Iron Deficiency Anemia ( IDA ) in Pregnant Women of Different Ages in Swat District , Khyber Pakhtunkhwa Pakistan

The aim of this study was to find out the incidence of anemia in pregnant women of Swat District; to analyze the iron variations and its dietary effects.Data were collected during the periods of January – September 2016. The study of samples comprised of 250 pregnant women in the different trimester. Blood sample from each woman was collected and full blood count (FBC) was conducted through Mindray BC-3000 plus hem analyzer for all pregnant individuals. Confirmed anemic cases were then examined for IDA with serum ferritin, serum iron, total iron binding capacity (TIBC) through Randox kit and serum transferrin saturation was estimated by formula (serum ferritin saturation =serum iron ×100/TIBC). The total number of participants in the first trimester were 50, among them 26 women were suffer from iron deficiency anemia (IDA) with 52% weightage of prevalence rate, (mean Hb concentration 9.602 ± 0.87 g/dl). The rates of IDA were 63.3%; ( mean Hb concentration 8.48 ± 1.24 g/dl) and 54%; ( mean Hb concentration 9.18 ± 1.28 g/dl), among 150 and 50 participants in the second and third trimester, respectively. A significant correlation was found between serum ferritin and Hb, serum ferritin against MCV and serum ferritin against MCH. The high prevalence of anemia was found 78.2% in the age group from 26-30 followed by 78.2% in the age group 36-40 years compared to those of other age groups in the second trimester. In this study the prevalence of IDA in third trimester is lower compared to first and second trimester. Preprints (www.preprints.org) | NOT PEER-REVIEWED | Posted: 27 January 2017 doi:10.20944/preprints201701.0126.v1


Introduction
Iron is a vital constituent of blood hemoglobin, which carries oxygen from the respiratory organ to the rest of the body.Iron is essential for the normal biological activities, including DNA synthesis, respiration, and cell division [1].Hemoglobin below 11 g/dL during pregnancy is considered abnormal and anemia can be observed due to iron deficiency (ID) [2].ID is the most globally nutritional problem and is considered at epidemic level in many developing countries [3].About 50% of ID cases are reported due to the insufficient iron uptake during pregnancy [4].Due to fetal growth, need for iron supplementation rises in the second and third period.To meet this increased iron demand fascination in the gut is not adequate.Therefore, iron equilibrium depends on parental iron stocks throughout these stages [5].The incidence of anemia in developed countries is 9% compared to 43% in developing countries [6].Anemia in early prenatal period has been related with adverse pregnancy outcomes [7].Most common symptoms of iron deficiency anemia (IDA) are fatigue, fainting and difficulty in breathing [4].Anemia is usually noticed in teenager mothers due to their unplanned pregnancies and the suboptimal nutrition status [8].Infant and young children suffer from anemia are at high risk of developmental abnormalities like cognitive, social emotional and adoptive functions [9].Prevalence of anemia is higher in those pregnant women who belong to low socioeconomic status in many parts of the world [10].While the other group of women is teenager mothers who face high risk to their health and realize greater nutritional requirements [11].The current study described, that nutritional deficiencies at beginning and throughout the primary prenatal period may impact the result of the pregnancy.Moreover, pregnancy at teenage must need the required diet for mother health in addition to the nutritional desires during gestation.In addition, women belong to low income families are commonly at more risk due to insufficient intake of balanced food.
The main cause of anemia is heavy bleeding during menstrual cycle and its effect is found in 9-14% women [12] During pregnancy the increase in demand of iron occurs which leads to, increase in iron binding capacity and serum transferrin level rises [13].

Study area
The study was conducted in Swat District, Khyber Pakhtunkhwa (K P), Pakistan.
Two maternity health clinics, Sabeel Surgical and Maternity Home (the study clinic), Shifa hospital (the control clinic) in the Saidu Sharif Swat were selected for data collection in this study.

Study Population
The study contributors were mainly pregnant women.All women at pregnancy were registered for antenatal health care at the maternal health Centre within the study periods for better counseling served as the study population.

Data collection
Two hundred and fifty clinically positive pregnancy cases from age 16 to 45 years nominated from the Swat District.Complete history collected from each patient were analyze in this study.

Sampling method
The study of samples comprised of 250 pregnant women in the all trimester (Total 250 cases; out of which 50 are in the 1 st trimester, 150 in 2 nd trimester and 50 cases are in the 3 rd trimesters) classified in to different age groups.Data were collected during the period since Jan to Sep, 2016.

Blood test
Blood sample from each woman was collected and full blood count (FBC) was conducted through Mindray BC-3000 plus hem analyzer for all pregnant individuals.Confirmed anemic individual were then examined for IDA with serum ferritin, serum iron, total iron binding capacity (TIBC) through Randox kit and serum transferrin saturation was estimated by formula (serum ferritin saturation =serum iron ×100/TIBC).

Statistical analysis
All experimental results were examined by statistical package for social sciences (SPSS) software database.Observations were considered statistically significant at P< 0.05).Scatter plots were also constructed for the serum ferritin against Hb, serum ferritin against MCV and serum ferritin against MCH.

Ethical considerations
To conduct this study, permission was taken from the MS of Sabeel Surgical and Maternity Home Swat.All patients were informed that data will be used for investigation purposes.

Result
Data shown in (

4.Discussion
In this study, we described that imbalance diet and lack of iron supplementation in pregnancy or in daily routine life develops the risk of IDA.High incidence rates of IDA with 75, 72, and 71% in different trimesters (1 st , 2 nd and 3 rd ); in 16-20 age group indicated the poor diet quality of pregnant women living in Swat District.The higher rank of anemia is found in developing world where its factors are numerous [14].Pregnant women using Iron supplementations seem to be more protective from severe IDA.In our study the highest prevalence of the anemia was found, 75% in age group of 16-20 years in the first trimester reflected the lack of regular medical checkup for young married women.Iron lost in fertile women is due to menstruation, breast feeding and pregnancy [15].Most of patients of 16-20 years old visited clinics after feeling sever fatigue and body pain were found pregnant.Similarly, the highest occurrences of anemia were found 78.2% in the age from 26-30 years followed by 78.2% in the age group 36-40 years compared to the other age groups in the second trimester.
The occurrences of microcytic, macrocytic and normocytic anemia are 80.2%, 14.9% and 4.9% in population of 250 pregnant women of different age group belongs to different region of Swat District.

Conclusion
In our study the prevalence of IDA in third trimester is lower as compared to the first and second trimester.The reason for decline in IDA might be frequent clinic consultations.In

Fig 1 Fig 2 Fig 3
Fig 1 Scatter plot of serum ferritin and Hb Pearson correlation P= 0.01

table 1
Differences in the incidence value amongst the different age groups in the second trimester were statistically significant (P = 0.00).Occurrence of IDA during third trimester, out of 50 participants 27 were found anemic which constitutes 54% of the sample size for the third trimester.The percent number of anemic patients in third trimester were,11.5, 10.3, 5.8, 9.2, ) represents the occurrence of IDA during first trimester in different age groups of studied population.Among 50 patients 26 were found anemic which constitutes 52% of the sample size.The proportion of anemic patients were found; 12.6, 9.3, 5, Table1shows percent anemic contributions in individual age group wise and total in population.

Table 2
Evaluation of pregnant women categorized by trimester of pregnancy with deference to Hb, serum ferritin, serum iron, TIBC, transferrin saturation, MCV and MCH.

Table 3
Classification of IDA severity in studied populationSeverity of IDA was classified into severe and moderate groups on the basis of serum ferritin level.The patients suffered from moderate IDA were 61.5, while 38.5% were found with severe level (Table4).