A total of 350 pregnant women were recruited between August 9, 2019 and June 15, 2020. From 350 questionnaires were implemented, 324 (92.6%) were completely filled out. Most of the incomplete data resulted of lacking to record hemoglobin level at term pregnancy. The participants’ characteristics were shown in Table 1 as their mean aged of 29.3 years, majority of them in the aged range of 20–35 years. Almost 60% were the second pregnancy, while almost all (98%) had stable marital status. More than half had graduate education and none smoking exposure. Most of them received Triferdine (59.4%) and ObiminAZ (38.0%) as the tablet for iron supplementation. Triferdine is produced and supplied by the Government Pharmaceutical Organization, contained of iron 60.81 mg, potassium iodide 0.15 mg; folic acid 0.4 mg. ObiminAZ is the product of the commercial pharmaceutical company, contained ferrous fumarate 200 mg, iodine 0.2 mg, folic acid 1 mg, and vitamin A, B1, B2, B6, B12, C, D, E, nicotinamide, zinc, and calcium lactate. The compliance as in Table 2 demonstrated that almost 90% of participants had compliance rate of greater than 80%. There was none in the compliance rate of 25–50% and a few of women in compliance rate < 25%.
Table 1
General characteristics of studied women
Characteristics
|
number
|
percentage
|
Age (yrs.)
|
< 20
|
5
|
1.43
|
20–35
|
302
|
86.29
|
> 35
|
43
|
12.29
|
Parity
|
1
|
142
|
40.57
|
≥ 2
|
208
|
59.43
|
Marital status
|
Married
|
343
|
98.00
|
Separated
|
6
|
1.71
|
Divorce
|
1
|
0.29
|
Education levela
|
Under graduate
|
145
|
41.43
|
Graduate or above
|
205
|
58.57
|
Smoking
|
Current smoking
|
5
|
1.43
|
Family members
|
142
|
40.57
|
none
|
203
|
58.00
|
Type of iron supplementation
(some of them had more than one type of supplementation)
|
Triferdine
|
208
|
59.40
|
ObiminAZ
|
133
|
38.00
|
Ferrous fumarate
|
14
|
4.00
|
Folic acid
|
18
|
5.14
|
others
|
13
|
3.71
|
a: Graduate and above = bachelor’s degree or above |
Table 2
Compliance rate of iron supplementation
Compliance rate
|
number
|
Percentage (%)
|
95%CI
|
> 80%
|
314
|
89.71
|
86.52–92.91
|
> 50–80%
|
33
|
9.43
|
6.35–12.51
|
25–50%
|
0
|
-
|
-
|
< 25%
|
3
|
0.86
|
0.00-1.83
|
In Table 3 showed the frequency and rate of side-effects occurrence among different compliance groups of iron supplementation. Mostly of reported side-effects were nausea and constipation. The less compliance rate found in the more proportion of side-effects occurrence as the results revealed that the total proportion of side-effects occurrence were 10.5%, 12.1%, 66.7% in > 80%, > 50–80%, < 25% compliance groups, respectively.
Table 3
Side-effects occurrence rate in different group of iron supplementation compliance
Side effects
|
> 80% (N = 33/314)
|
50–80% (N = 4/33)
|
< 25% (N = 2/3)
|
No.
|
%
|
95% CI
|
No.
|
%
|
95% CI
|
No.
|
%
|
95% CI
|
Nausea
|
14
|
4.46
|
2.46–7.37
|
3
|
9.09
|
1.91–24.33
|
2
|
66.67
|
9.43–99.16
|
vomiting
|
5
|
1.60
|
0.52–3.68
|
1
|
3.03
|
0.07–15.76
|
2
|
66.67
|
9.43–99.16
|
GI symptomsa
|
2
|
0.64
|
0.08–2.28
|
0
|
0
|
0.00-10.58
|
1
|
33.33
|
0.84–90.57
|
Constipation
|
18
|
5.73
|
3.43–8.91
|
1
|
3.03
|
0.08–15.76
|
0
|
0
|
0.00-70.76
|
Diarrhea
|
5
|
1.59
|
0.52–3.68
|
0
|
0
|
0.00-10.58
|
0
|
0
|
0.00-70.76
|
> 1 of above symptoms
|
6
|
1.91
|
0.70–4.11
|
1
|
3.03
|
0.08–15.57
|
2
|
66.67
|
9.43–99.16
|
None of the participants were categorized into compliance 25–50% group. |
a: GI symptoms = abdominal cramping/bloating |
In this study, the hemoglobin level in second trimester of pregnancy were evaluated vary between 28 and 36 weeks of gestation. According to the hospital protocol to take blood test for complete blood count, VDRL and anti-HIV in gestation of 28–32 weeks, however some of them were tested out of the hospital protocol range. Hemoglobin level at term was available in 324 from 350 women. The results in Tables 4 and 5, there was no difference rate of anemia during second trimester between all groups of compliance (p-value > 0.05). While at term pregnancy, rate of anemia was 50% (N = 1/2, 95%CI: 1.25–98.74) in < 25% compliance group. The lowest hemoglobin concentration was 9.7 gm/dl in second trimester and was 9.9 gm/dl at term of gestation, all of them were in > 80% and > 50–80% compliance groups. None of them had severe anemia.
Table 4
Effects of iron supplementation compliance rate on hemoglobin levels/anemia/high concentrated hemoglobinin the second trimester
Compliance
|
Number
(N = 350)
|
Hb
Mean ± SD
|
Anemic womena
|
High concentrated hemoglobin womenb
|
Number
|
%
|
Number
|
%
|
> 80%
|
314
|
12.00 ± 0.88
|
7
|
2.23
|
38
|
12.10
|
> 50–80%
|
33
|
11.92 ± 1.06
|
2
|
6.06
|
4
|
12.12
|
25–50%
|
0
|
0
|
0
|
0
|
0
|
0
|
< 25%
|
3
|
12.00 ± 0.92
|
0
|
0
|
0
|
0
|
a: Anemic women: Hb < 10.5 gm/dl |
b: High concentrated hemoglobin: Hb > 13 gm/dl |
Table 5
Effects of iron supplementation compliance on hemoglobin levels/anemia/high concentrated hemoglobin at term pregnancy
Compliance
|
Number
(N = 324)
|
Hb
Mean ± SD
|
Anemic womena
|
High concentrated hemoglobin womenb
|
Number
|
%
|
Number
|
%
|
> 80%
|
291
|
12.67 ± 0.90
|
5
|
1.72
|
94
|
32.30
|
> 50–80%
|
31
|
12.49 ± 0.92
|
1
|
3.23
|
8
|
25.81
|
25–50%
|
0
|
0
|
0
|
0
|
0
|
0
|
< 25%
|
2
|
11.00 ± 0.28
|
1
|
50.00
|
0
|
0
|
NB: Hb level available in 324 from 350 women |
a: Anemic women: Hb < 11 gm/dl |
b: High concentrated hemoglobin: Hb > 13 gm/dl |
In contrast, hemoglobin concentrations above 13 gm/dl, which defined as high concentrated hemoglobin, were more frequently found in > 80% compliance group (12.10%, 95%CI: 8.71–16.23) and > 50–80% compliance group (12.12%, 95%CI: 3.40–28.20) during second trimester. As well as at term pregnancy, 32.30% (95%CI: 26.96-38.00) in > 80% compliance group and 25.81% (95%CI: 11.86–44.61) in > 50–80% compliance group. There was no participant developed high hemoglobin concentration in < 25% compliance group in second trimester and at term pregnancy period. The maximum hemoglobin concentrations were 15.4 gm/dl and 16.2 gm/dl during second trimester and at term, respectively, all of them were in > 80% compliance group.