Anemia—prevalence and risk factors in pregnancy

      Abstract

      Background

      To assess the prevalence of decreased iron stores and anemia in pregnant women. To determine whether the risk factors: socio-demographic background, age, BMI, and parity are associated with abnormal hemoglobin concentrations and/or abnormal iron status.

      Methods

      A longitudinal study was carried out at the Department of Obstetrics, University Hospital of Zurich to establish the risk factors and prevalence of the decreased iron stores and anemia in early pregnancy. In order to determine the hematological parameters and ferritin levels, venous blood samples of 470 singleton pregnancies between 16 and 20 pregnancy weeks were collected. According to hemoglobin and iron status, the patients were divided into four groups: patients with iron deficiency anemia, patients with decreased iron stores, patients with anemia for other reasons and normal patients. The determinants socio-demographic background, age, BMI and parity were explored using multiple logistic regression analysis.

      Results

      The prevalence of decreased iron stores (ferritin<20 μg/l) was observed in 31.8% of subjects (149/470) and anemia (Hb<110 g/l) in 18.5% (87/470). The prevalence of iron deficiency anemia was higher among women coming from former Yugoslavia and developing countries (p=0.004 and p=0.012). In patients coming from developing countries, a significant increase of anemia for other reasons was observed (p=0.027) and in patients older than 30 years, a significant increase of decreased iron stores (p=0.018).

      Conclusions

      In our study population with low parity, the prevalence of abnormal hemoglobin and abnormal iron status was 50.2% (236/470), and socio-demographic background was the most important risk factor of anemia.

      Keywords

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      References

        • Taylor D.J.
        • Lind T.
        Red cell mass during and after normal pregnancy.
        Br J Obstet Gynaecol. 1979; 86: 364-370
        • Meng Lu Z.
        • Goldenberg R.L.
        • Cliver S.
        • Cutter G.
        • Brankson M.
        The relationship between maternal hematocrit and pregnancy outcome.
        Obstet Gynecol. 1991; 77: 190-194
        • Scholl T.O.
        Iron status during pregnancy: setting the stage for mother and infant.
        Am J Clin Nutr. 2005; 81: 1218S-1222S
        • Looker A.C.
        • Dallman P.R.
        • Carroll M.D.
        • Gunter E.W.
        • Johnson C.L.
        Prevalence of iron deficiency in the United States.
        JAMA. 1997; 277: 973-976
        • Karaoglu L.
        • Pehlivan E.
        • Egri M.
        • Deprem C.
        • Gunes G.
        • Genc M.F.
        • et al.
        The prevalence of nutritional anemia in pregnancy in an east Anatolian province, Turkey.
        BMC Public Health. 2010; 10: 329
        • Al-Farsi Y.M.
        • Brooks D.R.
        • Werler M.M.
        • Cabral H.J.
        • Al-Shafei M.A.
        Effect of high parity on occurrence of anemia in pregnancy: a cohort study.
        BMC Pregnancy Childbirth. 2011; 11: 7
        • Uche-Nwachi E.O.
        • Odekunde A.
        • Jacinto S.
        • Burnett M.
        • Clapperton M.
        • David Y.
        • et al.
        Anaemia in pregnancy: associations with parity, abortions and child spacing in primary healthcare clinic attendees in Trinidad and Tobago.
        Afr Health Sci. 2010; 10: 66-70
        • Idowu O.A.
        • Mafiana C.F.
        • Sotiloye D.
        Anaemia in pregnancy: a survey of pregnant women in Abeokuta, Nigeria.
        Afr Health Sci. 2005; 5: 295-299
        • Scholl T.O.
        • Hediger M.L.
        • Fischer R.L.
        • Shearer J.W.
        Anemia vs iron deficiency: increased risk of preterm delivery in a prospective study.
        Am J Clin Nutr. 1992; 55: 985-988
        • Xing Y.
        • Yan H.
        • Dang S.
        • Zhuoma B.
        • Zhou X.
        • Wang D.
        Hemoglobin levels and anemia evaluation during pregnancy in the highlands of Tibet: a hospital-based study.
        BMC Public Health. 2009; 9: 336
        • Deegan H.
        • Bates H.M.
        • McCargar L.J.
        Assessment of iron status in adolescents: dietary, biochemical and lifestyle determinants.
        J Adolesc Health. 2005; 37: 75
        • Charles A.M.
        • Campbell-Stennett D.
        • Yatich N.
        • Jolly P.E.
        Predictors of anemia among pregnant women in Westmoreland, Jamaica.
        Health Care Women Int. 2010; 31: 585-598
        • Al-Mehaisen L.
        • Khader Y.
        • Al-Kuran O.
        • Issa F.A.
        • Amarin Z.
        Maternal anemia in rural Jordan: room for improvement.
        Anemia. 2011; : 381812
        • Haidar J.
        Prevalence of anaemia, deficiencies of iron and folic acid and their determinants in Ethiopian women.
        J Health Popul Nutr. 2010; 28: 359-368
        • Haidar J.A.
        • Pobocik R.S.
        Iron deficiency anemia is not a rare problem among women of reproductive ages in Ethiopia: a community based cross sectional study.
        BMC Blood Disord. 2009; 9: 7
        • Hercberg S.
        • Preziosi P.
        • Galan P.
        Iron deficiency in Europe.
        Public Health Nutr. 2001; 4: 537-545
        • Allen L.H.
        Pregnancy and iron deficiency: unresolved issues.
        Nutr Rev. 1997; 55: 91-101
        • Viteri F.E.
        The consequences of iron deficiency and anaemia in pregnancy on maternal health, the foetus and the infant.
        SCN News. 1994; 11: 14-18
        • Zhou L.M.
        • Yang W.W.
        • Hua J.Z.
        • Deng C.Q.
        • Tao X.
        • Stoltzfus R.J.
        Relation of hemoglobin measured at different times in pregnancy to preterm birth and low birth weight in Shanghai, China.
        Am J Epidemiol. 1998; 148: 998-1006
      1. CDC criteria for anemia in children and childbearing-aged women.
        MMWR Morb Mortal Wkly Rep. 1989; 38: 400-404
      2. Institute of Medicine. Iron deficiency anemia: recommended guidelines for the prevention, detection, and management among U.S. children and women of childbearing age.
        National Academy Press, Washington, DC1993
        • Cogswell M.E.
        • Parvanta I.
        • Ickes L.
        • Yip R.
        • Brittenham G.M.
        Iron supplemetation during pregnancy, anemia, and birth weight: a randomized controlled trial.
        Am J Clin Nutr. 2003; 78: 773-781
        • NIH
        The practical guide: identification, evaluation, and treatment of overweight and obesity in adults.
        2000
        • Hess S.Y.
        • Zimmermann M.B.
        • Brogli S.
        • Hurrell R.F.
        A national survey of iron and folate status in pregnant women in Switzerland.
        Int J Vitam Nutr Res. 2001; 71: 268-273
      3. Swiss Federal Statistical Office.
        (In: 19-09-2005)
        • Freeman G.P.
        Immigration as a source of political discontent and frustration in Western democracies.
        Stud Comp Int Dev. 1997; 32: 42-64
        • Hamalainen H.
        • Hakkarainen K.
        • Heinonen S.
        Anaemia in the first but not in the second or third trimester is a risk factor for low birth weight.
        Clin Nutr. 2003; 22: 271-275
        • Casanova B.F.
        • Sammel M.D.
        • Macones G.A.
        Development of a clinical prediction rule for iron deficiency anemia in pregnancy.
        Am J Obstet Gynecol. 2005; 193: 460-466
        • Hercberg S.
        • Galan P.
        • Dupin H.
        Recent knowledge on iron and folate deficiency in the world. 197. INSERM, Paris1990: 700
        • Cemerlic-Zecevic E.
        • Catibusic F.
        • Milicic D.
        Nutritional influences on growth and prevalence of anaemia in children during the war in Sarajevo.
        Eur J Clin Nutr. 1995; 49: S43-S45
        • Bothwell T.H.
        • Charlton R.W.
        A general approach to the problems of iron deficiency and iron overload in the population at large.
        Semin Hematol. 1982; 19: 54-67
        • Galan P.
        • Yoon H.C.
        • Preziosi P.
        • Viteri F.
        • Valeix P.
        • Fieux B.
        • et al.
        Determining factors in the iron status of adult women in the SU.VI.MAX study. SUpplementation en VItamines et Mineraux AntioXydants.
        Eur J Clin Nutr. 1998; 52: 383-388
        • Rizk D.E.
        • Khalfan M.
        • Ezimokhai M.
        Obstetric outcome in grand multipara in the United Arab Emirates. A case control study.
        Arch Gynecol Obstet. 2001; 264: 194-198
        • Fareh O.I.
        • Rizk D.E.
        • Thomas L.
        • Berg B.
        Obstetric impact of anaemia in pregnant women in United Arab Emirates.
        J Obstet Gynaecol. 2005; 25: 440-444
        • Perry G.S.
        • Yip R.
        • Zyrkowski C.
        Nutritional risk factors among low-income pregnant US women: the Centers for Disease Control and Prevention (CDC) Pregnancy Nutrition Surveillance System, 1979 through 1993.
        Semin Perinatol. 1995; 19: 211-221