Iron deficiency anemia in pregnancy: Subgroup analysis from Riyadh mother and baby multicenter cohort study (RAHMA)

Abstract

OBJECTIVES: The objective of the study was to estimate the prevalence and risk factors of anemia among pregnant women in Riyadh and to examine its association with adverse pregnancy outcomes. METHODS: This study is a subgroup analysis from Riyadh mother and baby multicenter cohort study. Participants were grouped into four groups according to hemoglobin level: nonanemic (≥11.0 g/100 ml), mild (10–10.9 g/100 ml), moderate (7.0–9.9 g/100 ml), and severe anemia (<7.0 g/100 ml). Regression analyses were conducted to extrapolate the predicted probability (PP) for pregnancy outcomes. RESULTS: Out of 10,600 participants, 3261 (30.76%) were anemic; 1729 (16.3%), 1520 (14.3%), and 12 (0.1%) had mild, moderate, and severe anemia, respectively. The odds of anemia was higher in younger mothers (odds ratio [OR] = 0.94, confidence interval [CI]: 0.91–0.94) and in primiparous (OR = 1.01, CI: 0.90–1.14), while attendants of antenatal care and those who received iron supplements were less likely to be anemic (OR = 0.93, CI: 0.82–1.06) and (OR = 0.92, CI: 0.77–1.09), respectively. There was a significant increase in the odds of lower APGAR with the decreased hemoglobin; an increment of maternal hemoglobin by 1 g/100 ml decreased the likelihood of APGAR scores <7 by 9% (OR = 0.91, CI: 0.83–0.99). The PP showed a decrease in preterm birth (PTB) rate from 8% (CI: 6%–9%) to 6.5% (CI: 5%–8%), low birth weight (LBW) rate from 12% (CI 10%–13%) to 11% (CI: 9%–12%), stillbirth rate from 1.3% (CI: 0.7%–2.1%) to 1.1% (CI: 0.7%–1.6%), and maternal admission to intensive care unit (ICU) from 0.8% (CI: 0.2%–1.5%) to 0.2% (CI: 0.06%–0.4%), with increase of maternal hemoglobin from 7 g/100 ml to 15 g/100 ml. CONCLUSION: More than a third of the pregnant women in Riyadh had mild-to-moderate anemia. The odds of anemia increased in primipara, younger mothers, and those without antenatal care or iron supplementation. PP showed that anemia is associated with low APGAR scores, LBW, PTB stillbirth, and maternal admission to ICU.