• Dilshad Ahmed Khan
  • Samia Fatima
  • Rabia Imran
  • Farooq Ahmad Khan


Background: Anaemia in pregnancy is a common clinical problem contributing to increased maternaland foetal morbidity. This study was carried out to determine frequency of iron, folate and cobalamindeficiency and associated risk factors in the anaemic pregnant females who reported first time duringsecond and third trimester for antenatal check-up in the tertiary care hospital at Rawalpindi. Methods:This case control study was carried out in a tertiary care hospital at Rawalpindi. Two hundred and fiftypregnant women (age: 19–43 years) consisting of 125 anaemic (Hb< 110 g/L) and 125 non-anaemicwho reported first time at antenatal clinic were included. Data on socio-demographic characteristics,parity and dietary intake were collected. Complete blood counts were done. Serum ferritin, folate andcobalamin assays were performed by using DPC kits on Immulite-1000. Results: The pregnant womenwere categorised having mild (Hb up to 54%), moderate (Hb up to 36%), or severe (Hb up to10%)anaemia during antennal visit. They had significantly lower median (range) levels of haemoglobin 96(40–110) g/L, ferritin 8 (3–142) µg/L, folate 15 (3–54) ηmol/L and cobalamin 171 (111–629) ρmolLthan controls (p=<0.01). Micronutrient analysis revealed secondary pregnancy related deficiency ofIron (57%), folate (20%), combined iron and folate (19%) and cobalamin (4%) in the female. Amongthe risk factors, low income (OR: 7.69), multiparty (OR: 2.93), lack of iron/folate supplementation (OR2.91) and inadequate dietary intakes (OR 2.51) were associated with anaemia. Conclusion: Thepregnant anaemic women had iron (57%); folate (20%), followed by combined iron folate (19%), andcobalamin (4%) deficiency during first antenatal visit. Low income, multiparty, poor diet and lack ofsupplements are the main contributor in development of anaemia during pregnancy.Keywords: Anaemia, pregnancy, ferritin, cobalamin, iron, folate


Brabin BJ, Hakimi M, Pelletier D. An analysis of anaemia and

pregnancy-related maternal mortality. J Nutr 2001;131(2S-


World Health Organization, United Nations Children’s Fund,

United Nation University. Iron deficiency anaemia: a assessment,

prevention and control. A guide for programme managers.

Geneva: WHO, 2001.WHO/NHD /01.3.9.

VanderJagt DJ, Brock HS, Melah GS, El-Nafaty AU, Crossey

MJ, Glew RH. Nutritional factors associated with anaemia in

pregnant women in Northern Nigeria. J Health Popul Nutr


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

impact on perinatal outcome in a tertiary care hospital in

Pakistan. East Mediterr Health J 2004;10(6):801–7

Bakhtiar UJ, Khan Y, Nasar R. Relationship between maternal

hemoglobin and perinatal outcome. Rawal Med J 2007;32:102–4.

Karim SA, Khurshid M, Memon AM, Jafarey SN. Anaemia in

pregnancy--its cause in the underprivileged class of Karachi. J

Pak Med Assoc 1994;44(4):90–2.

Sohail R, Zainab S, Zaman F. Prevalence of anaemia in

obstetrical population. Ann King Edward Med Coll


Awan MM, Akbar MA, Khan MI. A study of anaemia in

pregnant women of Railway Colony, Multan. Pak J Med Res


Ronnenberg AG, Goldman MB, Aitken IW, Xu X. Anaemia and

deficiencies of folate and vitamin B-6 are common and vary with

season in Chinese women of childbearing age. J Nutr


Brian S, Alper, Kimber R, Reddy K A. Using ferritin levels to

determine iron deficiency anaemia in pregnancy. Journal of

Family Practice 2000;49:829–32.

Chandyo RK, Strand TA, Ulvik RJ, Adhikari RK, Ulak M, Dixit

H, et al. Prevalence of iron deficiency and anaemia among

healthy women of reproductive age in Bhaktapur, Nepal. Eur J

Clin Nutr 2007;61:262–9.

Gopalan C. Women and nutrition in India. Ind J Nutr Dietet


Karimi M, Kadivar R, Yarmohammadi H. Assessment of the

prevalence of iron deficiency anaemia, by serum ferritin, in

pregnant women of Southern Iran. Med Sci Monit


Hyder SMZ, Persson LA, Chowdhury M, Lonnerdal B, Ekstrom

EC. Anaemia and iron deficiency during pregnancy in rural

Bangladesh. Public Health Nutr 2004;7:1065–70.

Scholl TO. Iron status during pregnancy: setting the stage for

mother and infant. Am J Clin Nutr 2005;81(5):1218S–22S.

J Ayub Med Coll Abbottabad 2010;22(1) 21

Martí-Carvajal A, Peña-Martí G, Comunian G, Muñoz S.

Prevalence of anaemia during pregnancy: results of Valencia

(Venezuela) anaemia during pregnancy study. Arch Latinoam

Nutr 2002;52(1):5–11.

Seshadri S. Prevalence of micronutrient deficiency particularly of

iron, zinc and folic acid in pregnant women in South East Asia.

Bri J Nutr 2001;85(2):S87–S92.

Scholl TO, Hediger ML, Schall JI, Khoo CS, Fischer RL. Dietary

and serum folate: their influence on the outcome of Pregnancy.

Am J Cliii Nutr 1996;63:520–5.

Gibson RS, Abebe Y, Stabler S, Allen RH, Westcott JE, Stoecker

BJ, et al. Zinc, gravida, infection, and iron, but not cobalamin or

folate status, predict hemoglobin during pregnancy in Southern

Ethiopia. J Nutr 2008;138:581–6.

Khalil AA, Jabbar T, Akhtar S, Mohyuddin S. Frequency and

types of anaemia in an antenatal clinic in the third trimester of

pregnancy. Pak Armed Forces Med J 2007;57:273–8.

Agarwal KN, Agarwal DK, Sharma A, Sharma K, Prasad K,

Kalita MC et al. Prevalence of anaemia in pregnant & lactating

women in India. Indian J Med Res 2006;124(2):173–84.

Asif N, Hassan K, Mahmud S, Zaheer HA, Naseem L, Zafar T et

al. Comparison of Serum Ferritin Levels in Three Trimesters of

Pregnancy and Their Correlation with Increasing Gravidity. Int J

Pathol 2006;5(1):26–30.

Haniff J, Das A, Onn LT, Sun CW, Nordin NM, Rampal S, et al.

Anaemia in pregnancy in Malaysia: a cross-sectional survey.

Asia PAC J Clin Nutr 2007;16(3):527–36.

Gadowsky SL, Gale K, Wolfe SA, Jory J, Gibson R, O'Connor

DL. Biochemical folate, B12, and iron status of a group of

pregnant adolescents accessed through the public health system

in southern Ontario. J Adolesc Health 1995;16(6):465–74.




Most read articles by the same author(s)