Prevalence and foetomaternal effects of iron deficiency anaemia among pregnant women in Lagos, Nigeria

Autoři: Adegbenga Adetona Ajepe aff001;  Kehinde Sharafadeen Okunade aff001;  Adebayo Isaiah Sekumade aff001;  Ebunoluwa Seun Daramola aff001;  Mary Olufunmilayo Beke aff001;  Olaolopin Ijasan aff001;  Olusola Festus Olowoselu aff003;  Bukola Bosede Afolabi aff001
Působiště autorů: Department of Obstetrics & Gynaecology, Lagos University Teaching Hospital, Lagos, Nigeria aff001;  Department of Obstetrics & Gynaecology, College of Medicine, University of Lagos, Lagos, Nigeria aff002;  Department of Haematology and Blood Transfusion, College of Medicine, University of Lagos, Lagos, Nigeria aff003
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article
doi: 10.1371/journal.pone.0227965


Anaemia in pregnancy is a major health problem and an important cause of adverse foetomaternal outcomes in developing countries. Iron deficiency is the cause of the overwhelming majority of the cases of anaemia in pregnancy. Iron deficiency anaemia (IDA) has been linked with adverse foetal and maternal outcomes. This study investigated the prevalence of IDA and evaluated its effects on foetomaternal outcomes among parturients in Lagos, Nigeria. This was a cross-sectional study that enrolled 220 women aged 15–49 years with singleton gestation at term, between May 1, 2016, and March 31, 2017. Participants were selected by systematic sampling and baseline data were collected through interviews. Venous blood samples were obtained to measure haemoglobin and serum ferritin concentrations, and the associations between IDA (defined as anaemia and iron deficiency) and pregnancy outcomes were examined. A P-value <0.05 was considered as statistically significant. The prevalence of IDA was 12.3%. Routine antenatal iron supplementation (adjusted odds ratio 0.18, 95% confidence interval 0.07–0.46; P = 0.001) and interpregnancy interval of at least 2 years (adjusted odds ratio 0.20, 95% confidence interval 0.05–0.97; P = 0.021) have significant association with IDA. Iron deficiency anaemia was not significantly associated with adverse perinatal outcomes but there were significant associations with increased risk of blood transfusion (P = 0.001) and maternal infectious morbidities such as puerperal pyrexia (P = 0.041) and wound infection (P = 0.020). IDA is still a fairly common condition among parturients in Lagos and it’s mostly associated with maternal peripartum morbidities. Adequate pregnancy spacing through the use of effective contraception and routine antenatal iron supplementations in pregnancy is a recommended preventive measure against IDA and its adverse sequelae. Future studies should adopt the use of transferrin saturation (TSAT) in compliment with serum ferritin assay as a more sensitive marker of iron deficiency.

Klíčová slova:

Anemia – Blood transfusion – Ferritin – Hematology – Iron deficiency – Iron deficiency anemia – Pregnancy – Sickle cell disease


1. Reveiz L, Gyte GM, Cuervo LG, Casasbuenas A. Treatments for iron-deficiency anaemia in pregnancy. Cochrane Database Syst Rev. 2011: 5;(10): CD003094.

2. Balarajan Y, Ramakrishnan U, Ozaltin E, Shankar AH, Subramanian SV. Anaemia in low-income and middle-income countries. Lancet. 2011; 378(9809): 2123–2135. doi: 10.1016/S0140-6736(10)62304-5 21813172

3. Kilpatrick SJ. Anaemia and Pregnancy. In: Creasy RK, Resnik R, Greene MF, Iams JD, Lockwood CJ, Moore TR, Greene MF. (Editors). Creasy and Resnik’s Maternal-Fetal Medicine: Principles and Practice. 7th Ed. Philadelphia: Elsevier Saunders 2014: 918–931.

4. Tiwari M, Kotwal J, Kotwal A, Mishra P, Dutta V, Chopra S. Correlation of haemoglobin and red cell indices with serum ferritin in Indian women in second and third trimester of pregnancy. Med J Armed Forces India. 2013; 69(1): 31–6. doi: 10.1016/j.mjafi.2012.07.016 24532931

5. Afolabi BB, Oladipo OO, Akanmu AS, Abudu OO, Sofola OA, Broughton Pipkin F. Volume regulatory hormones and plasma volume in pregnant women with sickle cell disorder. J Renin Angiotensin Aldosterone Syst. 2016;17(3). pii: 1470320316670444

6. Steer PJ. Maternal hemoglobin concentration and birth weight–. The American journal of clinical nutrition. 2000; 71(5): 1285S–7S.

7. Lawson RJ. Anaemia in pregnancy. In: Lawson JB, Steward (Ed). Obstetrics and Gynaecology in Tropics and developing countries. Edward Arnold Publ. 1983:73–79.

8. Miller JL. Iron deficiency anemia: a common and curable disease. Cold Spring Harb Perspect Med. 2013; 3(7). pii: a01186

9. Shander A, Goodnough LT, Javidroozi M, Auerbach M, Carson J, Ershler WB, Ghiglione M, Glaspy J, Lew I. Iron deficiency anemia—bridging the knowledge and practice gap. Transfusion medicine reviews. 2014; 28(3): 156–66. doi: 10.1016/j.tmrv.2014.05.001 24931617

10. Drukker L, Hants Y, Farkash R, Ruchlemer R, Samueloff A, Grisaru-Granovsky S. Iron deficiency anemia at admission for labor and delivery is associated with an increased risk for Cesarean section and adverse maternal and neonatal outcomes. Transfusion. 2015; 55(12): 2799–806. doi: 10.1111/trf.13252 26246160

11. Stevens GA, Finucane MM, De-Regil LM, Paciorek CJ, Flaxman SR, Branca F, et al. Global, regional, and national trends in haemoglobin concentration and prevalence of total and severe anaemia in children and pregnant and non-pregnant women for 1995–2011: a systematic analysis of population-representative data. Lancet Glob Health. 2013; 1(1): e16–25.

12. Skikne BS. Serum transferrin receptor. Am J Hematol. 2008; 83(11): 872–5. doi: 10.1002/ajh.21279 18821709

13. Mei Z, Cogswell ME, Looker AC, Pfeiffer CM, Cusick SE, Lacher DA et al: Assessment of iron status in US pregnant women from the National Health and Nutrition Examination Survey (NHANES), 1999–2006. Am J Clin Nutr. 2011; 93(6): 1312–20. doi: 10.3945/ajcn.110.007195 21430118

14. Dignass A, Farrag K, Stein J. Limitations of Serum Ferritin in Diagnosing Iron Deficiency in Inflammatory Conditions. Int J Chronic Dis. 2018; 2018: 9394060. doi: 10.1155/2018/9394060 29744352

15. Peyrin-Biroulet L, Williet N, Cacoub P. Guidelines on the diagnosis and treatment of iron deficiency across indications: A systematic review. Am J Clin Nutr. 2015;102(6): 1585–1594. doi: 10.3945/ajcn.114.103366 26561626

16. Adams PC, Reboussin DM, Press RD, Barton JC, Acton RT, Moses GC et al. Biological variability of transferrin saturation and unsaturated iron-binding capacity. Am J Med. 2007; 120(11): 999.e1–e7.

17. Alwan NA, Cade JE, McArdle HJ, Greenwood DC, Hayes HE, Simpson NA. Maternal iron status in early pregnancy and birth outcomes: insights from the Baby’s vascular health and Iron in Pregnancy study. Br J Nutr. 2015; 113(12): 1985–92 doi: 10.1017/S0007114515001166 25946517

18. Nair M, Choudhury MK, Choudhury SS, Kakoty SD, Sarma UC, Webster P, et al On behalf of the IndOSS-Assam steering committee. Association between maternal anaemia and pregnancy outcomes: a cohort study in Assam, India. BMJ Global Health 2016; 1: e000026. doi: 10.1136/bmjgh-2015-000026 28588921

19. Aimakhu CO, Olayemi O. Maternal haematocrit and pregnancy outcome in Nigerian women. West Afr J Med. 2003; 22(1):18–21. doi: 10.4314/wajm.v22i1.27972 12769300

20. Araoye MO. Sample Size Determination. In: Araoye MO (ed) research methodology with statistics for health and social sciences. Nathadex publishers, 2003; 6(1): 115–121.

21. Erhabor O, Isaac IZ, Isah A, Udomah FP. Iron deficiency anaemia among antenatal women in Sokoto, Nigeria. Brit J Med Health Sci 1(4): 47–57.

22. Olusanya O, Okpere E, Ezimokhai M. The importance of social class in voluntary fertility control in a developing country. West Afr J Med. 1985; 4(4): 205–12.

23. Protocol Booklet. Abcam Ferritin Human ELISA Kit. 2016

24. WHO. Serum Ferritin Concentrations for The Assessment of Iron Status and Iron Deficiency in Populations. Vitamin and Mineral Nutrition Information System. Geneva: World Health Organization; 2011

25. Okunade KS, Adegbesan-Omilabu MA. Anaemia among pregnant women at the booking clinic of a teaching hospital in south-western Nigeria. Int J Med Biomed Res 2014; 3(2): 114–120.

26. Anorlu RI, Oluwole AA, Abudu OO. Sociodemographic factors in anaemia in pregnancy at booking in Lagos, Nigeria. J Obstet Gynaecol. 2006; 26(8): 773–6. doi: 10.1080/01443610600963846 17130028

27. VanderJagt DJ, Brock HS, Melah GS, El-Nafaty AU, Crossey MJ, Glew RH. Nutritional Factors Associated with Anaemia in Pregnant Women in Northern Nigeria. J Health Popul Nutr. 2007; 25(1): 75–81 17615906

28. Bukar M, Audu BM, Sadauki HM, Elnafaty AU, Mairiga AG. Prevalence of iron deficiency and megaloblastic anaemia at booking in a secondary health facility in north eastern Nigeria. Niger Med J 2009; 50(2): 33–7.

29. Auerbach M, Abernathy J, Juul S, Short V, Derman R. Prevalence of iron deficiency in first trimester, nonanemic pregnant women. J Matern Fetal Neonatal Med. 2019: 1–4.

30. World Health Organization. Guideline: Daily iron and folic acid supplementation in pregnant women. Geneva, Switzerland: WHO; 2012.

31. Peña-Rosas JP, De-Regil LM, Garcia-Casal MN, Dowswell T. Daily oral iron supplementation during pregnancy. Cochrane Database Syst Rev. 2015; (7): CD004736. doi: 10.1002/14651858.CD004736.pub5 26198451

32. Merchant K, Martoreli R. Frequent reproductive cycling: does it lead to nutritional depletion of mothers? Prog Food Nutr Sci 1988; 12(4): 339–369. 3077180

33. Conde-Agudelo A, Belizan JM. Maternal morbidity and mortality associated with interpregnancy interval: cross sectional study. BMJ. 2000; 321(7271): 1255–59. doi: 10.1136/bmj.321.7271.1255 11082085

34. Razzaque A, Da Vanzo J, Rahman M, et al. Pregnancy spacing and maternal morbidity in Matlab, Bangladesh. Int J Gynaecol Obstet. 2005; 89(suppl 1): S41–9.

35. Conde-Agudelo A, Rosas-Bermudez A, Kafury-Goeta AC. Effects of birth spacing on maternal health: a systematic review. Am J Obstet Gynecol. 2007; 196(4): 297–308. doi: 10.1016/j.ajog.2006.05.055 17403398

36. Dim CC, Onah HE. The prevalence of anaemia among pregnant women at booking in Enugu, South Eastern Nigeria. MedGenMed. 2007; 9(3): 11. 18092018

37. Nwizu EN, Iliyasu Z, Ibrahim SA, Galadanci HS. Socio-demographic and maternal factors in anaemia in pregnancy at booking in Kano, northern Nigeria. Afr J Reprod Health. 2011; 15(4): 33–41. 22571103

38. Owolabi AT, Fatusi AO, Kuti O, Adeyemi A, Faturoti SO, Obiajuwa PO. Maternal complications and perinatal outcomes in booked and unbooked Nigerian mothers. Singapore Med J. 2008; 49(7): 526–31. 18695859

39. Weiss G. Iron, infection and anemia—a classical triad. Wien Klin Wochenschr. 2002; 114(10–11): 357–67. 12708088

Článek vyšel v časopise


2020 Číslo 1