Keywords
Anemia; Risk factors; pregnant; women; Saudi Arabia.
Abstract
Background: Anemia in pregnancy is common public health problem with poor outcome for both mother and child. This study, aimed to determine the prevalence of anemia and its associated factors among pregnant women in an urban community at the north of Saudi Arabia.
Materials and methods: A cross-sectional study was carried out among 390 pregnant attending for antenatal care in one of eight Primary Health Care (PHC) centers in Hail city, Saudi Arabia.
Results: Among participants, 133 (34.1%) were anemic (hemoglobin level < 11 g/dl). Out of which, 24.9% were mildly anemic, 9.2% were moderately anemic and none of the participant was found to be severely anemic. The prevalence of anemia increased significantly with low income (p=0.026), bigger family size (p=0.020), increased parity (p=0.023), longer menstrual cycle >5 days (p=0.042), bleeding during pregnancy (p=0.028), infrequent intake of meat (p=0.020), the habit of drinking tea just after meals (p=0.019), past history of anemia (p<0.001), clinical anemia (pallor) (p<0.001). On the other hand, increased BMI (p=0.002) and frequent intake of food from restaurants (p=0.008) were found to be negatively associated with anemia among pregnant women.
Conclusion: In urban Hail, anemia among pregnant women was a moderate public health problem. Findings in this study gives insight to heath care providers about the importance of early detection and management of anemia in early pregnancy and the worth of advising women in preconception period and during antenatal care on adequate intake of iron rich dietary sources and supplementation with iron and folic acid.
References
References
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[2] Al-Khaffaf A, Frattini F, Gaiardoni R, Mimiola E, Sissa C, Franchini M. Diagnosis of anemia in pregnancy. J Lab Precis Med 2020;5:9.
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[7] Lin L, Wei Y, Zhu W, et al. Prevalence, risk factors and associated adverse pregnancy outcomes of anaemia in Chinese pregnant women: a multicentre retrospective study. BMC Pregnancy Childbirth. 2018;18(1):111. Published 2018 Apr 23. doi:10.1186/s12884-018-1739-8
[8] Tunkyi K, Moodley J. Anemia and pregnancy outcomes: a longitudinal study. J Matern Fetal Neonatal Med. 2018;31(19):2594-2598. doi:10.1080/14767058.2017.1349746
[9] Meda N, Dao Y, Touré B, Yameogo B, Cousens S, Graham W. Evaluer l'anémie maternelle sévère et ses conséquences: la valeur d'un simple examen de la coloration des conjonctives palpébrales [Assessing severe maternal anemia and its consequences: the value of a simple examination of the coloration of palpebral conjunctiva]. Sante. 1999;9(1):12-17.
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[11] Taha A., et al. “Iron deficiency anaemia in reproductive age women attending obstetrics and gynecology outpatient of university health centre in Al-Ahsa, Saudi Arabia”. African Journal of Traditional, Complementary and Alternative Medicines 11.2 (2014): 339-342.
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[14] Cochran, W. G. 1963. Sampling Techniques, 2nd Ed., New York: John Wiley and Sons, Inc.
[15] Tan S, Li H, Gao X, et al. Zhong Nan Da Xue Xue Bao Yi Xue Ban. Influential factors for anemia in pregnancy based on a nested case-control study in Changsha 2016;41(6):619-625. doi:10.11817/j.issn.1672-7347.2016.06.011
[16] Fan CL, Luo JY, Gong WJ, et al. Zhonghua Liu Xing Bing Xue Za Zhi. Nested case-control study on associated factors for anemia during pregnancy. 2017;38(9):1269-1273. doi:10.3760/cma.j.issn.0254-6450.2017.09.025.
[17] Melku M, Addis Z, Alem M, Enawgaw B. Prevalence and Predictors of Maternal Anemia during Pregnancy in Gondar, Northwest Ethiopia: An Institutional Based Cross-Sectional Study. Anemia. 2014;2014:108593. doi:10.1155/2014/108593
[18] Karaoglu L, Pehlivan E, Egri M, et al. The prevalence of nutritional anemia in pregnancy in an east Anatolian province, Turkey. BMC Public Health. 2010;10:329. Published 2010 Jun 10. doi:10.1186/1471-2458-10-329
[19] Baig-Ansari N, Badruddin SH, Karmaliani R, et al. Anemia prevalence and risk factors in pregnant women in an urban area of Pakistan. Food Nutr Bull. 2008;29(2):132-139. doi:10.1177/156482650802900207
[20] Abriha A, Yesuf ME, Wassie MM. Prevalence and associated factors of anemia among pregnant women of Mekelle town: a cross sectional study. BMC Res Notes. 2014;7:888. Published 2014 Dec 9. doi:10.1186/1756-0500-7-888
[21] Geissler C, Singh M. Iron, meat and health. Nutrients. 2011;3(3):283-316. doi:10.3390/nu3030283
[22] Cheng HL, Bryant C, Cook R, O’Connor H, Rooney K, Steinbeck K. The relationship between obesity and hypoferraemia in adults: a systematic review. Obes Rev. 2012;13:150-61. doi: 10.1111/j.1467-789X.2011.00938.x
[23] Al-Farsi YM, Brooks DR, Werler MM, Cabral HJ, Al-Shafei MA, Wallenburg HC. Effect of high parity on occurrence of anemia in pregnancy: a cohort study. BMC Pregnancy Childbirth. 2011;11:7. Published 2011 Jan 20. doi:10.1186/1471-2393-11-7
[24] King JC. The risk of maternal nutritional depletion and poor outcomes increases in early or closely spaced pregnancies. J Nutr. 2003;133:1732S-6S.
[25] Dewey KG, Cohen RJ. Does birth spacing affect maternal or child nutritional status? A systematic literature review. Matern Child Nutr. 2007;3:151-73.
[26] Akase T, Hihara E, Uematsu K, Kodaka M, Akase T, Tashiro S. Yakugaku Zasshi. Single center survey of the relationship between pregnancy anemia and prepregnancy lifestyle. 2008;128(7):1081-1086. doi:10.1248/yakushi.128.1081
[27] Pala K, Dundar N. Prevalence & risk factors of anaemia among women of reproductive age in Bursa, Turkey. Indian J Med Res. 2008;128(3):282-286.
[28] Wright S, Earland D, Sakhuja S, et al. Anemia in pregnancy in Western Jamaica. Int J Womens Health. 2017;9:431-439. Published 2017 Jun 8. doi:10.2147/IJWH.S129567
[29] Chang JS, Chen YC, Owaga E, Palupi KC, Pan WH, Bai CH. Interactive effects of dietary fat/carbohydrate ratio and body mass index on iron deficiency anemia among Taiwanese women. Nutrients. 2014;6:3929-41. doi: 10.3390/nu6093929.
[30] Kordas K, Centeno ZY, Pachón H, Soto AZ. Being overweight or obese is associated with lower prevalence of anemia among Colombian women of reproductive age. J Nutr. 2013;143:175-81. doi: 10.3945/jn.112.167767.
[31] Qin Y, Melse-Boonstra A, Pan X, Yuan B, Dai Y, Zhao J, Zimmermann MB, Kok FJ, Zhou M, Shi Z. Anemia in relation to body mass index and waist circumference among Chinese women. Nutr J. 2013;12:10. doi: 10.1186/1475-2891-12-10.
[32] Stoltzfus RJ, Edward-Raj A, Dreyfuss ML, et al. Clinical pallor is useful to detect severe anemia in populations where anemia is prevalent and severe. J Nutr. 1999;129(9):1675-1681. doi:10.1093/jn/129.9.1675
[33] Chowdhury ME, Chongsuvivatwong V, Geater AF, Akhter HH, Winn T. Taking a medical history and using a colour scale during clinical examination of pallor improves detection of anaemia. Trop Med Int Health. 2002;7(2):133-139. doi:10.1046/j.1365-3156.2002.00837.x
[1] World Health Organization. The Global Prevalence of Anaemia in 2011. Geneva, Switzerland: World Health Organization; 2015. Available at: https://apps.who.int/iris/handle/10665/177094
[2] Al-Khaffaf A, Frattini F, Gaiardoni R, Mimiola E, Sissa C, Franchini M. Diagnosis of anemia in pregnancy. J Lab Precis Med 2020;5:9.
[3] Global nutrition targets 2025: anaemia policy brief. Geneva: World Health Organization; 2014 (WHO/NMH/NHD/14.4; http://apps.who.int/iris/bitstream/10665/148556/1/WHO_NMH_ NHD_14.4_eng.pdf?ua=1. (accessed 4/8/2020)
[4] Figueiredo ACMG, Gomes-Filho IS, Batista JET, et al. Maternal anemia and birth weight: A prospective cohort study. PLoS One. 2019;14(3):e0212817. Published 2019 Mar 18. doi:10.1371/journal.pone.0212817
[5] Kozuki N, Lee AC, Katz J. Child Health Epidemiology Reference Group. Moderate to severe, but not mild, maternal anemia is associated with increased risk of small for-gestational-age outcomes. J Nutr 2012;142:358-62.
[6] Allen LH. Anemia and iron deficiency: effects on pregnancy outcome. Am J Clin Nutr. 2000;71(5 Suppl):1280S-4S. doi:10.1093/ajcn/71.5.1280s
[7] Lin L, Wei Y, Zhu W, et al. Prevalence, risk factors and associated adverse pregnancy outcomes of anaemia in Chinese pregnant women: a multicentre retrospective study. BMC Pregnancy Childbirth. 2018;18(1):111. Published 2018 Apr 23. doi:10.1186/s12884-018-1739-8
[8] Tunkyi K, Moodley J. Anemia and pregnancy outcomes: a longitudinal study. J Matern Fetal Neonatal Med. 2018;31(19):2594-2598. doi:10.1080/14767058.2017.1349746
[9] Meda N, Dao Y, Touré B, Yameogo B, Cousens S, Graham W. Evaluer l'anémie maternelle sévère et ses conséquences: la valeur d'un simple examen de la coloration des conjonctives palpébrales [Assessing severe maternal anemia and its consequences: the value of a simple examination of the coloration of palpebral conjunctiva]. Sante. 1999;9(1):12-17.
[10] Abdelhafez AM and El-Soadaa SS. “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 11.12 (2012): 1113-1120.
[11] Taha A., et al. “Iron deficiency anaemia in reproductive age women attending obstetrics and gynecology outpatient of university health centre in Al-Ahsa, Saudi Arabia”. African Journal of Traditional, Complementary and Alternative Medicines 11.2 (2014): 339-342.
[12] Mahfouz AA., et al. “Anemia among pregnant women in the Asir region, Saudi Arabia: an epidemiologic study”. The Southeast Asian Journal of Tropical Medicine and Public Health 25.1 (1994): 84-87.
[13] Rasheed P., et al. “Anemia in pregnancy: a study among attendees of primary health care centers”. Annals of Saudi Medicine 28.6 (2008): 449-452.
[14] Cochran, W. G. 1963. Sampling Techniques, 2nd Ed., New York: John Wiley and Sons, Inc.
[15] Tan S, Li H, Gao X, et al. Zhong Nan Da Xue Xue Bao Yi Xue Ban. Influential factors for anemia in pregnancy based on a nested case-control study in Changsha 2016;41(6):619-625. doi:10.11817/j.issn.1672-7347.2016.06.011
[16] Fan CL, Luo JY, Gong WJ, et al. Zhonghua Liu Xing Bing Xue Za Zhi. Nested case-control study on associated factors for anemia during pregnancy. 2017;38(9):1269-1273. doi:10.3760/cma.j.issn.0254-6450.2017.09.025.
[17] Melku M, Addis Z, Alem M, Enawgaw B. Prevalence and Predictors of Maternal Anemia during Pregnancy in Gondar, Northwest Ethiopia: An Institutional Based Cross-Sectional Study. Anemia. 2014;2014:108593. doi:10.1155/2014/108593
[18] Karaoglu L, Pehlivan E, Egri M, et al. The prevalence of nutritional anemia in pregnancy in an east Anatolian province, Turkey. BMC Public Health. 2010;10:329. Published 2010 Jun 10. doi:10.1186/1471-2458-10-329
[19] Baig-Ansari N, Badruddin SH, Karmaliani R, et al. Anemia prevalence and risk factors in pregnant women in an urban area of Pakistan. Food Nutr Bull. 2008;29(2):132-139. doi:10.1177/156482650802900207
[20] Abriha A, Yesuf ME, Wassie MM. Prevalence and associated factors of anemia among pregnant women of Mekelle town: a cross sectional study. BMC Res Notes. 2014;7:888. Published 2014 Dec 9. doi:10.1186/1756-0500-7-888
[21] Geissler C, Singh M. Iron, meat and health. Nutrients. 2011;3(3):283-316. doi:10.3390/nu3030283
[22] Cheng HL, Bryant C, Cook R, O’Connor H, Rooney K, Steinbeck K. The relationship between obesity and hypoferraemia in adults: a systematic review. Obes Rev. 2012;13:150-61. doi: 10.1111/j.1467-789X.2011.00938.x
[23] Al-Farsi YM, Brooks DR, Werler MM, Cabral HJ, Al-Shafei MA, Wallenburg HC. Effect of high parity on occurrence of anemia in pregnancy: a cohort study. BMC Pregnancy Childbirth. 2011;11:7. Published 2011 Jan 20. doi:10.1186/1471-2393-11-7
[24] King JC. The risk of maternal nutritional depletion and poor outcomes increases in early or closely spaced pregnancies. J Nutr. 2003;133:1732S-6S.
[25] Dewey KG, Cohen RJ. Does birth spacing affect maternal or child nutritional status? A systematic literature review. Matern Child Nutr. 2007;3:151-73.
[26] Akase T, Hihara E, Uematsu K, Kodaka M, Akase T, Tashiro S. Yakugaku Zasshi. Single center survey of the relationship between pregnancy anemia and prepregnancy lifestyle. 2008;128(7):1081-1086. doi:10.1248/yakushi.128.1081
[27] Pala K, Dundar N. Prevalence & risk factors of anaemia among women of reproductive age in Bursa, Turkey. Indian J Med Res. 2008;128(3):282-286.
[28] Wright S, Earland D, Sakhuja S, et al. Anemia in pregnancy in Western Jamaica. Int J Womens Health. 2017;9:431-439. Published 2017 Jun 8. doi:10.2147/IJWH.S129567
[29] Chang JS, Chen YC, Owaga E, Palupi KC, Pan WH, Bai CH. Interactive effects of dietary fat/carbohydrate ratio and body mass index on iron deficiency anemia among Taiwanese women. Nutrients. 2014;6:3929-41. doi: 10.3390/nu6093929.
[30] Kordas K, Centeno ZY, Pachón H, Soto AZ. Being overweight or obese is associated with lower prevalence of anemia among Colombian women of reproductive age. J Nutr. 2013;143:175-81. doi: 10.3945/jn.112.167767.
[31] Qin Y, Melse-Boonstra A, Pan X, Yuan B, Dai Y, Zhao J, Zimmermann MB, Kok FJ, Zhou M, Shi Z. Anemia in relation to body mass index and waist circumference among Chinese women. Nutr J. 2013;12:10. doi: 10.1186/1475-2891-12-10.
[32] Stoltzfus RJ, Edward-Raj A, Dreyfuss ML, et al. Clinical pallor is useful to detect severe anemia in populations where anemia is prevalent and severe. J Nutr. 1999;129(9):1675-1681. doi:10.1093/jn/129.9.1675
[33] Chowdhury ME, Chongsuvivatwong V, Geater AF, Akhter HH, Winn T. Taking a medical history and using a colour scale during clinical examination of pallor improves detection of anaemia. Trop Med Int Health. 2002;7(2):133-139. doi:10.1046/j.1365-3156.2002.00837.x