Abstract
BackgroundAnemia in pregnancy may not only be associated with maternal morbidity and mortality but can also be detrimental to the fetus. A definitive diagnosis of anemia is a pre-requisite to unravelling possible cause(s), to allow appropriate treatment intervention. It is hypothesised that measured hemoglobin (HGB), complemented by biochemical and other hematological parameters would enhance anemia diagnosis.MethodsThis was a cross-sectional study among 400 pregnant women comprising 253 anemic and 147 non-anemic pregnant women, attending an antenatal clinic at Bolgatanga Regional Hospital, Ghana. Venous blood was collected and hemoglobin genotype, complete blood count and biochemical parameters [ferritin, iron, total iron binding capacity (TIBC), transferrin saturation (TfS), C-reactive protein (CRP) and bilirubin] were determined. Thick blood films were prepared for malaria parasitemia, while early morning stool and midstream urine samples were examined for enteric and urogenital parasites, respectively.ResultsThere were significantly reduced levels of HGB (p < 0.0001), HCT (p < 0.0001), MCV (p < 0.0001), iron (0.0273), ferritin (p = 0.018) and transferrin saturation (0.0391) and increased WBC (p = 0.006), RDW (p = 0.0480), TIBC (p = 0.0438) and positivity of CRP in anemic, compared to non-anemic pregnant women. Anemic women were associated with increased proportion of hemoglobinopathies (AS, SS and SC), Plasmodium falciparum, Schistosoma hematobium and intestinal parasite infections.ConclusionAnemic pregnant women are associated with a significant derangement in hematological and iron indices that implicate iron deficiency. This was influenced by hemoglobinopathies and parasitic infections.
Highlights
Anemia in pregnancy may be associated with maternal morbidity and mortality but can be detrimental to the fetus
About 2 drops (6 μl) of blood were collected on a slide for the preparation of thick blood film to detect the presence of malaria parasites, according to the protocol described by Ahenkorah et al [21]
A higher proportion of anemic pregnant women had Mean Corpuscular Volume (MCV) < 80 fl (16.9% vs 5.4%; p = 0.0115), Red Cell Distribution Width (RDW) > 15.0% (15.0% vs. 3.4%; p = 0.0052), serum iron < 40 μg/dl (18.6% vs. 6.1%; p = 0.0092), ferritin < 12 ng/ml (16.2% vs. 6.1%; p = 0.0400) and total iron binding capacity (TIBC)> 500 μg/dl (15.4% vs. 3.4%; p = 0.0015), compared to non-anemic pregnant women
Summary
Anemia in pregnancy may be associated with maternal morbidity and mortality but can be detrimental to the fetus. It is hypothesised that measured hemoglobin (HGB), complemented by biochemical and other hematological parameters would enhance anemia diagnosis. Anemia is the most prevalent nutritional deficiency problem during pregnancy. Iron deficiency anemia is the leading cause of anemia in most developing countries [1]. In Ghana, anemia has been attributed to poor bioavailability of iron in the diet, which is due to the low intake of foods that enhance absorption of iron [4,5,6]. There is disproportionate increase in the plasma volume, relative erythrocyte number, leading to a fall in hemoglobin concentration [7]. Intestinal iron absorption increases during pregnancy but becomes poor in cases of associated parasitic infectious diseases, such as hookworm and roundworm infestations [9]
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