Anemia Prevalence after Iron Supplementation among Pregnant Women in Midwifes Practice of Primary Health Care Facilities in Eastern Indonesia

Abstract

Background Iron deficiency anemia (IDA) in pregnant women is common, and iron supplementation is given during pregnancy to reduce birth complication. This study aimed to explore the prevalence of anemia and type of anemia after iron supplementation among pregnant women in the eastern part of Indonesia. Methods A cross-sectional study design was conducted between January and March 2019 in three Primary Health Care (PHC) facilities at Kupang, West Timor. After consent, pregnant women who had taken their iron supplementation for at least 3 months were asked for iron pills intake by using a self-designed questionnaire and by counting the pills leftover. Complete blood count examination was performed, and the type of anemia was assessed using Shine and Lal index (SLI; MCV ∗ MCV ∗ MCH/100) to determine whether anemia was due to iron deficiency or β-thalassemia trait (β-TT). In a subset of iron tablets distributed in the PHCs, Fe-concentration was measured. Results Of 102 pregnant women included, only 25.5% had taken the pills with a pill count of >80%. Interestingly, Fe-concentration in the pills from three different PHC facilities varied between 75% and 100%. After iron supplementation, however, anemia was detected in 34.3%, and based on SLI, 14.7% was suspected because of iron deficiency and 19.6% was suspective of β-TT. Of note, nonanemic pregnant women (17.6%) had also low SLI, suggesting β-TT or other hemoglobinopathies. Conclusion Assessment of Shine and Lal index as the first step to screen the type of anemia in pregnant women from a limited area is of potential value, especially because Indonesia is located in the thalassemia belt area. An integrative approach and counseling among pregnant women with β-TT and their partners will increase thalassemia awareness and optimal birth management.

The Role of Fe, Zn, and Cu in Pregnancy

“…Then, as a result of increased hematopoiesis and the development of the fetus and placenta, the Fe reserves in the mother's body are exhausted [105]. This results in hypochromic microcytic anemia, especially in the 2nd and 3rd trimester, which may give adverse symptoms of organ and tissue dysfunction [106]. Premature birth or a low weight birth may occur [107], as well as myocardial hypoxia (e.g., tachycardia) [108], cerebral hypoxia (e.g., weakness, drowsiness, headaches, and dizziness) [109][110][111], immunosuppression [111], and appetite disorders (e.g., eating chalk) [112].…”

The Relationship Between the Adequacy of Iron Tablet Supplementation and Hemoglobin Level in Pregnant Women

“…Daily absorption of this mineral from diet is usually not sufficient to fulfill this need. Therefore it is necessary to increase iron intake through iron supplementation to help restore Hb levels in pregnant women [5]. Daily Fe supplementation is a relatively safe and effective approach to maintaining Hb concentration and avoiding anemia in pregnancy [24,25].…”

“…The need for iron in the first trimester of pregancy is low (0.8 mg/day), and then increases markedly in the second and third trimesters of pregnancy (6.3 mg/day). This relates to the progressive increase of blood volume from the 6 th to 8 th week of pregnancy, and reaches a peak in week 32-34 [5].…”

Thalassemia carrier detection among pregnant women

“…This study has included 102 pregnant women after having taken 90 iron tablets during antenatal visits in the Primary Health Care (PHC) facilities in Kupang, Eastern Indonesia, as published earlier. 6 …”