IRON, FOLATE AND COBALAMIN DEFICIENCY IN ANAEMIC PREGNANT FEMALES IN TERTIARY CARE CENTRE AT RAWALPINDI
Abstract
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, folateReferences
Brabin BJ, Hakimi M, Pelletier D. An analysis of anaemia and
pregnancy-related maternal mortality. J Nutr 2001;131(2S-
:604S–615S.
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
;25(1):75–81.
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
;10(2):146–8.
Awan MM, Akbar MA, Khan MI. A study of anaemia in
pregnant women of Railway Colony, Multan. Pak J Med Res
;43(1):11–4.
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
;130:2703–10.
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
;36:95–107.
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
;8:488–92.
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)
http://www.ayubmed.edu.pk/JAMC/PAST/22-1/Dilshad.pdf 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.
