Risk Factors and Adverse Perinatal Outcomes of Anemia in Zakho Maternity Hospital

Saraa Faiz  Abdulrahman; Shahla Kareem  Alalaf; Fatima Kamal  Khalid

doi:10.56056/407

Authors

Saraa Faiz Abdulrahman MBCHB, Senior house officer at Zakho Maternity Teaching Hospital
Shahla Kareem Alalaf MBCHB/ Professor. supervisor and trainer at College of Medicine, Hawler Medical University, Erbil, Kurdistan Region, Iraq.
Fatima Kamal Khalid MBCHB/CABOG, Senior Lecturer at Zakho Medical University, College of Medicine, Zakho City, Kurdistan Region, Iraq

DOI:

https://doi.org/10.56056/407

Keywords:

Anemia, Perinatal outcomes, Pregnancy, Risk factors

Abstract

Background and objectives: Maternal anemia pose significant challenges to perinatal health globally. The current study was conducted to investigate the association between severity of anemia in pregnant women and adverse perinatal outcomes.

Methods: A comparative descriptive study was conducted in Zakho Maternity Hospital, Zakho City, Kurdistan Region, Iraq from May 2022 to May 2023 involving 500 women during labor. The sample size included 253 anemic (Hemoglobin <11 g/dl) and 247 non-anemic pregnant women (Hemoglobin ?11 g/dl). Demographic character, mode of delivery and perinatal outcomes were compared between both groups.

Results: Among the 253 anemic women during labor involved in the study, 56.0% had mild, 42.4% had moderate, and 1.6% had severe anemia. Higher parity increased anemia risk (P<0.000), Among mothers with moderate anemia, 47.2% were multiparous compared to 26.4% primigravida. Similarly, among those with severe anemia, 42.8% were multiparous compared to 0% primigravida. Anemia was associated with extreme maternal age (<20 and >35 years) and rural housing (p<0.001), although work status had no significant impact (p=0.292). Maternal anemia correlated with poorer Apgar scores, with rates of (75.0%, 9.3%, and 1.4% for severe, moderate, and mild anemia, respectively). More NICU admissions were observed for babies born to mothers with severe anemia (100.0%), followed by moderate (17.8%) and mild (4.9%) anemia. Additionally, more low birth weight cases were observed, with a prevalence of 75.0% in severe anemia followed by moderate (7.5%) and mild anemia (2.1%).

Conclusion: A substantial link is there between anemia during pregnancy and maternal characteristics of parity and rural residence. Furthermore, poor perinatal outcomes had significant relation with anemia.

Downloads

Download data is not yet available.

References

1. Frayne J and Pinchon D. Anaemia in pregnancy. Aust J Gen Pract. 2019; 48:125.

2. Karami M, Chaleshgar M, Salari N, Akbari H, Mohammadi M. Global Prevalence of Anemia in Pregnant Women: A Comprehensive Systematic Review and Meta-Analysis. Matern Child Health J. 2022 Jul;26(7):1473-1487. doi: 10.1007/s10995-022-03450-1.

3. Victora CG, Christian P, Vidaletti LP, Gatica-Domínguez G, Menon P, Black RE. Maternal and Child Undernutrition Study Group. Maternal and child undernutrition and overweight in low- and middle-income countries. The Lancet. 2020; 395(10222): 1039-1086.

4. Black RE, Victora CG, Walker SP, Bhutta ZA, Christian P, de Onis M, et al. Maternal and child under nutrition and overweight in low- and middle-income countries. The Lancet. 2020; 395(10222): 1039-1086.

5. Stoltzfus RJ, Black MM, Egli IM. Anemia in pregnancy: A global public health challenge with multiple causes. Annu. Rev. Nutr. 2020; 40: 327-353.

6. Peña-Rosas JP, De-Regil LM, Garcia-Casal MN, Dowswell T. Daily oral iron supplementation during pregnancy. Cochrane Database Syst Rev. 2015 Jul 22; 2015(7): CD004736.

7. Suchdev PS, Flores-Ayala S. Anaemia in pregnancy: A global perspective on causes and interventions. BMJ Global Health. 2021; 6(5): e004712.

8. Afolabi OO, Ige OO, Adeoye OO. The association between maternal anemia and perinatal outcomes in different geographical regions: A systematic review and meta-analysis. BMC Pregnancy Childbirth. 2022; 22(1): 1-14.

9. Khan FS, Rahman S, Khan AR. Association of maternal anemia with perinatal outcomes in a tertiary care hospital of Karachi, Pakistan. Int. J. Gynecol. Obstet. 2020;151(2): 220-225.

10. Cogan P, Ng V, Studzinski M. Iron deficiency versus non-iron deficiency anemia in pregnancy: Impact on maternal and neonatal outcomes. Nutrients. 2022;14(17), 3467.

11. World Health Organization. Global Nutrition Report 2022: Transforming food systems for better health and nutrition. 2022. https://globalnutritionreport. org/reports/2022-global-nutrition-report/

12. Achebe MM and Gafter-Gvili A. How I treat anemia in pregnancy: iron, cobalamin, and folate. Blood. 2017; 129: 940–949.

13. Badireddy M, Baradhi K. Chronic anemia. Treasure Island (FL): StatPearls Publishing; 2024Jan. https://www.ncbi.nlm.nih.gov/books/NBK534803/

14. Maraj H, Kumari S. No clarity on the definition of parity: A survey accessing interpretation of the word parity amongst obstetricians and midwives and a literature review. Eur J Obstet Gynecol Reprod Biol. 2021 Aug; 263:15-19.

15. Pathirana J, Muñoz FM, Abbing-Karahagopian V, Bhat N, Harris T, Kapoor A, et al. Neonatal death: Case definition & guidelines for data collection, analysis, and presentation of immunization safety data. Vaccine. 2016;34(49): 6027–6037.

16. American college of obstetricians and Gynecologists. The Apgar score. October 2015. https://www.acog.org/clinical/clinical-guidance/committeeopinion/articles/201510/the-apgar-score/

17. Ray JG, Medcalf KE, Park AL. Association of Newborn Apgar Score with Maternal Admission to the Intensive Care Unit. JAMA Pediatr. 2016;170(1):88–89. doi:10.1001/jamapediatrics.2015.3035/

18. Battaglia FC, Lubchenco LO. A practical classification of newborn infants by weight and gestational age. J Pediatr. 1967 Aug;71(2):159-163.

19. Barut A, Mohamud DO. The association of maternal anaemia with adverse maternal and fetal outcomes in Somali women: a prospective study. BMC Womens Health. 2023; 23(1):193.

20. Addis AK, Mohamed DA. Prevalence of Anemia and Associated Factors among Pregnant Women in an Urban Area of Eastern Ethiopia. Anemia. 2014; 2014:561-567.

21. Baig-Ansari N, Badruddin SH, Karmaliani R, 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 Jun; 29(2): 132-139.

22. Chowdhury HA, Ahmed KR, Jebunessa F, Akter J, Hossain S, Shahjahan M. Factors associated with maternal anaemia among pregnant women in Dhaka city. BMC Women's Health. 2015 Sep 22; 15:77.

23. Kassa GM, Muche AA, Berhe AK, Fekadu GA. Prevalence and determinants of anemia among pregnant women in Ethiopia; a systematic review and meta-analysis. BMC Hematol. 2017 Oct 17; 17:17. doi: 10.1186/s12878-017-0090-z/

24. Lin L, Wei Y, Zhu W, Wang C, Su R, Feng H, et al. Gestational diabetes mellitus Prevalence Survey (GPS) study Group. Prevalence, risk factors and associated adverse pregnancy outcomes of anaemia in Chinese pregnant women: a multicenter retrospective study. BMC Pregnancy Childbirth. 2018 Apr 23;18 (1): 111.

25. Camara B, Oluwalana C, Miyahara R, Lush A, Kampmann B, Manneh K, et al. Stillbirths, neonatal morbidity, and mortality in health facility deliveries in urban Gambia. Front Pediatr. 2021; 9: 579922.

26. Shi H, Chen L, Wang Y, Sun M, Guo Y, Ma S, et al. Severity of anemia during pregnancy and adverse maternal and fetal outcomes. JAMA Netw Open. 2022;5(2): e2147046.