Prevalence and aetiologies of anaemia among first trimester pregnant women in Sri Lanka; the need for revisiting the current control strategies

Abstract Background The Sustainable development goals, which focus strongly on equity, aim to end all forms of malnutrition by 2030. However, a significant cause of intergenerational transfer of malnutrition, anaemia in pregnancy, is still a challenge. It is especially so in the low- and middle-income settings where possible context-specific aetiologies leading to anaemia have been poorly explored. This study explores the prevalence of etiological factors significantly contributing to anaemia in pregnancy in Sri Lanka, a lower-middle-income country with a high prevalence of malnutrition albeit robust public health infrastructure. Methods All first-trimester pregnant women registered in the public maternal care programme in the Anuradhapura district from July to September 2019 were invited to participate in Rajarata Pregnancy Cohort (RaPCo). After a full blood count analysis, high-performance liquid chromatography, peripheral blood film examination, serum B12 and folate levels were performed in anaemic participants, guided by an algorithm based on the red cell indices in the full blood count. In addition, serum ferritin was tested in a random subsample of 213 participants. Anaemic women in this subsample underwent B12 and folate testing. Results Among 3127 participants, 14.4% (95%CI 13.2–15.7, n = 451) were anaemic. Haemoglobin ranged between 7.4 to 19.6 g/dl. 331(10.6%) had mild anaemia. Haemoglobin ≥13 g/dl was observed in 39(12.7%). Microcytic, normochromic-normocytic, hypochromic-normocytic and macrocytic anaemia was observed in 243(54%), 114(25.3%), 80(17.8%) and two (0.4%) of full blood counts in anaemic women, respectively. Microcytic anaemia with a red cell count ≥5 * 106 /μl demonstrated a 100% positive predictive value for minor haemoglobinopathies. Minor hemoglobinopathies were present in at least 23.3%(n = 105) of anaemic pregnant women. Prevalence of iron deficiency, B12 deficiency and Southeast Asian ovalocytosis among the anaemic was 41.9% (95%CI 26.4–59.2), 23.8% (95%CI 10.6–45.1) and 0.9% (95%CI 0.3–2.3%), respectively. Folate deficiency was not observed. Conclusion Even though iron deficiency remains the primary cause, minor hemoglobinopathies, B 12 deficiency and other aetiologies substantially contribute to anaemia in pregnancy in this study population. Public health interventions, including screening for minor hemoglobinopathies and multiple micronutrient supplementation in pregnancy, should be considered in the national programme for areas where these problems have been identified.

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Haemoglobin and ferritin concentrations of pregnant women at term

Obstetric Medicine ◽

10.1258/om.2011.110033 ◽

2011 ◽

Vol 4 (4) ◽

pp. 152-155 ◽

Cited By ~ 1

Author(s):

A Adediran ◽

A Gbadegesin ◽

T A Adeyemo ◽

A A Akinbami ◽

A S Akanmu ◽

...

Keyword(s):

Pregnant Women ◽

Blood Count ◽

Full Blood Count ◽

Second Trimester ◽

Mean Values ◽

Iron Stores ◽

The Mean ◽

Anaemia In Pregnancy ◽

In Pregnancy ◽

Hiv Negative

Background Anaemia in pregnancy is defined as haemoglobin (Hb) concentrations of less than 11 g/dL while low ferritin is defined as serum ferritin (SR) levels of less than 10 µg/L. Hb and ferritin concentrations of pregnant women at term were determined to establish their mean values and to determine the prevalence of anaemia in our locality. Methods Haemoglobin and ferritin levels of 170 non-smoking and HIV-negative pregnant women were determined at term. The majority 143 of 170 (84.1%) of the pregnant women recruited for the study, booked at the beginning of the second trimester and received 200 mg elemental iron in three divided doses and 5 mg folic acid daily which were commenced at booking. Five millilitres of blood were collected from each patient at term into EDTA bottles for full blood count analysis and another 5 mL into plain bottles for SR assay. Results The mean Hb and ferritin values were 10.9 ± 1.9 and 47.84 ± 98.39 µg/L, respectively. The prevalence of anaemia at term was 46.4%. Only 11.2% (19 of 170) of pregnant women at term had low SR (iron stores). A statistically significant relationship was found between women's education and SR ( P = 0.032). Booking status also correlated directly with SR and haemoglobin concentrations, while increasing age and parity did not. Conclusion About half of the patients were anaemic. Iron deficiency is not the major cause of anaemia in pregnancy in this study because the majority of the pregnant women had normal iron stores. Education and booking status are possible factors that contribute to anaemia.

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Cross-sectional study to assess etiology and associated factors for anaemia during first trimester of pregnancy in Anuradhapura District, Sri Lanka: a protocol

F1000Research ◽

10.12688/f1000research.28226.1 ◽

2021 ◽

Vol 10 ◽

pp. 223

Author(s):

Gayani Amarasinghe ◽

Vasana Mendis ◽

Thilini Agampodi

Keyword(s):

Sri Lanka ◽

Data Collection ◽

Pregnant Women ◽

Associated Factors ◽

First Trimester ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Anaemia In Pregnancy ◽

In Pregnancy

Background: Anaemia in pregnancy, which can lead to adverse maternal and fetal outcomes, is a significant global health problem. Despite Sri Lanka’s strong public health system and commitment towards prevention, maternal anaemia remains a major problem in the country. While prevention is focused on iron deficiency, detailed etiological studies on this topic are scarce. Moreover, estimates of socio demographic and economic factors associated with anaemia in pregnancy, which can provide important clues for anaemia control, are also lacking. This study aims to evaluate the hemoglobin distribution, spatial distribution, etiology and associated factors for anaemia in pregnant women in Anuradhapura, Sri Lanka. Methods: This is a cross sectional study of pregnant women in their first trimester registered for antenatal care from July to September 2019 in the Anuradhapura district. The minimal sample size was calculated to be 1866. Initial data collection has already been carried out in special field clinics for pregnant women between June to October 2019. An interviewer-administered questionnaire, a self-completed dietary questionnaire and an examination checklist were used for data collection. In addition, all participants underwent complete blood count testing. Further investigations are being conducted for predicting the etiology of anaemia based on a developed algorithm (such as high-performance liquid chromatography [HPLC] and peripheral blood film analysis). Discussion: Being the largest study on anaemia during pregnancy in a single geographical area in Sri Lanka, this study will provide important clues about geographical clustering of anaemia cases with similar etiology, associated factors and etiologies which would help to develop interventions to improve the health of pregnant women in the area. The possibility of selection bias is a potential limitation associated with the study design.

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Anaemia in pregnancy: prevalence and treatment response to various modalities: a prospective study

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20203857 ◽

2020 ◽

Vol 9 (9) ◽

pp. 3784

Author(s):

G. D. Maiti ◽

Shilpa Gupta ◽

Jaskanwar Singh

Keyword(s):

Iron Deficiency ◽

Pregnant Women ◽

Iron Deficiency Anaemia ◽

Intravenous Iron ◽

Iron Therapy ◽

Deficiency Anaemia ◽

Thalassemia Trait ◽

Anaemia In Pregnancy ◽

Intravenous Iron Therapy ◽

In Pregnancy

Background: Anaemia seen in pregnancy are largely preventable and easily treatable if detected in time, despite this, anaemia still continues to be a common cause of maternal and perinatal morbidity and mortality in India.Methods: A prospective observational study of 200 pregnant women with anaemia was carried out from Jun 2017 to December 2018 at a Tertiary care hospital with pan India population. Patients underwent clinical examination and laboratory tests to find out the severity and type of anaemia and were treated accordingly. Iron deficiency anaemia was treated with oral or intravenous iron therapy depending upon the hemoglobin concentration. Patients were followed up after 28 days of treatment and hemoglobin estimation was done to monitor the treatment response.Results: A total 36.49% pregnant women had hemoglobin less than 10 gm%. 151 out of 200 women had serum ferritin <12 ng/ml which indicates that iron deficiency anaemia is the commonest type of anaemia in pregnancy. Overall, out of 200 patients 5.5% patients were found to have hemoglobinopathies (β thalassemia trait). After 28 days of treatment mean increase in hemoglobin was 2.40 gm% and 4.24 gm% in patients receiving oral and intravenous iron therapy respectively.Conclusions: A total 36.49% pregnant women were found to have anaemia during pregnancy and iron deficiency anaemia is the commonest type of anaemia. Therefore, there is still a need for dietary counselling and health education in the community. 5.5% patients were found to have beta thalassemia trait which was detected only after conducting hemoglobin electrophoresis. Both oral and intravenous iron therapy are effective in treatment of iron deficiency anaemia but intravenous iron therapy results in a more rapid resolution of anaemia.

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The Effect of Health Education of Anemia in Relation with Knowledge of First-Trimester Pregnant Women in PMB Putu Mastiningsih, Abiansemal

STRADA JURNAL ILMIAH KESEHATAN ◽

10.30994/sjik.v8i1.196 ◽

2019 ◽

Vol 8 (1) ◽

pp. 16-20

Author(s):

Ni Gusti Ayu Pramita Aswitami ◽

Ni Putu Mirah Yunita Udayani

Keyword(s):

Developing Countries ◽

Health Education ◽

Iron Deficiency ◽

Pregnant Women ◽

First Trimester ◽

Maternal Knowledge ◽

Iron Supplement ◽

Acute Bleeding ◽

Pregnancy Care ◽

In Pregnancy

Anemia in pregnancy is the condition in which the level of mother’s hemoglobin is less than 12 gr/dL (Winkjosastro, 2002). According to WHO’s data, the maternal death in developing countries accounts for 40% related to anemia state in pregnancy. Most of the case is caused by iron deficiency and acute bleeding. Prevention of anemia can be done by giving the iron supplement tablets. However, by giving iron tablets alone, is not enough if pregnant women do not have any compliance about how to take it on. Maternal knowledge is known as the influence of that compliance. In order to increase their knowledge about anemia, providing the health education is a pivotal role. Health education in pregnancy care is an effort to influence other people, whether individuals, groups, or communities so that they do what is expected of education actors.

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Efficacy and safety of intravenous iron sucrose therapy in a pregnant women with iron deficiency anaemia in pregnancy

MedPulse International Journal of Gynecology ◽

10.26611/101210213 ◽

2019 ◽

Vol 12 (2) ◽

pp. 79-81

Author(s):

Bhagwan Mahadev Patil ◽

◽

Vishwanath Iraba Dange ◽

Keyword(s):

Iron Deficiency ◽

Pregnant Women ◽

Iron Deficiency Anaemia ◽

Intravenous Iron ◽

Iron Sucrose ◽

Efficacy And Safety ◽

Deficiency Anaemia ◽

Anaemia In Pregnancy ◽

In Pregnancy

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DYNAMIC OF SERUM FERRITIN LEVEL IN FIRST TRIMESTER PREGNANCY

The Avicenna Medical Journal ◽

10.15408/avicenna.v1i1.15639 ◽

2020 ◽

Vol 1 (1) ◽

pp. 1-4

Author(s):

Muniroh Muniroh ◽

Alyya Siddiqa ◽

Raden Partinah

Keyword(s):

Iron Deficiency ◽

Pregnant Women ◽

Serum Ferritin ◽

Serum Ferritin Level ◽

Ferritin Level ◽

Data Distribution ◽

First Trimester ◽

Normal Range ◽

Median Serum ◽

In Pregnancy

Background: Incidence of anemia in pregnant women was 37.1%, proportion was similar between urban vs rural areas (36.4% vs 37.8%). According to 2007 RISKESDAS, iron deficiency accounted for most common type of anemia in pregnancy. Iron deficiency anemia in pregnancy has a negative impact both on the mother and the fetus. Serum ferritin is a parameter for iron deficiency. Objective of this study was to overlook serum ferritin levels in trimester 1pregnancy.Methods: The design was retrospective cohort. Samples obtained from first trimester pregnant women who performed a pregnancy check up at Hasanah Graha Afiah Hospital Depok in the period of April 2016 - July 2017. Data were presented in percentages for categorical data. Numerical data presented in medians and ranges for abnormal data distribution; and mean and standard intersections for normal data distribution. This study involved 64 samples that met the inclusion and exclusion criteria.Results: Median serum ferritin levels in this study were still in the normal range of 40.82 (6.97 - 172.66) μg / L. Twenty one subjects (69.1%) had normal serum ferritin level (≥30 μg/L) and 47 (30.9%) had low ferritin level.Conclusions: Median serum ferritin in this study was within normal range. Low level of serum ferritin found in 21 subjects, three among them also suffered from anemia.

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Retrospective study on prevalence of anaemia among pregnant women at booking in a health care centre in Udairamsar, Bikaner, Rajasthan, India

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20164745 ◽

2016 ◽

Vol 4 (1) ◽

pp. 235

Author(s):

Aarti Acharya ◽

Rekha Acharya ◽

Ratti Ram Meena

Keyword(s):

Pregnant Women ◽

First Trimester ◽

Folic Acid Supplementation ◽

Severe Form ◽

Health Care Centre ◽

Training Centre ◽

High Prevalence ◽

One Year ◽

Anaemia In Pregnancy ◽

In Pregnancy

Background: Anaemia in pregnancy is one of the major risk among them. This is associated with abortions, premature births, postpartum haemorrhage and low birth weight. Thus anaemia is considered as one of the most frequent complications of pregnancy and there is need of early detection.Methods: Retrospective record based study conducted at Rural Health Training Centre Udairamsar, Bikaner, Rajasthan. Data regarding pregnancy are collected from 1April 2015 to31 March 2016 by referring the records maintained at RHTC. Data was analysed using SPSS 20.Results: A total of 135 pregnant women were registered for ANC care during this one year period. Majority (64.44%) belonged to the age group of 20-25 years and 94.8% were Hindu by religion. 48.18% of pregnant women were registered during first trimester followed by 28.88% who had registered during second trimester and rest at third trimester. Prevalence of anaemia in the present study was found to be 89.26% with 121 cases among which 92 cases were mild form, 28 cases were moderate form and only 1 case was of severe form with Haemoglobin level below 7g/dl. The study didn’t show any significant association between anaemia and booking trimester.Conclusions: There is high prevalence (85.2%) of anemia among pregnant women. It was also noted that 45.1% of the pregnant women registered after first trimester of pregnancy. Hence leading to late acceptance of antenatal care and iron and folic acid supplementation which is given to reduce the cases of anemia in pregnancy.

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Cross-sectional study to assess etiology and associated factors for anaemia during first trimester of pregnancy in Anuradhapura District, Sri Lanka: a protocol

F1000Research ◽

10.12688/f1000research.28226.2 ◽

2021 ◽

Vol 10 ◽

pp. 223

Author(s):

Gayani Amarasinghe ◽

Vasana Mendis ◽

Thilini Agampodi ◽

Suneth Agampodi

Keyword(s):

Sri Lanka ◽

Data Collection ◽

Pregnant Women ◽

Associated Factors ◽

First Trimester ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Anaemia In Pregnancy ◽

In Pregnancy

Background: Anaemia in pregnancy, which can lead to adverse maternal and fetal outcomes, is a significant global health problem. Despite Sri Lanka’s strong public health system and commitment towards prevention, maternal anaemia remains a major problem in the country. While prevention is focused on iron deficiency, detailed etiological studies on this topic are scarce. Moreover, estimates of socio demographic and economic factors associated with anaemia in pregnancy, which can provide important clues for anaemia control, are also lacking. This study aims to evaluate the hemoglobin distribution, and geographical distribution, contribution of known aetiologies and associated factors for anaemia in pregnant women in Anuradhapura, Sri Lanka. Methods: This is a cross sectional study of pregnant women in their first trimester registered for antenatal care from July to September 2019 in Anuradhapura district. The minimal sample size was calculated to be 1866. Initial data collection has already been carried out in special field clinics for pregnant women between June to October 2019. An interviewer-administered questionnaire, a self-completed dietary questionnaire and an examination checklist were used for data collection. In addition, all participants underwent complete blood count testing. Further investigations are being conducted for predicting the etiology of anaemia based on a developed algorithm (such as high-performance liquid chromatography [HPLC] and peripheral blood film analysis). Discussion: Being the largest study on anaemia during pregnancy in a single geographical area in Sri Lanka, this study will provide important clues about geographical clustering of anaemia cases with similar etiology, associated factors and etiologies which would help to develop interventions to improve the health of pregnant women in the area. The possibility of selection bias is a potential limitation associated with the study design.

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