60% of the participants were diagnosed with normocytic anemia. The second trimester had the highest prevalence, with 51.9% for the anemic and 45.8% for IDA subjects, while the first trimester showed the lowest prevalence, with 14.8 % for anemic and 12.5% for IDA subjects. Age, occupation, gravidity with anemia, and iron deficiency anemia did not make a significant difference. Moreover, there was no significant difference in blood indices between anemic and IDA participants. The serum ferritin level was unaffected by the pregnancy trimesters.
Downloads
References
WHO. Haemoglobin Concentrations for the Diagnosis of Anemia and Assessment of Severity. (WHO/NMH/NHD/MNM/11.1), Geneva, Switzerland, 2011. Available from: https://www.who. int/publications/i/item/WHO-NMH-NHD-MNM-11.1 [Last accessed on 2023 Jan 10].
A. H. James. Iron deficiency anemia in pregnancy. Obstetrics and Gynecology, vol. 138, no. 4, pp. 663-674, 2021.
P. T. Bhattacharya, S. R. Misra and M. Hussain. Nutritional aspects of essential trace elements in oral health and disease: An extensive review. Scientifica (Cairo), vol. 2016, p. 5464373, 2016.
J. Roganović and K. Starinac. Iron deficiency Anemia in children. In: Current Topics in Anemia. Vol. 47. IntechOpen, London, pp. 47-71, 2018.
WHO. Serum Ferritin Concentrations for the Assessment of Iron Status in Individuals and Populations: Technical Brief. Geneva, Switzerland, (9789240008526), 2020. Available from: https:// apps.who.int/iris/handle/10665/337666 [Last accessed on 2023 Jan 10].
L. Zeng, L. Pei, C. Li and H. Yan. Iron deficiency anemia. In: Current Topics in Anemia. Vol. 47. IntechOpen, London, pp. 3-27, 2017.
S. Sundararajan and H. Rabe. Prevention of iron deficiency anemia in infants and toddlers. Pediatric Research, vol. 89, no. 1, pp. 63-73, 2021.
G. Kejela, A. Wakgari, T. Tesfaye, E. Turi, M. Adugna, N. Alemu and L. Jebessa. Prevalence of anemia and its associated factors among pregnant women attending antenatal care follow up at Wollega University referral hospital, Western Ethiopia. Contraception and Reproductive Medicine, vol. 5, no. 1, p. 26, 2020.
G. C. Di Renzo, F. Spano, I. Giardina, E. Brillo, G. Clerici and L. C. Roura. Iron deficiency anemia in pregnancy. Women’s Health, vol. 11, no. 6, pp. 891-900, 2015.
N. Milman. Oral iron prophylaxis in pregnancy: Not too little and not too much!. Journal of Pregnancy, vol. 2012, p. 514345, 2012.
M. Goonewardene, M. Shehata and A. Hamad. Anemia in pregnancy. Best Practice and Research Clinical Obstetrics and Gynaecology, vol. 26, no. 1, pp. 3-24, 2012.
A. G. Cantor, C. Bougatsos, T. Dana, I. Blazina and M. McDonagh. Routine iron supplementation and screening for iron deficiency anemia in pregnancy: A systematic review for the US Preventive Services Task Force. Annals of Internal Medicine, vol. 162, no. 8, pp. 566-576, 2015
M. Mawani, S. A. Ali, G. Bano and S. A. Ali. Iron deficiency anemia among women of reproductive age, an important public health problem: Situation analysis. Reproductive System and Sexual Disorders, vol. 5, no. 3, p. 187, 2016.
S. Sharma, S. P. Kaur and G. Lata. Anemia in pregnancy is still a public health problem: A single center study with review of literature. Indian Journal of Hematology and Blood Transfusion, vol. 36, no. 1, pp. 129-134, 2020.
G. A. Stevens, M. M. Finucane, L. M. De-Regil, C. J. Paciorek, S. R. Flaxman, F. Branca, J. P. Peña-Rosas, Z. A. Bhutta, M. Ezzati and Nutrition Impact Model Study Group (Anaemia). Global, regional, and national trends in haemoglobin concentration and prevalence of total and severe anemia in children and pregnant and non- pregnant women for 1995–2011: A systematic analysis of population-representative data. The Lancet Global Health, vol. 1, no. 1, pp. e16-e25, 2013.
WHO. Anemia in Women and Children: WHO Global Anemia Estimates. 2021 ed. Geneva, Switzerland, 2021. Available from: https://www.who.int/data/gho/data/themes/topics/anemia_in_women_and_children [Last accessed on 2023 Jan 20].
K. G. van Zutphen, K. Kraemer and A. Melse-Boonstra. Knowledge gaps in understanding the etiology of anemia in Indonesian adolescents. Food and Nutrition Bulletin, vol. 42, no. 1 suppl, pp. S39-S58, 2021.
C. S. Benson, A. Shah, M. C. Frise and C. J. Frise. Iron deficiency anemia in pregnancy: A contemporary review. Obstetric Medicine, vol. 14, no. 2, pp. 67-76, 2021.
D. Kibru, B. Gelaw, A. Alemu and Z. Addis. Helicobacter pyloriinfection and its association with anemia among adult dyspeptic patients attending Butajira Hospital, Ethiopia. BMC Infectious Diseases, vol. 14, no. 1, pp. 656, 2014.
S. Chandra, A. K. Tripathi, S. Mishra, M. Amzarul and A. K. Vaish. Physiological changes in hematological parameters during pregnancy. Indian Journal of Hematology and Blood Transfusion, vol. 28, no. 3, pp. 144-146, 2012.
WHO. Global Nutrition Targets 2025, Anemia Policy Brief. (WHO/NMH/NHD/MNM/14.4), Geneva, Switzerland, 2014. Availablefrom: https://www.who.int/publications/i/item/WHO-NMHNHD-14.4 [Last accessed on 2023 Jan 20].
B. S. Maner and L. Moosavi. Mean corpuscular volume. In: StatPearls. StatPearls Publishing LLC, Treasure Island, FL, 2022. Available from: https://www.ncbi.nlm.nih.gov/books/ NBK545275 [Last accessed on 2023 Jan 20].
M. Nair, D. Churchill, S. Robinson, C. Nelson-Piercy, S. J. Stanworth and M. Knight. Association between maternal haemoglobin and stillbirth: A cohort study among a multi-ethnic population in England. British Journal of Haematology, vol. 179, no. 5, pp. 829-837, 2017.
R. Rezgale, I. Pudule, V. Cauce, K. K. Antila, V. Bule, G. Lazdane, D. Rezeberga and L. Meija. Iron status in pregnant women in latvia: An epidemiological, cross-sectional, multicenter study according to WHO and UK criteria. Medicina (Kaunas), vol. 58, no. 7, p. 955, 2022.
M. A. Alreshidi and H. K. Haridi. Prevalence of anemia and associated risk factors among pregnant women in an urban community at the North of Saudi Arabia. Journal of Preventive Medicine and Hygiene, vol. 62, no. 3, p. E653, 2021.
A. S. Laganà, S. G. Vitale, H. B. Frangež, E. Vrtačnik-Bokal and R. D’anna. Vitamin D in human reproduction: The more, the better? An evidence-based critical appraisal. European Review for Medical and Pharmacological Sciences, vol. 21, no. 18, pp. 4243-4251, 2017.
Z. K. Khalil. Prevalence of anemia and determination of some hematological parameters among pregnant women in Baghdad city. Iraqi Journal of Science, vol. 58, no. 2C, pp. 1001-1008, 2017.
N. K. Mahamoud, B. Mwambi, C. Oyet, F. Segujja, F. Webbo, J. C. Okiria and I. M. Taremwa. Prevalence of anemia and its associated socio-demographic factors among pregnant women attending an antenatal care clinic at Kisugu Health Center IV, Makindye division, Kampala, Uganda. Journal of Blood Medicine, vol. 11, pp. 13-18, 2020.
S. Tan, H. Li, X. Gao, S. Xiang, Q. He, L. Zhang, L. Huang, C. Xiong, Q. Yan and Y. Yan. Influential factors for anemia in pregnancy based on a nested case-control study in Changsha. Journal of Central South University, vol. 41, no. 6, pp. 619-625, 2016.
B. Balis, Y. Dessie, A. Debella, A. Alemu, D. Tamiru, B. Negash, H. Bekele, T. Getachew, A. Eyeberu and S. Mesfin. Magnitude of anemia and its associated factors among pregnant women attending antenatal care in hiwot fana specialized University Hospital in Eastern Ethiopia. Frontiers in Public Health, vol. 10, pp. 867888, 2022.
C. Geissler and M. Singh. Iron, meat and health. Nutrients, vol. 3, no. 3, pp. 283-316, 2011.
L. Karaoglu, E. Pehlivan, M. Egri, C. Deprem, G. Gunes, M. F. Genc and I. Temel. The prevalence of nutritional anemia in pregnancy in an east Anatolian province, Turkey. BMC Public Health, vol. 10, p. 329, 2010.
C. L. Fan, J. Y. Luo, W. J. Gong, X. Q. Liu, S. J. Zhou, F. F. Zhang, J. Zeng,H. X. Li and N. Feng. Nested case-control study on associated factors for anemia during pregnancy. Zhonghua Liuxingbingxue Zazhi, vol. 38, no. 9, pp. 1269-1273, 2017.
WHO. Guideline: Intermittent Iron and Folic Acid Supplementation in Menstruating Women. Geneva, Switzerland. (9789241502023), 2011. Available from: https://www.who.int/publications/i/item/9789241502023 [Last accessed on 2023 Jan 20].
D. A. Fenta, M. M. Nuru, T. Yemane, Y. Asres and T. B. Wube. Anemia and related factors among highly active antiretroviral therapy experienced children in Hawassa comprehensive specialized hospital, southern Ethiopia: Emphasis on patient management. Drug, Healthcare and Patient Safety, vol. 12, pp. 49-56, 2020.
J. Ford. Red blood cell morphology. International Journal of Laboratory Hematology, vol. 35, no. 3, pp. 351- 357, 2013.
O. Bayarkhuu and O. Tsogbadrakh. EP01. 50: Prevalence, types and risk factors associated with anemia in pregnancy at the Chingeltei District Health Center in Ulaanbaatar, Mongolia. Ultrasound in Obstetrics and Gynecology, vol. 60, pp. 99-99, 2022.
B. Singh, S. P. Verma, A. S. Chauhan and D. P. Verma. Prevalence of anemia among reproductive-age females in the Tharu tribe of the Indo–Nepal border region. Journal of Family Medicine and Primary Care, vol. 11, no. 6, pp. 2961-2964, 2022.
S. Baradwan, A. Alyousef and A. Turkistani. Associations between iron deficiency anemia and clinical features among pregnant women: A prospective cohort study. Journal of Blood Medicine, vol. 9, pp. 163-169, 2018.
X. Liu, H. An, N. Li, Z. Li, Y. Zhang, Y. Zhang, L. Le, H. Li, J. Liu and R. Ye. Preconception hemoglobin concentration and risk of low birth weight and small-for-gestational-age: A large prospective cohort study in China. Nutrients, vol. 14, no. 2, p. 271, 2022.
S. Patra, S. Pasrija, S. Trivedi and M. Puri. Maternal and perinatal outcome in patients with severe anemia in pregnancy. International Journal of Gynecology and Obstetrics, vol. 91, no. 2, pp. 164-165, 2005.
A. Abriha, M. E. Yesuf and M. M. Wassie. Prevalence and associated factors of anemia among pregnant women of Mekelle town: A cross sectional study. BMC Research Notes, vol. 7, no. 1, p. 888, 2014.
C. Cao and K. O. O’Brien. Pregnancy and iron homeostasis: An update. Nutrition Reviews, vol. 71, no. 1, pp. 35-51, 2013.
N. Milman. Postpartum anemia I: Definition, prevalence, causes, and consequences. Annals of Hematology, vol. 90, no. 11, pp. 1247-1253, 2011.
R. Tandon, A. Jain and P. Malhotra. Management of iron deficiency anemia in pregnancy in India. Indian Journal of Hematology andBlood Transfusion, vol. 34, pp. 204-215, 2018.
M. Tiwari, J. Kotwal, A. Kotwal, P. Mishra, V. Dutta and S. Chopra. Correlation of haemoglobin and red cell indices with serum ferritin in Indian women in second and third trimester of pregnancy. Medical Journal Armed Forces India, vol. 69, no. 1, pp. 31-36, 2013.
A. M. Abdelhafez and S. S. El-Soadaa. Prevalence and risk factors of anemia among a sample of pregnant females attending primary health care centers in Makkah, Saudi Arabia. Pakistan Journal of Nutrition, vol. 11, no. 12, p. 1113, 2012.
G. Sultana, S. Haque, T. Sultana, Q. Rahman and A. Ahmed. Role of red cell distribution width (RDW) in the detection of iron deficiency anemia in pregnancy within the first 20 weeks of gestation. Bangladesh Medical Research Council Bulletin, vol. 37, no. 3, pp. 102-105, 2011.
W. F. Rayburn. Maternal and fetal effects from substance use. Clinical Perinatology, vol. 34, no. 4, pp. 559-571, 2007.
D. Viswanath, R. Hegde, V. Murthy, S. Nagashree and R. Shah. Red cell distribution width in the diagnosis of iron deficiency anemia. Indian Journal of Pediatrics, vol. 68, no. 12, pp. 1117-1119, 2001.
Copyright (c) 2023 Mustafa Y. Rashid, Adnan L. Abdulraheem, Gulzar S. Hama Amin, Shwan S. Weli, Rahman K. Faraj, Ali J. Muhialdin, Seerwan A. Raheem
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Authors who publish with this journal agree to the following terms:
1. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License [CC BY-NC-ND 4.0] that allows others to share the work with an acknowledgment of the work's authorship and initial publication in this journal.
2. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
3. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).