Abstract
ObjectivesThe aim of this study was to examine the relationships between psychological and social factors and late pregnancy IDA among pregnant women in rural Viet Nam.MethodsPregnant women from 50 randomly-selected communes within Ha Nam province were recruited and assessed at 12 - 20 weeks gestation (Wave 1, W1). They were followed up in the last trimester (Wave 2, W2). IDA was defined as Haemoglobin < 11 g/dL and serum ferritin < 15 ng/mL. Symptoms of Common Mental Disorders (CMD) were assessed by the Edinburgh Postnatal Depression Scale-Vietnam (EPDS-V). Persistent antenatal CMD was defined as having an EPDS-V score ≥ 4 in both W1 and W2. Hypothesis models were tested by Structural Equation Modeling analyses.ResultsA total of 378 women provided complete data at both W1 and W2. The incidence risk of IDA in the third trimester was 13.2% (95% confidence interval (CI): 9.8-16.7). Persistent CMD was found in 16.9% (95% CI: 13.1-20.7) pregnant women and predicted by intimate partner violence, fear of other family members, experience of childhood abuse, coincidental life adversity, and having a preference for the sex of the baby. There was a significant pathway from persistent CMD to IDA in late pregnancy via the length of time that iron supplements had been taken. Receiving advice to take iron supplements and higher household wealth index were indirectly related to lower risk of late pregnancy IDA. Early pregnancy IDA and being multi-parous also contributed to late pregnancy IDA.ConclusionsAntenatal IDA and CMD are prevalent public health problems among women in Viet Nam. The link between them suggests that while direct recommendations to use iron supplements are important, the social factors associated with common mental disorders should be addressed in antenatal care in order to improve the health of pregnant women and their infants.
Highlights
Antenatal iron deficiency anaemia (IDA) can cause adverse perinatal outcomes, including increased risk of pregnancyrelated death and preterm birth in the mother and low birthweight, and delayed cognitive development in the child [1]
In Viet Nam, a lower-middle income country, we have shown that pregnant women with common mental disorder (CMD) are less likely to take antenatal iron supplements [17] or use iodised salt [18]
There were no significant differences between women who did or did not provide complete data in terms of sociodemographic and reproductive characteristics, exposure to gender-based violence (Table 1), IDA at W1 (2.4 vs. 2.5, p=0.9) and CMD at either W1 (38.9% vs. 48.7%, p=0.16) or W2 (28.0 vs. 29.3, p=0.87)
Summary
Antenatal iron deficiency anaemia (IDA) can cause adverse perinatal outcomes, including increased risk of pregnancyrelated death and preterm birth in the mother and low birthweight, and delayed cognitive development in the child [1]. Despite remarkable achievements worldwide in the promotion of universal antenatal iron supplementation, the prevalence of IDA among pregnant women remains high and of serious concern in low and lower-middle-income countries [1,3] This has been attributed to several factors including poor compliance with the daily recommended supplementation regime [4,5,6,7]. The potential mechanisms of this effect are not well understood, but it is hypothesized that IDA alters myelination and neurotransmitter metabolism and function, which in turn contributes to depressive symptoms including fatigue, irritability, apathy, and an inability to concentrate [13,14] The possibility that these two conditions are reciprocally related or that the relationship acts in both directions has not been considered to date
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