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Compliance of Iron Supplementation During Pregnancy and Factors Effecting Compliance. 1 IRON SUPPLEMENTATION DURING PREGNANCY The Professional Medical Journal www.theprofesional.com ORIGINAL PROF-0-3318 DOI: 10.29309/TPMJ/2019.26.12.3318 COMPLIANCE OF IRON SUPPLEMENTATION DURING PREGNANCY AND FACTORS EFFECTING COMPLIANCE. 1. MBBS, DMRT Assistant Professor Department of Radiotherapy & Nuclear Medicine Haroon ur Rashid1, Sheraz Saleem2, Khan Muhammad Babar3, Khalid Mahmood4, Hina Younis5, Sargodha Medical College, Safirah Maheen6 Sargodha. 2. MBBS, FCPS (Medicine) ABSTRACT… Objectives: This study aims at measuring compliance to iron supplements Assistant Professor because iron deficiency anemia (IDA) is worldwide problem among pregnant women, so Iron Department of Medicine DHQ Teaching Hospital, supplements are advised usually in once daily regimen but compliance to iron supplements Sargodha medical College, therapy is a major problem due to possible side effects and long-term duration of therapy. Study Sargodha. Design: Retrospective questionnaire-based study. Setting: Mola Bakhsh Hospitals, Sargodha, 3. MBBS, FCPS (Surgery) Associate Professor Pakistan, Period: From February to December, 2018. Material & Methods: This study was Department of Surgery design to check compliance to iron supplementation during pregnancy and various factors Bolan Medical College, Quetta. related to directly and indirectly noncompliance to iron supplementation. A total of 267 pregnant 4. MBBS, FCPS (Surgery) females were recruited in study. Data was collected through a questionnaire translated in local Assistant Professor Department of Surgery language. On this basis sample population was divided into three groups compliant, partially DHQ Teaching Hospital, compliant and non-compliant major factors associated with the prevalence of anemia and non- Sargodha Medical College, compliance to iron supplements were education, side effects, financial issues, forgetfulness, Sargodha. 5. Pharm-D, M.Phil (Pharmaceutics) personal beliefs, disliking of pharmaceutical preparation etc. Results: After thorough analysis it College of Pharmacy, was found that iron deficiency anemia is prevalent in about 64% of females in the third trimester. University of Sargodha, Sargodha. Improvement in Hb level in third trimester compared to 1st trimester was taken as parameter 6. Pharm-D, M.Phil (Pharmaceutics) for measurement of compliance. Conclusion: side effects due these iron supplements and College of Pharmacy, University of Sargodha, Sargodha. certain human habits act as hurdle to fight anemia during pregnancy and to eradicate these hurdles certain steps like education of women about anemia, its causes, health implication and Correspondence Address: imparting nutritional education with special emphasis to improve dietary intake of proteins and Dr. Haroon-ur-Rashid Department of Radiotherapy and iron. Nuclear Medicine, Sargodha Medical College, Key words: Anemia, Compliance, Hemoglobin, Iron Supplements, Pregnancy. University of Sargodha, Sargodha. [email protected] Article Citation: Haroon ur Rashid, Saleem S, Babar KM, Mahmood K, Younis H, Maheen Article received on: S. Compliance of Iron Supplementation during pregnancy and factors 25/02/2019 effecting compliance. Professional Med J 2019; 26(12):2128-2134. Accepted for publication: DOI: 10.29309/TPMJ/2019.26.12.3318 15/08/2019 INTRODUCTION each trimester of pregnancy. As menstruation Iron is an essential element and required for stops during first trimester consequently iron the appropriate functioning of hemoglobin. It requirements decrease, which shows saving of is involved in oxygen transport, cytochromes, 0.56 mg Fe/d (160 mg/pregnancy).2 the mitochondrial electron transport chain and cellular metabolism. It is involved in important In second trimester, requirements for iron functions with catalases and peroxidases increase and continue during whole pregnancy. involved in redox reactions. Metallo-proteins The hematologic changes lead to increase also contain iron which is essential for DNA oxygen consumption by both mother and fetus. synthesis, steroid and hormones synthesis, cell As pregnancy proceeds iron requirements for proliferation, gene regulation and differentiation, fetal development increase steadily in proportion neutrophil respiratory burst of phagocytosis and to the weight of the fetus as, with most of the iron drug metabolism.1 accumulating during the third trimester.3 In the same way, in pregnant women demand Balance of iron can be maintained throughout the for iron increase evenly throughout gestation. pregnancy if there are sufficient iron stores at the The need for iron varies considerable during beginning of pregnancy. When a woman normally Professional Med J 2019;26(12):2128-2134. www.theprofesional.com 2128 IRON SUPPLEMENTATION DURING PREGNANCY 2 takes an iron containing diet, a pre-pregnancy 2. To correlate the level of compliance and iron store of 300 mg may be enough to carry adherence to the iron supplements and its her pregnancy, If the diet contains less iron than influence over the hemoglobin levels of the optimal value than more iron store is needed.4 pregnant women. 3. Major factors affecting compliance. The World Health Organization (WHO) recommends that hemoglobin (Hb) preferably METHODOLOGY should be maintained at or above 11.0 g/dl, and it A retrospective cohort study conducted in Mola should not be allowed to decrease below 10.5g/ Baksh Hospital in which total 267 pregnant dl during second trimester of pregnancy.5 women took part that were in first and third trimester of pregnancy. Exclusion criteria followed In pregnancy anemia is one of the most serious women that were in 2nd trimester and those having health problems for both mother and child. It is pregnancy or other hematological complications. associated with heart failure, reduced immune Study defined compliance as the adherence of response, intrauterine growth retardation and pregnant women the practice of taking of iron maternal and perinatal mortality. Half of the supplements on daily basis. Lab findings of pregnant women in developing countries are Hemoglobin level were compared with standard effected by anemia. There are many factors value Hemoglobin level byWHO.8 which cause anemia in pregnancy, the main causes are hemorrhage, nutritional deficiencies, Collection of data from the respective subjects infestations, infections, malaria, AIDS/ HIV was carried out with the help of an interview infections, hemoglobinathies, sickle cell disease, based questionnaire consisted of variables such and intestinal parasitosis.6 as socio-demographic parameters, knowledge about anemia, prevalence of anemia and factor According to Health Survey and Pakistan affecting compliance. Assessment totally relied Demographics 2006-07, maternal mortality upon the response of subjects to the questionnaire was revealed to be high with 276 deaths per and depiction of results was carried out in the 100,000 live births as compare to 1 in 8,000 in the form of tables and graphs. Prevalence of anemia developed countries. Among 89 Pakistani women among the subjects was categorized as 1. one dies due to the complications of child birth.7 Anemic in 1st trimester; 2. Anemic in 3rd trimester; 3. Non-anemic in 1st trimester; 4. Non-anemic in Strategies to prevent anemia in pregnancy in in 3rd trimester. In the results the assessment of developing countries usually focus on iron and supplementation compliance was categorized folic acid supplementation in antenatal care, into one of the three groups i.e. partially compliant, malaria chemoprophylaxis and also anthelminthic Compliant and Non-compliant. treatment may have beneficial results. Main problem with iron supplementation during RESULTS AND DISCUSSIONS pregnancy is compliance, due to various factors The main results from the analysis were presented women often fail to take the iron supplements in tables and graphs given below. regularly as advised by their health care professionals and leads towards high prevalence Subject Demographic Data of anemia in pregnant mothers. This reveals the A total of 267 pregnant females form Mola importance and need to study the factors which Bakhsh Hospital Sargodha took part in study. All effect compliance of iron supplements.9 of the participating females were in the 1st and 3rd trimester. With respect to age the population Therefore, the objectives of the study were to was divided into three groups, group 1 includes 1. Determination of frequency of iron deficiency patients with less than 25 years of age including anemia in pregnant females in Sample 25.46% of sample population, group 2 patients Population of Sargodha district. with 25-35 years of age include 52.80% and Professional Med J 2019;26(12):2128-2134. www.theprofesional.com 2129 IRON SUPPLEMENTATION DURING PREGNANCY 3 group 3 subjects with age greater than 35 years World Health Organization estimates that 58% includes 21.72% of the population. of pregnant women in low-income countries are anemic.2 None of the sample population was 11.98% of the subjects were found to be found to be suffering from any chronic disease. educated higher than intermediate while most of Data reveals that 78.27% of patient population the population 58.05% was under intermediate visit antenatal clinic regularly. 64.04 % of total and 29.96% were found to be under primary or patient population were found to be anemic at illiterate. Only 30 out of 267 females were found the end of their 3rd trimester, 39.32% of population to be working in different professional fields show fluctuating Hb during their pregnancy.
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