DOI: https://dx.doi.org/10.18203/2349-3933.ijam20222661
Published: 2022-10-26

Prevalence of iron deficiency anemia in pregnancy and its therapeutic response to treatment: a retrospective audit in a tertiary hospital

Mooi Zhen Jack, Tan Jia Hui, Nurul Alya Binti Che Ariffin, Ooi Shie Mun, Kavitha Nagandla, Nazimah Idris

Abstract


 

Background: Iron deficiency anemia is the commonest type of nutritional anemia seen during pregnancy. Despite implementing oral iron prophylaxis in pregnancy, IDA in pregnant women constitute a major health problem. The present study aims to look at the prevalence of IDA in a pregnant population in Seremban, Malaysia and their response to treatment.

Methods: This is a retrospective study looking into the prevalence of iron deficiency anaemia among pregnant women who delivered between October 2019 to March 2020 in a state hospital in Seremban, Malaysia and their response to treatment. Main outcome measures were the prevalence of iron deficiency anaemia, associated demographic and clinical factors and response to iron therapy.

Results: About 920 patients’ records were included for analysis. The prevalence of anaemia in this cohort was 42.8% (N=394).  The prevalence of iron deficiency anemia (IDA) was 31.5% (N=124) among the anemic patients or 13.5% of the studied population. The mean hemoglobin level for this group was 10.0±0.74 g/dl (6.8-10.9 g/dl) and majority had mild anemia (91.9%, N=114). 68.5% IDA patients were successfully treated by 36 weeks pregnancy. Of the remaining 39 patients who were still anemic, 37 (94.9%) had mild anemia with mean hemoglobin level of 10.3g/dl (SD 0.48, range 9.0-10.9 g/dl).

Conclusion: Current treatment strategy is inadequate to achieve the set national target. There is a role for an early recourse to parenteral iron therapy to improve treatment outcome. 


Keywords


Iron deficiency Anemia, Pregnancy, Prevalence, Treatment outcomes

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References


Bothwell TH. Iron requirements in pregnancy and strategies to meet them. Am J Clin Nutr. 2000; 72(l):257S-64S.

Mahdy ZA, Jumaida AB, Muhammad Za’im SH, Rahana AR, Mukudan K, Zaleha MI. Antenatal iron deficiency in an urban Malaysian Population. Med Health. 2017;12(1):27-33.

Scholl TO. Iron status during pregnancy: setting the stage for mother and infant. Am J Clin Nutr. 2005; 81(5):1218S-22.

Goonewardene M, Shehata M, Hamad A. Anaemia in pregnancy. Best Pract Res Clin Obstet Gynaecol. 2012;26(1):3-24.

Chai ZF, Gan WY, Chin YS, Ching YK, Appukutty M. Factors associated with anemia among female adult vegetarians in Malaysia. Nutr Res Pract. 2019; 13:23-31.

Jamaiyah H, Anita D, Lim TO, Chen WS, Noraihan MN, Sanjay R, et al. Anemia in pregnancy in Malaysia: A cross-sectional survey. Asia Pac J Clin Nutr. 2007;16(3):527-36.

Tan AC, Leong EW, Chua AC, Moy FM. Racial variations in booking haemoglobin of primigravidae in Malaysia: a prospective study. BMC Res Notes. 2013;6:173.

Milman N. Iron deficiency and anaemia in pregnant women in Malaysia-still a significant and challenging health problem. J Preg Child Health. 2015;2:168-76.

Pavord S, Myers B, Robinson S, Allard S, Strong J, Oppenheimer C. UK guidelines on the management of iron deficiency in pregnancy. Br Haematol. 2011;23:13-9.

Allen JD. Intravenous versus oral iron for treatment of anemia in pregnancy: a randomized trial. Obstet Gynecol. 2006;107(3):742.

Api O, Breyman C, Çetiner M, Demir C, Ecder T. Diagnosis and treatment of iron deficiency anemia during pregnancy and the postpartum period: Iron deficiency anemia working group consensus report. Turk J Obstet Gynecol. 2015;12(3):173-81.

Chai ZF, Gan WY, Chin YS, Ching YK, Appukutty M. Factors associated with anemia among female adult vegetarians in Malaysia. Nutr Res Pract. 2019; 13:23-31.

Foo LH, Khor GL, Tee ES, Prabakaran D. Iron status and dietary iron intake of adolescents from a rural community in Sabah, Malaysia. Asia Pacific J Clin Nutr. 2004;13:48-55.

Dorsamy V, Bagwandeen C, Moodley J. The prevalence, risk factors and outcomes of anaemia in South African pregnant women: a systematic review and meta-analysis. Syst Rev. 2022;16:11-9.

Foo LH, Khor GL, Tee ES, Dhanaraj P. Determinants of iron status in Malaysian adolescents from a rural community. Int J Food Sci Nutr. 2004; 55:517-25.

Kassa GM, Muche AA, Berhe AK, Fekadu GA. Prevalence and determinants of anaemia among pregnant women in Ethiopia; A systematic review and meta-analysis. BMC Haematol. 2017;17:17-23.

Goh Th, Hariharan M. Iron deficiency anemia and serum ferritin levels in Malaysia women. Med J Malaysia. 1986;41(4):300-4.

Rijken MJ. Quantifying low birth weight, preterm birth and small for gestational age effects of malaria in pregnancy: a population cohort study. PLoS One. 2014;9:1-8.

Beard JL, Hendricks MK, Perez EM, Murray-Kolb LE, Berg A, et al. Maternal iron deficiency anaemia affects postpartum emotions and cognition. J Nutr. 2005;135:267-72.

Birgegård G, Schneider K, Ulfberg J. High incidence of iron depletion and restless leg syndrome (RLS) in regular blood donors: intravenous iron sucrose substitution more effective than oral iron. Vox Sang. 2010;99(4):354-61.

Congdon EL, Westerlund A, Algarin CR, Peirano PD, Gregas M, et al. Iron deficiency in infancy is associated with altered neural correlates of recognition memory at 10 years. J Pediatr. 2012;160: 1027-33.

Hamid Jan JM Jr, Amal KM, Rohani A, Norimah AK. Association of Iron Deficiency with or without Anaemia and Cognitive Functions among Primary School Children in Malaysia. Malays J Nutr. 2010; 16:261-70.

Nik Rosmawati N, Mohd Nazri S, Mohd II. The rate and risk factors for anemia among pregnant mothers in Jerteh Terengganu, Malaysia. J Community Med Health Educ. 2012;2(150):2161-71.

Hassan R, Abdullah WZ, Hussain NHN. Anemia and iron status of Malay women attending an antenatal clinic in Kubang Kerian, Kelantan, Malaysia. Southeast Asian J Trop Med Public Health. 2005;36:1304-7.

Thirukkanesh S, Zahara AM. Compliance to vitamin and mineral supplementation among pregnant women in urban and rural areas in Malaysia. Pac J Nutr. 2010;9:744-50.

Reveiz L, Gyte GM, Cuervo LG. Treatments for iron-deficiency anaemia in pregnancy. Cochrane Database Syst Rev. 2007.

Bayoumeu F, Subiran-Buisset C, Baka NE, Legagneur H, Monnier-Barbarino P, Laxenaire MC. Iron therapy in iron deficiency anemia in pregnancy: intravenous route versus oral route. Am J Obstet Gynecol 2002;186:518-22.

Silverstein SB, Rodgers GM. Parenteral iron therapy options. Am J Hematol. 2004;76:74-8.

Sharma JB, Jain S. A prospective, partially randomized study of pregnancy outcomes and hematologic responses to oral and intramuscular iron treatment in moderately anemic pregnant women. Am J Clin Nutr. 2004;79:116-22.

Khalafallah AA, Dennis AE, Ogden K, Robertson I, Charlton RH, Bellette JM, et al. Three-year follow-up of a randomised clinical trial of intravenous versus oral iron for anaemia in pregnancy. BMJ Open. 2012;2(5):e000998.

Shi H, Chen L, Wang Y. Severity of anemia during pregnancy and adverse maternal and fetal outcomes. JAMA Netw Open. 2022;5(2):e2147046.