Abstract
BackgroundAnaemia is associated with maternal and perinatal morbidity and mortality. The pooled prevalence of anaemia in the South African (SA) pregnant population was ascertained by systematically reviewing available literature. Severity, risk factors (HIV, tuberculosis, race, province, year of study), maternal morbidity and mortality (hypertensive disorders of pregnancy), birth outcomes (including low birth weight) and supplementation during pregnancy were also described.MethodsEligible studies reported on haemoglobin concentration or prevalence of anaemia in a SA pregnant population and were available in full text. Case-control and estimation studies were excluded with no restriction on the date of publication. PubMed, CINAHL, EMBASE, EBSCO, Ovid maternity and infant care databases, Cochrane Database of Systematic Reviews, Web of Science and SCOPUS were searched, using the keywords ‘anaemia’, ’haemoglobin’, ‘pregnancy’, ‘South Africa’. Risk of bias was conducted using the Hoy tool and the Doi plot and LFK ratio. Overall study quality was assessed using the GRADE tool. Due to heterogeneity amongst studies subgroup analyses were performed (random effects and quality effects model) using MetaXL addon tool for Microsoft Excel.ResultsThe initial search yielded 7010 articles and 26 were selected for inclusion. Twenty studies were cross-sectional, three were longitudinal and one a randomised control trial. Studies ranged in publication year from 1969 to 2020. The pooled prevalence of anaemia in pregnant women in SA was determined to be 31% (95% CI, 23–40%). Hypertensive disorders of pregnancy and low birth weight were associated with anaemia. While iron deficiency was reported as the main cause, other risk factors included HIV and other infections.DiscussionLimitationsThere was limited data reporting on prevalence of anaemia and direct maternal and foetal outcomes. Heterogeneity amongst studies was not explained by subgroup analysis. Majority of cross-sectional study designs reduced the ability to infer causality.InterpretationWhile the prevalence of anaemia remains high and of concern, risk factors are varied. Iron deficiency is still common but the presence of comorbidities also contributes to anaemia and should not be ignored. More longitudinal research into associations between anaemia and birth outcomes is needed due to a lack of available evidence.Systematic review registrationPROSPERO 2020: CRD42020157191.
Highlights
Anaemia is associated with maternal and perinatal morbidity and mortality
Hypertensive disorders of pregnancy and low birth weight were associated with anaemia
The association of anaemia in patients with TB [66, 67]: we found only one study that reported on TB as a mediator of anaemia status, with a high prevalence of 70% in the pregnant population [61]
Summary
Anaemia is associated with maternal and perinatal morbidity and mortality. The pooled prevalence of anaemia in the South African (SA) pregnant population was ascertained by systematically reviewing available literature. Risk factors (HIV, tuberculosis, race, province, year of study), maternal morbidity and mortality (hypertensive disorders of pregnancy), birth outcomes (including low birth weight) and supplementation during pregnancy were described. Iron deficiency anaemia is the commonest type Vulnerable population groups such as pre-school children and women of reproductive age are most affected [3]. Pregnant women who need to accommodate the haemodynamic demands of pregnancy may be at higher risk for anaemia, which is increased by exposure to synergistic inflammatory and infective conditions. This can lead to complications for both mother and baby, such as spontaneous abortion, preterm delivery, low birth weight and/or developmental delay in infants, with increased mortality in severe cases [4, 5]. Future pregnancies are worse affected [6, 7]
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