• Ayesha Farooq
  • Shahid Rauf
  • Uzma Hassan
  • Naushaba Sadiq


Background: The effect of multiple pregnancies, a very common pattern in reproductive lifestyle ofPakistani women, needs to be addressed to see if it affects the iron content and hence cause irondeficiency. Recognising this deficiency prior to development of anaemia can prevent disastrousconsequences that can complicate the life of the mother and foetus especially in developing countries.The objective of this study was to assess the effect that the stress of multiple pregnancies has on the ironstatus of the body. Methods: This comparative study was conducted in a focus group of femalepopulation. Two hundred subjects were selected by convenient sampling and grouped depending ontheir parity status. Data regarding diet, and socioeconomic history was collected on pre-designedquestionnaire. Serum Ferritin was used to assess iron deficiency using the ElectrochemiluminescenceImmunoassay (ECLIA). Data was statistically analysed using SPSS-17. Results: Mean value of serumFerritin in the nulliparous group was 76.52±4.92 ηg/mL with 16% of nulliparous subjects showinglower than normal values. Thirty-six percent of uniparous subjects showed low serum Ferritin values,mean value being 45.74±4.51 ηg/mL. Seventy-two percent of the multiparous subjects showed irondeficiency with Ferritin levels of <20 ηg/mL. Mean serum Ferritin in this group was 25.21±2.75ηg/mL. The differences between the Ferritin levels of the study groups were highly significant(p<0.01). Conclusions: Multiparous women had lower serum Ferritin levels than the control groupsuggesting that the stress of multiple pregnancies takes its toll on the iron content of the body.Keywords: Multiparous, Ferritin, Iron deficiency, Electrochemiiluminescence Immunoassay


Akhter P, Mohammad D, Orfi SD, Ahmad N, Rehman K.

Assessment of daily iron intake for the Pakistani population. J

Nutr Food Sci 2005;35(2):109–17.

Chen J, Zhao, Zhang X, Yin S, Piao J, Huo J. Studies on the

effectiveness of Na Fe EDTA-fortified soy sauce in controlling

Iron deficiency: a population based intervention trial. Food Nutr

Bull 2000;26:177–86.

WHO/UNICEF/UNU. Iron deficiency anaemia: assessment,

prevention and control. Aguide for programme managers.

Geneva: WHO; 2001. (WHO/NHD/01.3).

Brady PG. Iron deficiency anemia: a call for. South Med J


Government of Pakistan, Finance Division. Economic Survey

–6 Islamabad: Government of Pakistan Economic

Adviser’s Wing Finance Division; 2006.

Hashmi AF, Qureshi HH, Akhtar DS. Adolescent reproductive

health-A manual for family physicians. Karachi: College of

Physicians and Surgeons of Pakistan;1999.

Anonymous. Gravidity and Parity Definitions (and their

Implications in Risk Assessment). Availabe at:

Andrejevic A, Cvetkovic S, Vitosevic Z, Andrejevic L, Relic G.

Multiparty, perinatal morbidity and mortality. Clin Exp Obstet

Gynecol 2011;38(1):71–5.

El-Sahn F, Sallam S, Mandil A, Galal O. Anaemia among

Egyptian adolescents: prevalence and determinants. East

Mediterr Health J 2000;6(5–6):1017–25.

Lone FW, Qureshi RN, Emanuel F. Maternal anaemia and its

impact on perinatal outcome. Trop Med Int Health 2004;9:486–90.

Devlin TM. Textbook of Biochemistry with clinical correlations.

th Edition, New Jersey, USA: Wiley Medical Publications; 2011.


Frith-Terhune AL, Cogswell ME, Khan LK, Will JC,

Ramakrishnan U. Iron Levels - am I at risk - Heart Healthy

Women. Am Heart J 2000;140(1):98–104.

Cobas E. Elecys Enzymatic test Immuno Diagnostic System on

the Elecys 2010, Modular Analytics E170 or Cobas E

Immunoassay analyzer (Roche Diagnostics GmbH) (2010).

Retrieved on 12th February, 2011 from

Lotz J, Hafner G. Prellwitz W. Reference study for Ferritin

Assays. Kurzmitteilung Clin Lab 1997;439:993–4.

Turgeon O'Brien H, Santure M, Maziade J. The Association of

Low and High Ferritin Levels and Anaemia with Pregnancy

Outcome. Can J Diet Pract Res 2000;61(3):121–7.

Milmani N, Bergholt T, Eriksen L, Byg KE, Graudal N,

Pedersen P, et al. Iron prophylaxis during pregnancy – How

much iron is needed? A randomized dose response study of 20–

mg ferrous iron daily in pregnant women. Acta Obstet

Gynecol Scand 2005;84:238–47.

Cunningham FG, Leveno KJ, Bloom SL, Hauth JC, Gilstrap II

LC, Wenstrom KD. Williams Obstetrics. Companies; 22nd Ed.

New York, USA: McGraw-Hill; 2005.

Newman-Dorland WA. Dorland’s Illustrated Medical Dictionary.

nd Ed. Philadelphia: Saunders-Elsevier; 2012.

Story M, Stang J. Nutrition and the pregnant adolescent: A

practical reference guide: Appendix C2: Nutrition Assessment

Forms, FFQ. LET Publications; 2008. p 237. Available at: Retrieved on 26th

January 2011.

de Benoist B, McLean E, Egli I, Cogswell M. WHO Global

Database on Anemia: Worldwide prevalence of anemia 1993–

; p7: Table 3.2: Global anaemia prevalence and number of

individuals affected. Retrieved on 10th January, 2012. Available


Bagchi1 K. Iron deficiency anaemia –an old enemy. East

Mediterr Health J 2004;10:754–60.

Ansari NB, Halai S, Karmaliani BR, Harris H, Jehan I, Pasha O,

et al. Anemia prevalence and risk factors in pregnant women in

an urban area of Pakistan. Food Nutr Bull 2008;29(2):132–9.

Ansari T, Ali L, Aziz T, Ara J, Liaquat N, Tahir H. Nutritional

iron deficiency in women of child bearing age-What to do? J

Ayub Med Coll Abbottabad 2009;21(3):17–20.

J Ayub Med Coll Abbottabad 2011;23(2) 35

Longo D, Fauci A, Kasper D, Hauser S, Jameson J, Loscalzo J.

Harrison’s principles and practice of internal medicine. 18th

Edition. New York: McGraw-Hill Professional; 2011.

Hallberg L. Iron balance in pregnancy. Vitamins and Minerals in

Pregnancy and Lactation. Nestles Nutr Workshop Series


Milman N, Bergholt T, Byg KE, Eriksen L, Graudal N. Iron status

and iron balance during pregnancy. A critical reappraisal of iron

supplementation. Acta Obstet Gynecol Scand 1999;78:749–57.

Anonymous. Anemia during pregnancy a major public health

problem. Safe Mother 1993;11:1–2.

US Preventive Services Task Force. Routine iron

supplementation during pregnancy. Policy statement. Review

article. JAMA 1993;270:2846–54.

Report of a Joint FAO/WHO Expert Consultation. Requirements

of Vitamin A, iron, folate and Vitamin B12. FAO Food Nutr Pap





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