Pregnancy Associated Iron Deficiency Anemia from Selected Rural Areas of Sargodha-Punjab, Pakistan

Research Article National Journal of Medical and Health Sciences (NJMHS) 2020, Volume 2, No.1, pp. 23-30 Pregnancy associated iron deficiency anemia from selected rural areas of Sargodha-Punjab, Pakistan Naveed Munir1,2*, Tahira Zahoor1, Zahed Mahmood2, Muhammad Akram3, Muhammad Jahangir2, Syed Muhammad Ali Shah3 Abstract Objective: Anemia during pregnancy is a frequent medical problem that contributes to increased maternal and fetal morbidity. Current work was planned to investigate the iron deficiency anemia associated with pregnancy. Material and Methods: A total of 150 pregnant females with different trimester and different history of gravidity were selected from different rural areas of Sargodha District, Punjab-Pakistan. A questionnaire was completed and blood samples were collected from all subjects to determine the concentration of Hemoglobin, serum Iron and Total iron binding capacity. Results: Study results revealed that prevalence of iron deficiency anemia is more significant (p<0.05) during second trimester with Hemoglobin concentration (9.1±1.7 g/dL), iron (29±5.1 µg/dL) and TIBC (367±91 µg/dL) as compared to first and third trimester. Furthermore, the results showed that prevalence of iron deficiency anemia is 89% with hemoglobin < 11.0 g/dL; of which mild anemia was 47 % (Hb 9-11 g/dL), moderate anemia 33% (Hb 7-8.9g/dL), severe anemia 08% (Hb <7 g/dL) and only 11 % pregnant female have hemoglobin > 11 g/dL. Conclusion: It could be concluded that iron deficiency anemia is significantly associated with progression of gestational period which is more prevalent in rural areas of Sargodha. Further, this condition can be controlled by improving the socioeconomic status of local population, by encouraging the intake of iron rich foods as well as with iron supplementation. Key Words: Anemia, iron deficiency, pregnancy, rural areas 1College of Allied Health Professionals, Directorate of Medical Sciences, Government College University Faisalabad-Pakistan 2Department of Biochemistry, Government College University Faisalabad-Pakistan 3Department of Eastern Medicine, Government College University Faisalabad-Pakistan *Corresponding author’s email address: [email protected] Pregnancy associated iron deficiency anemia from selected rural areas INTRODUCTION In developed world as well as in Anemia from Greek word Anaimia, developing countries like Pakistan, Iron meaning “with no blood”. It is a Deficiency Anemia (IDA) during condition in which either there is a pregnancy is a well-reported concern of decreased erythrocytes number or their the healthcare practitioners. Globally oxygen-carrying capacity in around 1.62 billion people are anemic compromised to fulfill the normal and amongst which 56 million are functioning of the body. Anemia is pregnant women (Barrett et al., 1994). usually common in women In developing countries, the frequency predominantly at the time of pregnancy of iron deficiency anemia is 40-80%. In and is the usual risk factor for the life of Pakistan, anemia was reported in 29- both the mother and fetus. There is 50% of child bearing women living in association of anemia with increased urban areas (Cantor, A. G., et al. 2015). pre-eclampsia (31.2%), pre-term labour Incidence of anemia due to iron (28.2%) and maternal sepsis deficiency varies in child bearing (Abbaspour et al., 2014; MMWR women of Multan (76%), Karachi Recomm. 1998). Anemia during (64%) and Lahore (73%) reported in pregnancy is mild when hemoglobin published studies (De Benaze et al., concentration is between 10.0-11.0 1989; Garn et al., 1981; Hemminki et g/dL, moderate when Hb concentration al., 1978). The differences in the is 7.0-9.9 g/dL and severe when the reported prevalence rate might be due concentration of hemoglobin is <7.0 to varying characteristics of the target g/dL (Agarwal et al., 1991; Allen et al., population. In spite of its known effect 2000). About 75% of the anemia cases on population, there is scarcity of are caused due to iron deficiency and availability of data on the deficiency of has an array of associated contributing micronutrients. Spot identification of factors including genetic, nutritional, high-risk individuals, like women of infectious diseases, abortion, child-bearing age who might be at risk multiparity and frequent labour of getting anemia in near future and (MMWR Recomm 1998; Barrett et al., probing into the causative factors is 1994; Barton et al., 1994). Taking need of the hour in third world foods that are deficient in iron and the countries like Pakistan. In countries like reduced bioavailability of administered Pakistan, the role of socio-cultural iron required during pregnancy are the barriers for woman cannot be ignored major causes of iron deficiency as socio-cultural setup create severe (Blumberg et al., 1994.) The iron challenges for women. Hence, the requirement become six to seven folds present study was planned for the high during early to late pregnancy determining the prevalence of iron (Brabin et al., 2013). National Journal of Medical and Health Sciences (NJMHS) Vol.2 (1), 2020. 24 Naveed Munir et al. deficiency anemia in child bearing pregnancy on the basis of age (Group women of Sargodha district. 1= age upto 25 Years of old, Group 2= age > 25 years), Trimester as 1st MATERIALS & METHODS trimester, 2nd trimester and 3rd trimester, Place of Work: Gravida-para history and severity of This research work was performed in anemia. RHM Midh Ranjha Medical Centre, Statistical Analysis: Tehsil Kotmomin, District Sargodha, Collected data was presented as Mean ± Punjab-Pakistan. Female confirmed SD. Student t-test and Tukey test were with pregnancy history were requested used to evaluate the results statistically. to participate in this study. RHM Midh P-values less than 0.05 were considered Ranjha Medical Centre is providing statistically significant results. health facilities to associated small rural Working definitions: areas including Takhat Hazara, Mohri Anemia: Wal, Badar Ranjha, Chak Sulman, Kot The anemia during pregnancy is Miyana, Chak Miyana, Badeen, Syed defined as hemoglobin (Hb) < 10 g/dL. Nou etc. Iron deficiency Anemia (IDA): Plan of Work and grouping of The iron deficiency anemia is defined patients: as a low hemoglobin levels (< 10 g/dL), In each case, clinical history was a low serum iron (<7.1 µg/l) and a high recorded and a questionnaire was total iron-binding capacity prepared to get clinical history, age, (>13.1 µmol/l) (Clark, 2009). sex, gravida-para history, history of trimester and socioeconomic status of RESULTS AND DISCUSSION selected subjects (n= 150). Patients The results of the current study showed with history of hepatitis B, C, HIV, that 89% of the female patients are tuberculosis and other infectious anemic due to iron deficiency; hence, diseases were excluded. Blood samples females are more commonly affected were collected to perform the with iron deficiency than males hemoglobin concentration especially during child bearing age. The (Cheesbrough, M. 2006), serum iron data is given in Figures 1-4 and Table (SI) by chromazurol B (CAB) method 1-2. (Garcic, A. 1979.) and serum total iron The Figure 1 shows the Pie-graph for binding capacity (TIBC) using the the distribution of iron deficiency method of Fairbanks and Klee, anemia in pregnant females. In our (Fairbanks VF, Klee GG. 1987). study, we found that only 11% women The selected patients were classified of child bearing age are free from into different groups to evaluate the anemia. It is reported that, there is progress of anemia associated with higher risk of iron deficiency in women National Journal of Medical and Health Sciences (NJMHS) Vol.2 (1), 2020. 25 Pregnancy associated iron deficiency anemia from selected rural areas at puberty and menstruation. Moreover, during the 2nd and 3rd trimesters of Majority of females during pregnancy pregnancy, the requirement of iron and lactation do not get the required markedly increased because of high iron and hence, anemia due to iron fetal and placental growth rates, and the deficiency is more common in child expansion of maternal red cell mass. bearing women due to reduced iron Consequently, anemia affects 50 to intake in their diet. According to the 70% of child bearing women in 3rd National Health and Nutrition developing countries (Shams et al., Examination Survey (1988 to 1994) 2017). Figure 2 shows the distribution conducted in USA, anemia due to iron of gravida and para among selected deficiency is higher in children living at population. or below the poverty level. The most common risk factor in 37% of the cases was pregnancy. Pregnancy was found as the frequent risk factor for iron deficiency anemia reported in many studies. (Hameed et al., 2018). Figure 1: Pie graph for the distribution of iron deficiency anemia in pregnant females Figure 3: Iron deficiency Anemia distributed among two age groups (Means ± SD) Figure 2: Distribution of Gravida, The Figure 3 shows the distribution of para among selected study Iron deficiency Anemia among two age population groups: first one up to 25 years of age National Journal of Medical and Health Sciences (NJMHS) Vol.2 (1), 2020. 26 Naveed Munir et al. and second one beyond 25 years of age. revealed by pairwise study using Tukey Hb, serum iron contents and TIBC were test. estimated in the population under study. Interestingly we found that iron Table 1: Student t-test to evaluate the deficiency anemia was equally pregnancy associated iron deficiency distributed among the both age groups. anemia The Figure 4 shows the association of Source DF Adj SS Adj MS P-Value iron deficiency anemia at different trimester. Thus, in current study it is found that Factor 2 26.64 13.318 0.002* nutritional inadequacy is the 2nd largest cause of anemia due to iron deficiency as the study population belongs to poor Error 97 200.91 2.071 families with typically a single bread earner for a large number of dependent Total 99 227.54 family members and have no any associated disease (Baig-Ansari et al., 2008).

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