Iron deficiency anemia in adolescent pregnancy: investigation of its effects and the related factors
Abstract
Introduction: Adolescent
pregnancies and their maternal and fetal complications are a global health
burden. Iron deficiency anemia is among the factors, which might contribute to
these negative consequences. In this study, we aimed to evaluate the frequency
of iron deficiency anemia among pregnant adolescents followed at the Düzce
University Medical Faculty Hospital and to investigate its maternal and fetal
effects.
Methods: A total
of 122 pregnant women under 19 years of age were included in this case-control
study. The socio-economic characteristics, hematological status, and adverse
maternal and perinatal outcomes possibly related to iron deficiency anemia were
evaluated.
Results: The incidence of anemia among the studied women was 29.5%, and 56.5%
were receiving iron supplementation. Oral iron supplementation rate was 33.3%
in the anemic group and 66.2% in the non-anemic group (p = 0.01). While the
serum ferritin and hemoglobin levels were lower in the anemic group, iron
binding capacity was lower in the non-anemic group, and the difference between
the groups was statistically significant (p = 0.01, p = 0.01, and p = 0.02;
respectively). Concerning adverse perinatal outcomes, preeclampsia was seen in
11.4% of the anemic group and 4.6% in the non-anemic group; the difference was
statistically significant (p = 0.01).
Conclusions: Iron deficiency anemia is a common problem in adolescent pregnancy.
However, many anemic pregnant adolescents do not receive iron treatment.
Positive effects on some maternal and perinatal outcomes can be achieved by
administering iron supplementation to these women. Iron use should be increased
to combat iron deficiency anemia during pregnancy.
Keywords
References
- Goonewardene M, Shehata M, Hamad A. Anemia in pregnancy. Best Pract Res Clin Obstet Gynaecol. 2012;26:3-24. doi: https://doi.org/10.1016/j.bpobgyn.2011.10.010
- McLean E, Cogswell M, Egli I, Wojdyla D, De Benoist B. Worldwide prevalence of anaemia, WHO Vitamin and Mineral Nutrition Information System, 1993–2005. Public Health Nutr. 2009; 12: 444-54. doi: https://doi.org/10.1017/S1368980008002401
- Clark SF. Iron deficiency anemia. Nutr Clin Pract 2008;23:128–41. doi: https://doi.org/10.1177/0884533608314536
- Scholl TO. Maternal iron status: relation to fetal growth, length of gestation, and iron endowment of the neonate. Nutr Rev 2011; 69: 23–9. doi: https://doi.org/10.1111/j.1753-4887.2011.00429
- Balarajan Y, Ramakrishnan U, Ozaltin E, et al. Anaemia in low income and middle-income countries. Lancet 2011;378:2123–35. doi: https://doi.org/10.1016/S0140-6736(10)62304-5
- de Sa SA, Willner E, Duraes Pereira TA, et al. Anemia in pregnancy: impact on weight and in the development of anemia in newborn. Nutr Hosp 2015;32:2071–9. doi: https://doi.org/10.3305/nh.2015.32.5.9186
- Kozuki N, Lee AC, Katz J, Child Health Epidemiology Reference Group. Moderate to severe, but not mild, maternal anemia is associated with increased risk of small-for-gestational-age outcomes. J Nutr. 2012;142:358–62. doi: https://doi.org/10.3945/jn.111.149237
- Sekhar DL, Murray-Kolb LE, Kunselman AR, et al. Differences in risk factors for anemia between adolescent and adult women. J Womens Health (Larchmt) 2016;25:505–13. doi: https://doi..org/10.1089/jwh.2015.5449
- WHO. Iron deficiency anaemia: assessment, prevention, and control: a guide for programme managers. Geneva: United Nations Children’s Fund, and United Nations University (WHO/UNICEF/UNU); 2001.
- WHO. Serum ferritin concentrations for the assessment of iron status and iron deficiency in populations. Vitamin and mineral nutrition information system. Geneva (Switzerland): World Health Organization; 2011
- World Health Organization. Definition, Diagnosis and Classification of Diabetes Mellitus and its Complications: Report of a WHO Consultation Part 1: Diagnosis and Classification of Diabetes Mellitus.2nd ed. Geneva, Switzerland: World Health Organization; 1999. (WHO/NCD/NCS/99).
- Gardosi J, Mongelli M, Wilcox M, Chang A. An adjustable Fetal Weight Standard. Ultrasound Obstet Gynecol 1995;6:168–74. WHO. The global prevalence of anaemia in 2011. Geneva: World Health Organization; 2015.
- Milman N, Taylor CL, Merkel J, Brannon P. Iron status in pregnant women and women of reproductive age in Europe. American J Clin Nutr. 2017; 106:1655–62. doi: https://doi.org/10.3945/ajcn.117.156000
- Pinho-Pompeu M, Surita FG, Pastore DA, Paulino DSM, Pinto E Silva JL. Anemia in pregnant adolescents: impact of treatment on perinatal outcomes. J Matern Fetal Neonatal Med. 2017;30:1158-62. doi: https://doi.org/10.1080/14767058.2016.1205032
- van den Broek NR, Jean-Baptiste R, Neilson JP. Factors associated with preterm, early preterm and late preterm birth in Malawi. PLoS One 2014;9:e90128. doi: https://doi.org/10.1371/journal.pone.0090128
- Smithers LG, Gialamas A, Scheil W, et al. Anaemia of pregnancy, perinatal outcomes and children's developmental vulnerability: a whole-of-population study. Paediatr Perinat Epidemiol 2014; 28: 381–90. doi: https://doi.org/10.1111/ppe.12149
- Räisänen S, Kancherla V, Gissler M, et al. Adverse perinatal outcomes associated with moderate or severe maternal anaemia based on parity in Finland during 2006-10. Paediatr Perinat Epidemiol 2014;28:372–80. doi: https://doi.org/10.1111/ppe.12134
- Bencaiova G, Breymann C. Mild Anemia and Pregnancy Outcome in a Swiss Collective. Journal of Pregnancy. 2014;2014:307535. doi: https://doi.org/10.1155/2014/307535
- Gambling L, Kennedy C, McArdle HJ. Iron and copper in fetal development. Semin Cell Dev Biol. 2011; 22: 637–44. doi: https://doi.org/10.1016/j.semcdb.2011.08.011
- Chandra-Mouli V, Camacho AV, Michaud PA. WHO guidelines on preventing early pregnancy and poor reproductive outcomes among adolescents in developing countries. J Adolesc Health 2013;52:517–22. doi: https://doi.org/10.1016/j.jadohealth.2013.03.002
- Kaya A.E , Başbuğ A, Sönmez C.I, Barut C, Şengün Y , Çağlar M. Late Adolescent Pregnancies, Maternal and Fetal Outcomes. Family Practice & Palliative Care. 2017; 2: 22-27. doi: https://doi.org/10.22391/920.327993
- Mahavarkar SH, Madhu CK, Mule VD. A comparative study of teenage pregnancy. J Obstet Gynaecol 2008; 28: 604–7. doi: https://doi.org/10.1080/01443610802281831
- Pena-Rosas JP, De-Regil LM, Dowswell T, Viteri FE. Daily oral iron supplementation during pregnancy. Cochrane Database Syst Rev 2012; 12: CD004736. doi: https://doi.org/10.1002/14651858.CD004736
- Ziaei S, Norrozi M, Faghihzadeh S, Jafarbegloo E. A randomised placebo controlled trial to determine the effect of iron supplementation on pregnancy outcome in pregnant women with haemoglobin > or = 13.2 g/dl. BJOG 2007; 114:684–8. doi: https://doi.org/10.1111/j.1471-0528.2007.01325
- Shastri L, Mishra PE, Dwarkanath P, Thomas T, Duggan C, Bosch R, McDonald CM, Thomas A, Kurpad AV. Association of oral iron supplementation with birth outcomes in non-anaemic South Indian pregnant women. Eur J Clin Nutr 2015;69:609–13. doi: https://doi.org/10.1038/ejcn.2014.248
- Timur H, Kokanalı MK, Topçu HO, et al. Factors that affect perinatal outcomes of the second pregnancy of adolescents. J Pediatr Adolesc Gynecol 2016;29:18–21. doi: https://doi.org/10.1016/j.jpag.2015.05.002
Abstract
Giriş: Adölesan gebelikler ve bu gebeliklerde
görülen maternal ve fetal olumsuz sonuçlar küresel bir sağlık problemidir.
Demir eksikliği anemisi ise bu olumsuz sonuçlara neden olabilecek faktörler
arasında gösterilmektedir. Biz bu çalışma ile Düzce Üniversitesi Tıp Fakültesi
Hastanesinde takip edilmiş adölesan gebeler arasındaki demir eksikliği anemisi
sıklığını, bununla ilişikli olabilecek demografik ve sosyo-ekonomik özellikleri
ve adölesan gebeliklerde görülen demir eksikliği anemisinin maternal ve fetal
sonuçlar üzerine olan etkisini değerlendirmeyi amaçladık.
Yöntem: Retrospektif vaka-kontrol
niteliğindeki bu çalışmaya Düzce Üniversitesi Tıp Fakültesi Kadın Hastalıkları
ve Doğum Kliniğine başvuran 19 yaş altındaki toplam 122 gebe dahil edildi.
Gebelerin sosyo-ekonomik özellikleri, hematolojik durumları ve demir eksikliği
anemisi ile ilişkili olabilecek olumsuz maternal ve perinatal sonuçları
değerlendirildi.
Bulgular: Çalışmaya dahil edilen
kadınlar arasında anemi görülme oranı %29,5’di ve demir suplemantasyonu alan
kadın oranı %56,5’di. Anemik grupta oral demir suplemantasyon oranı %33,3 iken
non-anemik grupta %66,2 idi (p=0,01). Serum ferritin, hemoglobin değerleri
anemik grupta daha düşük iken, demir bağlama kapasitesi non-anemik grupta daha
düşüktü ve gruplar arasındaki fark istatistiksel olarak anlamlıydı (p=0,01,
p=0,01, p=0,02; sırasıyla). Olumsuz perinatal sonuçlar açısından yalnızca
preeklampsi; anemik grupta %11.4 oranında görülürken, non-anemik grupta %4,6
oranında görüldü. Gruplar arasındaki fark istatistiksel olarak anlamlıydı (p=0,01).
Sonuç: Adölesan gebelikte demir eksikliği anemisi sık karşılaşılan bir
sorundur. Buna rağmen birçok anemik adölesan gebe demir tedavisi
almamaktadır. Demir eksikliği anemisi,
demir suplemantasyonu ile tedavi edilirse bazı maternal ve perinatal sonuçlar
üzerine olumlu etkileri olabilir. Gebelikte demir eksikliği anemisi ile
mücadele için demir kullanımının yaygınlaştırılması gerekmektedir.
Keywords
References
- Goonewardene M, Shehata M, Hamad A. Anemia in pregnancy. Best Pract Res Clin Obstet Gynaecol. 2012;26:3-24. doi: https://doi.org/10.1016/j.bpobgyn.2011.10.010
- McLean E, Cogswell M, Egli I, Wojdyla D, De Benoist B. Worldwide prevalence of anaemia, WHO Vitamin and Mineral Nutrition Information System, 1993–2005. Public Health Nutr. 2009; 12: 444-54. doi: https://doi.org/10.1017/S1368980008002401
- Clark SF. Iron deficiency anemia. Nutr Clin Pract 2008;23:128–41. doi: https://doi.org/10.1177/0884533608314536
- Scholl TO. Maternal iron status: relation to fetal growth, length of gestation, and iron endowment of the neonate. Nutr Rev 2011; 69: 23–9. doi: https://doi.org/10.1111/j.1753-4887.2011.00429
- Balarajan Y, Ramakrishnan U, Ozaltin E, et al. Anaemia in low income and middle-income countries. Lancet 2011;378:2123–35. doi: https://doi.org/10.1016/S0140-6736(10)62304-5
- de Sa SA, Willner E, Duraes Pereira TA, et al. Anemia in pregnancy: impact on weight and in the development of anemia in newborn. Nutr Hosp 2015;32:2071–9. doi: https://doi.org/10.3305/nh.2015.32.5.9186
- Kozuki N, Lee AC, Katz J, Child Health Epidemiology Reference Group. Moderate to severe, but not mild, maternal anemia is associated with increased risk of small-for-gestational-age outcomes. J Nutr. 2012;142:358–62. doi: https://doi.org/10.3945/jn.111.149237
- Sekhar DL, Murray-Kolb LE, Kunselman AR, et al. Differences in risk factors for anemia between adolescent and adult women. J Womens Health (Larchmt) 2016;25:505–13. doi: https://doi..org/10.1089/jwh.2015.5449
- WHO. Iron deficiency anaemia: assessment, prevention, and control: a guide for programme managers. Geneva: United Nations Children’s Fund, and United Nations University (WHO/UNICEF/UNU); 2001.
- WHO. Serum ferritin concentrations for the assessment of iron status and iron deficiency in populations. Vitamin and mineral nutrition information system. Geneva (Switzerland): World Health Organization; 2011
- World Health Organization. Definition, Diagnosis and Classification of Diabetes Mellitus and its Complications: Report of a WHO Consultation Part 1: Diagnosis and Classification of Diabetes Mellitus.2nd ed. Geneva, Switzerland: World Health Organization; 1999. (WHO/NCD/NCS/99).
- Gardosi J, Mongelli M, Wilcox M, Chang A. An adjustable Fetal Weight Standard. Ultrasound Obstet Gynecol 1995;6:168–74. WHO. The global prevalence of anaemia in 2011. Geneva: World Health Organization; 2015.
- Milman N, Taylor CL, Merkel J, Brannon P. Iron status in pregnant women and women of reproductive age in Europe. American J Clin Nutr. 2017; 106:1655–62. doi: https://doi.org/10.3945/ajcn.117.156000
- Pinho-Pompeu M, Surita FG, Pastore DA, Paulino DSM, Pinto E Silva JL. Anemia in pregnant adolescents: impact of treatment on perinatal outcomes. J Matern Fetal Neonatal Med. 2017;30:1158-62. doi: https://doi.org/10.1080/14767058.2016.1205032
- van den Broek NR, Jean-Baptiste R, Neilson JP. Factors associated with preterm, early preterm and late preterm birth in Malawi. PLoS One 2014;9:e90128. doi: https://doi.org/10.1371/journal.pone.0090128
- Smithers LG, Gialamas A, Scheil W, et al. Anaemia of pregnancy, perinatal outcomes and children's developmental vulnerability: a whole-of-population study. Paediatr Perinat Epidemiol 2014; 28: 381–90. doi: https://doi.org/10.1111/ppe.12149
- Räisänen S, Kancherla V, Gissler M, et al. Adverse perinatal outcomes associated with moderate or severe maternal anaemia based on parity in Finland during 2006-10. Paediatr Perinat Epidemiol 2014;28:372–80. doi: https://doi.org/10.1111/ppe.12134
- Bencaiova G, Breymann C. Mild Anemia and Pregnancy Outcome in a Swiss Collective. Journal of Pregnancy. 2014;2014:307535. doi: https://doi.org/10.1155/2014/307535
- Gambling L, Kennedy C, McArdle HJ. Iron and copper in fetal development. Semin Cell Dev Biol. 2011; 22: 637–44. doi: https://doi.org/10.1016/j.semcdb.2011.08.011
- Chandra-Mouli V, Camacho AV, Michaud PA. WHO guidelines on preventing early pregnancy and poor reproductive outcomes among adolescents in developing countries. J Adolesc Health 2013;52:517–22. doi: https://doi.org/10.1016/j.jadohealth.2013.03.002
- Kaya A.E , Başbuğ A, Sönmez C.I, Barut C, Şengün Y , Çağlar M. Late Adolescent Pregnancies, Maternal and Fetal Outcomes. Family Practice & Palliative Care. 2017; 2: 22-27. doi: https://doi.org/10.22391/920.327993
- Mahavarkar SH, Madhu CK, Mule VD. A comparative study of teenage pregnancy. J Obstet Gynaecol 2008; 28: 604–7. doi: https://doi.org/10.1080/01443610802281831
- Pena-Rosas JP, De-Regil LM, Dowswell T, Viteri FE. Daily oral iron supplementation during pregnancy. Cochrane Database Syst Rev 2012; 12: CD004736. doi: https://doi.org/10.1002/14651858.CD004736
- Ziaei S, Norrozi M, Faghihzadeh S, Jafarbegloo E. A randomised placebo controlled trial to determine the effect of iron supplementation on pregnancy outcome in pregnant women with haemoglobin > or = 13.2 g/dl. BJOG 2007; 114:684–8. doi: https://doi.org/10.1111/j.1471-0528.2007.01325
- Shastri L, Mishra PE, Dwarkanath P, Thomas T, Duggan C, Bosch R, McDonald CM, Thomas A, Kurpad AV. Association of oral iron supplementation with birth outcomes in non-anaemic South Indian pregnant women. Eur J Clin Nutr 2015;69:609–13. doi: https://doi.org/10.1038/ejcn.2014.248
- Timur H, Kokanalı MK, Topçu HO, et al. Factors that affect perinatal outcomes of the second pregnancy of adolescents. J Pediatr Adolesc Gynecol 2016;29:18–21. doi: https://doi.org/10.1016/j.jpag.2015.05.002
Details
| Primary Language | English |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Original Research |
| Authors | |
| Publication Date | October 4, 2018 |
| Submission Date | June 3, 2018 |
| Acceptance Date | September 25, 2018 |
| Published in Issue | Year 2018 Volume: 3 Issue: 3 |
