Anemia during pregnancy and its effect on fetal birth weight in a sample of Jordanian women

Objective: To assess the prevalence of anemia in a sample of Jordanian pregnant women and to find out whether packed cell volume (PCV) affected by the use of iron supplements during pregnancy and has effect on fetal weight

Introduction The World Health Organizatin(WHO) estimates that 52%of pregnant women in developing countries are anemic compared with 23% in the developed world.

Maternal anemia, per se, is a major risk factor for an unfavorable outcome for both mother and child as different types of decompensations occur with varying degree of anemia. It may be associated with premature labor, low birth weight, and even maternal and perinatal mortality. Intrauterine growth restriction and significant fall in birth weight has been reported when women had severe anemia.

Increase infant birth weight. Studies have shown that iron supplementation can: Increase infant birth weight. Could also increase Apgar score of the infants and decrease the incidence of asphyxia.

In Jordan ,many women take their iron supplement irregularly In Jordan ,many women take their iron supplement irregularly. Only a few were adherent to its daily use.

In our study, we tried to assess the prevalence of anemia in a sample of women who delivered at our hospital, and to correlate their packed cell volume (PCV) to the use of iron supplements during pregnancy and to the fetal weight.

A retrospective study During the study period, there were a total of 1030 deliveries .

Exclusion criterias Women at risk to deliver low birth babies ( preterm delivery, IUGR,preeclampsia,congenital malformations ). Women whose early hemoglobin was not known. Who had had blood transfusion during this pregnancy. Women with multiple pregnancy. Women whose pregnancies ended with intrauterine fetal death (IUFD), Women with any pre-existing haemoglobinopathy . Chronic blood loss ( Chronic gastrointestinal bleeding). known to have connective tissue diseases as(SLE,RA). This left a total of 668 women eligible for inclusion

(Thalesemi a,Sickle cell anemia) From gastroi ntestina l tract Table 1. Causes of exclusion: Month Eligible Total   Unbooke d Preterm Or have obstetrical complicati ons IUFD Blood transfusio n Twins pregnancy Haemglobi nopathies (Thalesemi a,Sickle cell anemia) Chroni c disease (SLE,R A) Bleedin g From gastroi ntestina l tract 207 (20.10%) 93 (9.1%) 28 (2.72%) 15 (1.46%) 13 (1.26%) 4 (0.39% ) 2 (0.19%) 668 (64.85 %) 1030

We used the World Health Organization definition ( Hemoglobin value of less than 11.0 g/dL) to define anemia in pregnancy. (Ferrous Sulphate 50 mg tablets) is prescribed for pregnant women. Those women who use iron tablets on daily bases are considered regular users. The weights of the babies was taken,. Anything less than 2500 gm. was considered low birth weight

Statistical methods The statistical significance of the association between anaemia and fetal birth weight was calculated using the x2 test. P values <0.05 were considered statistically significant.

Results: 211 women have packed cell volume less than 33% ,the prevalence of anemia in our sample is 31.6%. Regular use of iron supplements in pregnancy was associated with an elevation of the mean pre-delivery PCV (P<0.05). Non-use of the iron supplements was associated with a drop in the pre-delivery PCV compared to early pregnancy levels (P<0.05). Irregular use of iron supplements was not associated with an evident change in PCV (P>0.05).

Table 2. Correlation between iron supplements and changes in early and pre-delivery PCV Mean pre- delivery PCV Iron supplements No n=130 Irregular n=176 Regular n=362 All 668 Early 35.15%±2.45 34.47%±2.12 31.07%±2.23 32.80% Pre-delivery 33.65%± 2.15 34.65%±1.98 35.07%±2.17 34.76% P <0.05* >0.05

Anemic women with PCV < 33 gave low birth weight infants (P<0 High PCV was associated with delivery of normal and large infants (P<0.05).

Table 3. Pre-delivery PCV and birth weight Mean pre- delivery PCV Fetal weight Total Normal (2.5-3.5 Kg) Low (<2.5 Kg) High (>3.5 Kg) ≥33 Non-anemic 412(81.9%)* 14(10.5%)* 31(96.9%) (P<0.05) * 457 <33 Anemic 91(18.1%) 119 (89.5%) (P<0.05) * 1(3.1%) * 211 503 133 32 668

Discussion: Iron deficiency anemia is common problem in developing countries. It remains a public health issue of great magnitude despite measures taken by various national and international organizations to control it. Effective management is needed to prevent adverse maternal and pregnancy outcomes.

The fetus is relatively protected from the effects of iron deficiency by up regulation of placental iron transport proteins . Pregnancy results in an overall additional iron requirement of about 1000 mg. Pregnant women with mild anemia usually tolerate it without adverse maternal and perinatal outcomes. severe anemia g may lead to grave complications to both the mother and the fetus .So prevention and treatment of anemia during pregnancy is of paramount significance.

The prevalence of anemia in our sample is 31. 6% The prevalence of anemia in our sample is 31.6%.This figure is consistent with previous studies done in Jordan which shows prevalence rate of anemia among pregnant women in northern part Jordan in a recent study 34.7% and 42% in another one . The reported prevalence of anemia is 31.9% in Saudi Arabia,35.3% in Nigeria(16),and (55%) in Sharkia Governorate, Egypt . Our study is done in Amman the capital of Jordan and we expect that the prevalence may be higher in northern and southern part of Jordan where poverty is more.

This study demonstrated that regular iron supplements during pregnancy is associated: With a reduced incidence of anemia Reduced incidence of delivery of small babies. Our results are similar to those by Rohilla et al, Hinderaker et al, and are collaborated by the World Health Organization global database on anemia.

All efforts should be made to identify women at risk of anemia and to supplement them with iron as severe anemia is associated with increased perinatal morbidity and mortality. In developing countries like Jordan we should spread the awareness about the benefits of iron supplement during pregnancy. Reducing severe anemia can lead to reduction in the mortality and morbidity triggered by this preventable condition.

Conclusion The management of anemia during pregnancy remains is an important issue in modern obstetrics. Correct diagnosis and treatment lead to reduction in fetal and maternal risks and improved birth weight.

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