Table. 1. Prevalence of anemia among pregnant women according to the pregnancy trimester. (n=336)
Overall (n,%)
|
Third trimester (n,%)
|
Second trimester (n,%)
|
First trimester (n,%)
|
Hemoglobin level
|
288(28.6)
|
122(36.3)
|
125 (37.2)
|
41 (12.2)
|
<11 g/dl
|
303( 30.1)
|
113(33.6)
|
102 (30.4)
|
88( 26.2)
|
≥ 11 g/dl
|
417(41.3)
|
101(30.1)
|
109(32.5)
|
207(61.6)
|
No Hb available
|
11.04(1.03)
|
10.81 (1.26)
|
10.81 (1.16)
|
11.50 (1.13)
|
Mean (SD) of Hemoglobin
|
A total of 591 (51.5%) hemoglobin tests were conducted during pregnancy for the study sample, where a total of (1008) hemoglobin tests were expected if hemoglobin was evaluated in every trimester12. A total of 288 tests were diagnostic of anemia; of whom 41 were identified in the first trimester, 125 in the second, and 122 in the third. The overall prevalence of anemia was 28.6 % (288/336), 12.2 % (41/336) in the first trimester, 37.2% (125/336) in the second trimester and 36.3 % (122/336) in the third trimester. The mean hemoglobin ranged between 10.81 in the second and third trimesters to 11.5 in the first trimester. Table 1 shows the frequencies and prevalence of anemia by trimesters.
Table. 2. Level of anemia among anemic pregnant women according to the pregnancy trimester
Third trimester (n, %)
|
Second trimester (n, %)
|
First trimester (n, %)
|
Anemia level
|
68 (55.7)
|
75 (60)
|
25 (60.9)
|
Mild
|
53 (43.4)
|
49 (39.2)
|
16(39.02)
|
Moderate
|
1 (0.82)
|
1 (2.4)
|
0
|
Severe
|
Results shown in table 2 reveal that most anemic pregnant women were classified as mild and moderate, with only two women having severe anemia detected in the second and third trimesters.
Table .3 Association of anemia in first-trimester pregnancy with participants’ demographic and clinical characteristics (n=336)
OR(CI)
|
P
|
β
|
Moderate anemia (Hb:9.9-7) (N=17; 5.06%)
|
Mild anemia (Hb:10‑10.9) (N=25, 7.44)
|
No anemia (Hb:≥11)
(N=88; 26.19%)
|
|
1.02 (0.931-1.135)
|
0.581
|
0.028
|
32.5 ±5.6
|
29.5±6.3
|
32.7± 5.3
|
Age (mean ± SD)
|
1.35(0.219- 8.33)
|
5 (29.4)
|
10 (40%)
|
27 (30.68)
|
<30
|
1(0.173-5.79)
|
7(41.1)
|
10(40)
|
28(31.82)
|
30-34
|
3.12 (0.377-25.91)
|
2(11.8)
|
3 (12)
|
25(28.41)
|
35-39
|
1
|
3(17.6)
|
2(8)
|
8 (9.09)
|
40+
|
0.844 (0.645-1.104)
|
0.271
|
-0.169
|
4±1.9
|
3 ±1.7
|
3.35±1.9
|
Gravidity (mean ± SD)
|
0.804(0.569-1.14)
|
0.215
|
-0.219
|
2.38±1.7
|
1.56±1.2
|
1.86±1.5
|
Parity (mean ± SD)
|
0.823( 0.469-1.45)
|
0.500
|
-0.195
|
0.63±0.95
|
0.44±0.96
|
0.47±0.86
|
Abortion (mean ± SD)
|
Table.3. Summarizes the difference in sociodemographic characteristics between anemic and non‑anemic women. The mean age was similar in the three groups; however, women ages (35-39) were more likely to be associated with anemia when compared to women in other age groups (odds ratio [OR] = 3.12, CI 0.337–25.91). The mean gravidity was similar in the three groups; however, the value of beta indicates that there is an inverse relationship between gravidity and hemoglobin. The same was noted for parity and number of abortions.
In regard to screening for iron deficiency through measurement of ferritin among the 129 women seen in the first trimester, ferritin was tested in 4 (4.5%) women who had no anemia, in 6 (24%) with mild anemia, and in 2 (12.5%) with moderate anemia. Iron was measured in 3 (3.4%) women with no anemia and in 3 (12%) women with mild anemia and 1 (6.3%) with moderate anemia. Total iron binding capacity was not measured for any patient. Among 227 women seen in the second trimester, ferritin was tested in 3 (2.9%) of women who had no anemia, 1 (1.33%) for mild, 7 (14.3%) for moderate, and 1(100%) for severe. Serum iron was measured in 1 (9.98%) for women who had no anemia, 1(1.33 %) with mild anemia, 5(10.2 %) with moderate anemia, and 1(100%) with severe anemia. Among 235 women seen in the third trimester, ferritin was tested in 5 (4.4 %) women who had no anemia, 4 (5.9 %) with mild anemia, 6 (11.3 %) with moderate anemia, and 1 (100%) with severe anemia. Serum iron was measured in 1 (0.8%) woman who had no anemia, 2 (2.9 %) with mild anemia, 5(9.4 %) with moderate anemia, and 1(100%) with severe anemia.
Table.4. Average hemoglobin and serum ferritin levels of participants by trimesters
|
Hemoglobin: mean (SD) (n,%)
|
Serum ferritin: median (lower quartile-upper quartile
|
First trimester
|
11.50(1.14)
|
9.90(4.07-23.05)
|
Second trimester
|
10.81(1.16)
|
10.07(3.78-20.82)
|
Third trimester
|
10.81(1.2)
|
10.40( 4.9-16.1)
|
Overall
|
11.04 (1.03)
|
10.14(5.42-18.24)
|
P value
|
0.084
|
0.645
|
Table.4. showed there are no differences in hemoglobin and ferritin levels of participants by trimesters, where P –value > 0.05.
Table.5. Ferritin levels among pregnant women according to the trimester. (n=336)
Level of ferritin
|
<15
|
15-30
|
>30
|
Not measured
|
First trimester (n,%)
|
9(2.67)
|
2(0.59)
|
1(0.3)
|
324(96.4)
|
Second trimester (n,%)
|
8 (2.83)
|
2(0.59)
|
2(0.59)
|
324(96.4)
|
Third trimester (n,%)
|
10(2.97)
|
3(0.89)
|
2(0.59)
|
321(95.5)
|
Overall (n,%)
|
27(2.67)
|
7(0.69)
|
5(0.50)
|
969( 96.13)
|
Ferritin was rarely measured in our cohort, with less than 5% of women having ferritin measured in any trimester (Table 5). When Ferritin was measured, most women had levels below 15 ng/ml.
Table.6. Comparing ferritin results among women with and without anemia according to trimester
Third trimester
|
Second trimester
|
First trimester
|
|
Among those without anemia113
|
Among those with anemia,122
|
Among those without anemia,102
|
Among those with anemia,125
|
Among those without anemia,88
|
Among those with anemia,41
|
|
5(4.4)
|
10(8.2)
|
3 (2.9)
|
9(7.2)
|
4 (4.5%)
|
8 (19.5)
|
Ferritin testing performed, %
|
5,
12
(6.20- 158.80)
|
10,
8.46
(1.60-311)
|
3,
13.20
(9.57-87.40)
|
9
6.80
(2.84- 31)
|
4
19.90
(10.50-28.40)
|
8
5.50
(1.60-46.17)
|
Ferritin, μg/l n
median [minimum– maximum]
|
The pattern of physicians not screening for iron deficiency did not improve as pregnancies progressed. Screening practices and screening results are summarized in Table 6 and supplementary materials.
When charts were reviewed for management of pregnant women with anemia, it was noted that almost all patients were prescribed oral iron: 41/41 (100%) in the first trimester, 124/125 (99.2%) in the second trimester, and 121/122 (99.2%) in the third trimester. IV iron was also prescribed in 6/41 (14.6%) in the first trimester, 12/125 (9.6%) in the second trimester, and 16/122 (13.1%) in the third trimester. Blood transfusion was given to 2 patients with severe anemia in the third trimester.