DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20180171

Maternal anaemia and its effects on neonatal anthropometric parameters in patients attending a tertiary care institute of Solan, Himachal Pradesh, India

Manisha Behal, Rajeev Vinayak, Anuj Sharma

Abstract


Background: Anaemia during pregnancy is a significant concern in India. The consequences of iron deficiency anaemia during pregnancy are often serious and long lasting for both the mother and the foetus. Haematocrit measurement is an acceptable and recommended method for anaemia determination especially in situations where limited resources are available, and the technical support is poor. There is a rough conversion factor of 3 which converts the HCT value to approximate haemoglobin level. Present study desires to know the prevalence of anaemia (with classification into mild, moderate and severe) in 3rd trimester pregnancy, to know effect of anaemia in pregnancy on new-born anthropometric parameters and to assess the validity of the threefold conversion between haemoglobin and haematocrit for the determination of anaemia in pregnancy.

Methods: The estimation of haematocrit was done by micro-haematocrit method and estimation of haemoglobin was done by automated blood cell analyzer based on cyanmethemoglobin method. Welch's ANOVA, Post Hoc games Howell test and Bland Altman limits of agreement method were used for statistical analysis.

Results: Present study showed that 53.75% women in their 3rd trimester were anaemic (mild, moderate and severe anaemic mothers were 22.25%, 28.25% and 3.25% respectively). The standard 3-fold conversion between the haemoglobin and haematocrit was not found to be valid for the assessment of anaemia in the 3rd trimester pregnancy. Finally, while comparing anthropometric measurements between mild/ no anaemia group with severe anaemia group we found that all measurements were less in severe anaemia group and this difference was statistically significant.

Conclusions: This study shows that 53.75% women in their 3rd trimester were anaemic, which closely mimic the WHO data but is about 11% more than the prevalence in Himachal Pradesh. Secondly, the standard 3-fold conversion between the haemoglobin and haematocrit was not found to be valid for the assessment of anaemia in the 3rd trimester pregnancy. Finally, birth weight, height, head circumference, chest circumference and mid-arm circumference were significantly affected by third trimester haemoglobin that too the most in severe anaemia cases.


Keywords


Anaemia, Pregnancy, Hematocrit, Hemoglobin

Full Text:

PDF

References


World Health Organization. The global prevalence of anaemia in 2011. Available at http://apps.who.int/iris/bitstream/10665/177094/1/9789241564960_eng.pdf

DeMaeyer EM, Dallman P, Gurney JM, Hallberg L, Sood SK, Srikantia SG, World Health Organization. Preventing and controlling iron deficiency anaemia through primary health care: a guide for health administrators and programme managers. 1989. Available at http://www.who.int/nutrition/publications/micronutrients/anaemia_iron_deficiency/9241542497.pdf

World Health Organisation. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Vitamin and Mineral Nutrition Information System. Geneva: World Health Organization. 2011. Available at http://apps.who.int/iris/bitstream/10665/85839/3/WHO_NMH_NHD_MNM_11.1_eng.pdf?ua=1

World Health Organization. Nutritional anaemias: report of a WHO scientific group [meeting held in Geneva from 13 to 17 March 1967]. Available at http://apps.who.int/iris/bitstream/10665/40707/1/WHO_TRS_405.pdf

World Health Organization. The management of nutrition in major emergencies. World Health Organization; 2000.

Centers for Disease Control (CDC). CDC criteria for anemia in children and childbearing-aged women. MMWR. Morbidity and mortality weekly report. 1989;38(22):400.

Milman N. Anemia: still a major health problem in many parts of the world! Ann Hemato. 2011;90(4):369-77.

Breymann C, Bian XM, Blanco-Capito LR, Chong C, Mahmud G, Rehman R. Expert recommendations for the diagnosis and treatment of iron-deficiency anemia during pregnancy and the postpartum period in the Asia-Pacific region. J Perinatal Med. 2011;39(2):113-21.

Breymann C. Iron supplementation during pregnancy. Fetal and maternal medicine review. 2002;13(1):1-29.

Perewusnyk G, Huch R, Huch A, Breymann C. Parenteral iron therapy in obstetrics: 8 years’ experience with iron-sucrose complex. British J Nutr. 2002;88(01):3-10.

Haas JD, Brownlie T. Iron deficiency and reduced work capacity: a critical review of the research to determine a causal relationship. J Nutr. 2001;131(2):676S-90S.

Telatar B, Comert S, Vitrinel A, Erginoz E, Akin Y. The effect of maternal anemia on anthropometric measurements of newborns. Saudi Med J. 2009;30(3):409-12.

Kalaivani K. Prevalence and consequences of anaemia in pregnancy. Indian J Med Res. 2009;130(5):627-33.

World Health Organization. Iron deficiency anaemia: assessment, prevention and control: a guide for programme managers. 2001.

National Committee for Clinical Laboratory Standards. Reference and Selected Procedures for the Quantitative Determination of Haemoglobin in Blood: approved standards. 2nd ed. Villanova, PA, National Committee for Clinical Laboratory Standards, 1994.

Von Schenck H, Falkensson M, Lundberg B. Evaluation of "HemoCue", a new device for determining hemoglobin. Clin Chem. 1986;32(3):526-9.

Johns WL, Lewis SM. Primary health screening by haemoglobinometry in a tropical community. Bull World Health Organization. 1989;67(6):627.

Keen ML. Hemoglobin and hematocrit: an analysis of clinical accuracy-case study of the anemic patient. Nephrol Nur J. 1998;25(1):83.

Quintó L, Aponte JJ, Menéndez C, Sacarlal J, Aide P, Espasa M, et al. Relationship between haemoglobin and haematocrit in the definition of anaemia. Tropical Med Int Health. 2006;11(8):1295-302.

Shah VB, Shah BS, Puranik GV. Evaluation of non-cyanide methods for hemoglobin estimation. Indian J Pathol Microbiol. 2011;54(4):764.

Chakravarthy VK, Chandra DN, Prasanna BS, Rao TJ, Rao DR. Haemoglobin estimation by non-cyanide methods. J Clin Diag Res. 2012;6(6).

World Health Organization (WHO). Recommended method for the determination of packed cell volume by centrifugation (prepared by Expert Pane on cytometry of the International Council for WHO/DIL/00. WHO, Geneva. 2000;1:1-9.

Hillman RS, Finch CA. Red cell manual. 6th ed. Philadelphia: FA Davis Company; 1994.

Bain BJ, Bates I. Basic haematological techniques. In: Lewis SM, Bain BJ, Bates I, editors. Dacie and Lewis practical haematology. 9th ed. Edinburgh: Churchill Livingstone; 2001:19-46.

Graitcer PL, Goldsby JB, Nichaman MZ. Hemoglobins and hematocrits: are they equally sensitive in detecting anemias? Am J Clin Nutr. 1981;34(1):61-4.

De Benoist B, McLean E, Egli I, Cogswell M, Cogswell M. WHO global database on anaemia. Geneva: WHO. 2008:1993-2005.

Carneiro IA, Drakeley CJ, Owusu-Agyei S, Mmbando B, Chandramohan D. Haemoglobin and haematocrit: is the threefold conversion valid for assessing anaemia in malaria-endemic settings? Malaria J. 2007;6(1):67.

Rodríguez-Morales AJ, Sánchez E, Arria M, Vargas M, Piccolo C, Colina R, et al. Haemoglobin and haematocrit: the threefold conversion is also non-valid for assessing anaemia in Plasmodium vivax malaria-endemic settings. Malaria J. 2007;6(1):1.

Lee SJ, Stepniewska K, Anstey N, Ashley E, Barnes K, Binh TQ, et al. The relationship between the haemoglobin concentration and the haematocrit in Plasmodium falciparum malaria. Malaria J. 2008;7(1):149.

Amarasiri AM, Wickramaratne KA. Assessing the validity of the threefold conversion between hemoglobin and hematocrit for the determination of anemia in pregnancy. In KDU International Research Conference, 2014. 2015:24.

Ekwochi U, Ifediora C, Osuorah DC, Ndu IK, Amadi OF, Odetunde IO. Evaluation of the packed cell volume (PCV) as a potential screening tool for iron deficiency anaemia among under-5 children in a resource limited setting. J Exp Res. 2015;3(2):81-5.

de Onis M, Onyango AW, Van den Broeck J, Chumlea CW, Martorell R. Measurement and standardization protocols for anthropometry used in the construction of a new international growth reference. Food Nutr Bull. 2004; 25(1):S27-36.

Medicare M. CLIA programs; regulations implementing the Clinical Laboratory Improvement Amendments of 1988 (CLIA)-HCFA. Final rule with comment period. Fed Regist. 1992;57(40):7002-186.

Radtke H, Polat G, Kalus U, Salama A, Kiesewetter H. Hemoglobin screening in prospective blood donors: comparison of different blood samples and different quantitative methods. Transfusion Apheresis Sci. 2005;33(1):31-5.

Hinkle DE, Wiersma W, Jurs SG. Applied statistics for the behavioral sciences. 5th ed. Boston: Houghton Mifflin; 2003.

International Institute for Population Sciences (IIPS), 2014. District Level Household and Facility survey (DLHS-4), 2012-13: India. Himachal Pradesh: Mumbai: IIPS. Available at http://rchiips.org/pdf/dlhs4/report/HP.pdf

Yi SW, Han YJ, Ohrr H. Anemia before pregnancy and risk of preterm birth, low birth weight and small-for-gestational-age birth in Korean women. Eu J Clin Nutr. 2013;67(4):337-42.

Bora R, Sable C, Wolfson J, Boro K, Rao R. Prevalence of anemia in pregnant women and its effect on neonatal outcomes in Northeast India. J Maternal-Fetal Neonatal Med. 2014;27(9):887-91.

Godhia M, Nigudkar M, Desai R. Anthropometric indices of their full-term and pre-term newborns. Pak J Nutr. 2012;11(4):343-9.

Hadipour R, Norimah AK, Poh BK, Firoozehchian F, Hadipour R, Akaberi A. Haemoglobin and serum ferritin levels in newborn babies born to anaemic Iranian women: A cross-sectional study in an Iranian hospital. Pak J Nutr. 2010;9(6):562-6.

Breymann C. Iron deficiency anemia in pregnancy. Expert Rev Obstet Gynecol. 2013;8(6):587-96.

Pavord S, Hunt B, editors. The obstetric hematology manual. Cambridge University Press; 2010.

Iron DA. Recommendations to prevent and control iron deficiency in the United States. MMWR: Morbidity and Mortality Weekly Report. 1998;47:1-29.