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

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.

LITERATURE REVIEW: DAMPAK ANEMIA DEFISIENSI BESI PADA IBU HAMIL

In general, the most common cause of anaemia in pregnancy is iron deficiency, which arises from maternal-fetal iron transfer, which is often exacerbated by a decrease in maternal iron stores. According to the World Health Organization (WHO), pregnancy anaemia is a global health problem that affects almost half of pregnant women. The purpose of this study was to conduct a journal review of explanatory and experimental articles published in the last 5 years starting in 2016 on deficiency anaemia in pregnancy. The research method is carried out by literature study using an electronic reference library through Medline, PubMed, NCBI, Science Direct and Proquest by investigating the impact of anaemia in pregnant women. The results literature from research in various developing and developed countries show that there is an impact that occurs when the mother had anaemia during pregnancy, namely prematurity, low birth weight, postpartum hemorrhage, maternal mortality, cesarean delivery and mental development of children. The conclusion is that there are several effects of anaemia in pregnant women, which are prematurity, low birth weight, postpartum hemorrhage, maternal mortality, cesarean delivery and children's mental development.

Pregnancy‐associated haemolytic anaemia: A cause not to be forgotten

Anaemia in pregnancy is common, however, only a few cases of pregnancy-associated autoimmune haemolytic anaemia have been documented. Typically, such cases involve a positive direct antiglobulin test and have the potential to cause haemolytic disease of the fetus and newborn. Rarely, no autoantibodies are detected. We report two cases of direct antiglobulin test negative haemolytic anaemia occurring in multiparous women with no cause found. Both women had a haematological response to corticosteroid therapy and delivery.

Anaemia in pregnancy: a cross sectional study

Background: Aim of the study was to find the factors leading to anemia in pregnancy. The main objective was to study the various sociodemographic factors leading to anemia and to assess the knowledge about anemia among pregnant females.Methods: The present cross sectional study was carried out at urban health centre, to determine the factors leading to anemia in pregnancy. A total of 100 pregnant females were registered. Demographic data was collected by interview method. A pretested and pre designed questionnaire was used for data collection. Hb was estimated using Sahli’s hemoglobinometer and females having haemoglobin less than 11 mg/dl were considered anaemic. Data analysis was done using SPSS software. Results: The overall mean haemoglobin (Hb) was 9.58+2.2g/dl. It was seen that diet, family size, education, social class, gravida and parity are associated with anaemia in pregnancy. Conclusions: After adjusting for all the possible covariates there seems to be significant association between Hb levels and age group, education level, family size, diet, gravida and parity.

Prevalence and Associated Risk Factors for Anaemia Among Pregnant Women Attending Ante-Natal Clinic, Eswatini

Background: Anaemia is one of the most common nutritional deficiency diseases observed globally and it affects about a third of the world’s population. Anaemia in pregnant women is a worldwide public health concern that has severe consequences for both mothers and infants, including maternal death and foetal and infant mortality. In Low-income countries (LICs), 25% of indirect maternal mortality and 30% of neonatal deaths are due to anaemia in pregnancy. Therefore, this study aimed to determine the prevalence of anaemia and assess associated factors among pregnant women attending ante-natal care (ANC) clinic in the Kingdom of Eswatini, which might help for screening, prevention and treatment of anaemia and ultimately prevent its adverse effects. Method: A total of 550 pregnant women between 15 and 49 years from three health facilities were randomly enrolled using a cross-sectional study design, from January to March 2021. Non-probability sampling approach was used to select the appropriate study unit. A face-toface interview was done using a structured questionnaire to collect data. Multiple logistic regression was performed to assess the factors associated with anaemia among the women.Results: The overall anaemia prevalence among pregnant women was 43.1% (95% CI: 38.947.3). The mild, moderate and severe cases of anaemia were 21.3% (95%CI: 17.9-24.9); 21.1% (95%CI: 17.8-24.7) and 0.7% (95%CI: 0.2-1.9), respectively. The prevalence of anaemia was high among women aged 20-24 (11.1%, 95%CI: 8.6-14.0) and 25-29years (11.1%, 95%CI: 8.6-14.0). Factors associated with anaemia included living in the urban area (OR=1.8, 95%CI: 1.19-2.72, p=0.005) and having anaemia 6 months before pregnancy (OR=4.64, 95%CI: 1.1518.71, p=0.031). Additionally, gestational age at first ANC also was positively associated with anaemia: 3rd trimester (OR=10.42, 95%CI: 4.27-25.4, p<0.001) and 2nd trimester (OR=1.62, 95%CI: 1.02-2.60, p=0.043) Conclusion: Anaemia remains prevalent among pregnant women in Eswatini. Thus, a comprehensive anaemia prevention program would be justified and could lower the country’s burden of anemia.

736Low Birth weight in new born, anaemia in pregnancy in Fluoride endemic areas of Rajasthan

Background Rajasthan has been documenting severe anaemia in pregnancy, resulting in low birth weight. Current study was planned to explore potential linkages between exposure to fluoride, anaemia in pregnancy and low birth weight in infant. Methods Antenatal mothers from one fluoride endemic district (FD) and one non-fluoride endemic district (NFD) of western Rajasthan were recruited and followed up till delivery. Data included socio-demographic, lifestyle, diet, medication history. Lab Investigations included Hb, Urinary Fluoride. Results Out of total 1401 women, mean age of women from FD were 23.87 (+ 3.8) yrs and from NFD were 25.53(+ 3.82) yrs. Mean fluoride values in the urine samples of pregnant females were found to be 2.06 (0.0 to 14.4 mg/L) in FD and 1.43 (0.00 to 12.7 mg/L) in NFD. Mean fluoride values in water samples were 0.72 (0.0 to 3.80 mg/L) in FD and 0.21 (0.0 to 2.69 mg/L) in NFD. Mean weight of newborn from FD were 2.92 (+ 0.47) yrs and from NFD were 2.94 (+ 0.56) kg. 22% Newborn in FD and 18% in NFD had low birth weight. Conclusions Infants born in Fluoride endemic area have lower birth weight as compared to non-Fluoride endemic area. Antenatal women in Fluoride endemic areas are more anaemic. Key messages Fluoride endemicity is an important factor to be considered while addressing Anaemia in pregnancy and Low Birth Weight Babies in Western Rajasthan, India.

Prevalence of anaemia in pregnancy at antenatal care booking in a teaching hospital in Southern Nigeria

Background: Anaemia in pregnancy is the commonest haematological condition seen in pregnant women in most developing countries. It is a global public health problem causing maternal and fetal morbidity and mortality. Objective was to determine the prevalence of anaemia and associated socio-demographic factors among pregnant women at booking at Rivers State University Teaching Hospital (RSUTH).Methods: A retrospective study conducted from 1st January, 2015 to 31st December, 2020 at the antenatal clinic (ANC) of RSUTH. The laboratory records of 9990 pregnant women who booked for antenatal care were retrieved and reviewed. This included the socio-demographic characteristics and routine investigations. Data was extracted, coded and analyzed using the IBM statistical package for social sciences (SPSS) version 23.0 (Armonk, NY). P value <0.05 was considered statistically significant.Results: Total number of women who booked for antenatal care was 9990 women. Of this, 8635 women were anaemic giving a prevalence rate of 86.4%. Mild anaemia was seen in 7061 (70.68%); 1546 (15.48%) had moderate anaemia and 28 (0.28%) had severe anaemia. Of 8635 (86.4%) women who were anaemic, 1647 (19.07%), 5036 (58.32%) and 1952 (22.61%) were seen in the first, second and third trimesters respectively. Mean and modal packed cell volume (PCV) were 29±3.1% and 29% respectively. The range of PCV was 18-42%. Mean age was 31±4.7 years and age range was 15-48 years. Modal parity was zero. Nulliparous and multiparous women accounted for 3586 (35.9%) and 3751 (37.5%) of the women respectively. There was a significant correlation between anaemia and age, parity, level of education, occupation and genotype at booking.Conclusions: The prevalence of anaemia was unacceptably high. There is need for education on anaemia at the antenatal clinics and close monitoring of the interventional measures put in place to prevent anaemia in pregnancy, in order to improve the pregnancy outcome.