Abstract
In Sri Lanka, the prevalence of anaemia in pregnancy was estimated to be approximately 29% in 2001 but is estimated to have significantly reduced to be < 20%, at least in certain areas, during the last decade. Among its many causes, nutritional iron deficiency anaemia (IDA) is the commonest, but establishing a definitive diagnosis is difficult. Strategies adopted globally, as well as in Sri Lanka, to prevent IDA in pregnancy, have changed significantly during the last three decades. A comprehensive literature review was carried out and inter alia three relevant World Health Organization Guidelines, in which the author was a member of the guideline development group and six other publications of the author, on the topic of iron deficiency (ID) and IDA in pregnancy are included in this review. Ten studies on the detection and prevention of ID and IDA in pregnancy, carried out from 1990 to 2017 at the Academic Obstetrics and Gynaecology Unit (AOGU) of the Teaching Hospital Mahamodera, Galle (THMG) are described. The results and conclusions of these studies were: poor compliance and unsatisfactory methods of ingestion of the antenatal oral iron supplement could have contributed to the high rates of ID and IDA at term during the period 1990 to 1992; haematological indices during pregnancy need to be interpreted with caution; although the agreement between haematological indices obtained from different laboratories in Galle in 2000 was unsatisfactory, better agreement was observed in 2015; the rates of ID and IDA in pregnant women presenting for antenatal care to the AOGU of the THMG have significantly decreased from approximately 69% and 44% respectively in 1990 to approximately 37% and 17% respectively in 2015. Therefore, weekly antenatal oral iron supplements should be adequate to improve birth outcomes in the non-anaemic women attending this clinic.
Highlights
Anaemia in pregnancy, defined as a haemoglobin concentration (Hb) < 110 g /L, is a significant public health problem globally [1]
The aim of this review is to describe the difficulties in establishing a diagnosis of iron deficiency anaemia (IDA) and iron deficiency (ID) in pregnancy, and the significant changes in the rates of IDA and ID
Ten studies on the detection and prevention of ID and IDA in pregnancy, carried out from 1990 to 2017 at the AOGU of the THMG are described. The objectives of these were to: describe the rates of ID and IDA in women presenting for antenatal care in 1990 and compare with the same in 2015 ( 24.25); describe the effectiveness of the antenatal oral iron supplementation programme in 1992 [26]; measure the agreement between haematological indices obtained by different laboratories in 2000 [27] and compare with the same in 2015 [28]; assess the validity of commonly used haematological indices [29]; describe the effectiveness of intermittent antenatal oral iron supplementation between 1994 to 1996 [30,31,32] and compare it with the same in 2015/2016 [33]
Summary
Anaemia in pregnancy, defined as a haemoglobin concentration (Hb) < 110 g /L, is a significant public health problem globally [1]. Its prevalence in Sri Lanka was estimated to be approximately 29% in 2001(2) and 34% in 2007 [3]. In 2009, using a small sample of 228 pregnant women, the prevalence of anaemia during pregnancy was estimated to be approximately 17% in Sri Lanka, Galle Medical Journal, Vol 26: No 3, September 2021 ranging from approximately 7% in Kurunegala to 29% in the Colombo Municipality [4]. Routine daily antenatal oral iron supplementation programmes have been implemented in low income countries for several decades, their effectiveness in preventing IDA at term has been shown to be suboptimal, and its safety, especially in areas where Malaria is prevalent, has been questioned [14]. Sri Lanka has been declared “Malaria Free” by the World Health Organization (WHO) in 2016 [15], routine daily antenatal oral iron supplementation would probably be beneficial only in pregnant women with ID [16, 17]. Such a programme could be appropriate at least in certain areas of Sri Lanka, no such programme has been implemented in any area in Sri Lanka up to date
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