Skip to main content

Anemia and other hematological profiles of pregnant women attending antenatal care in Debre Berhan Referral Hospital, North Shoa, Ethiopia

Abstract

Objective

The aim of the study was to determine level of anemia and other hematological profiles in pregnant women attending antenatal care clinic in Debre Berhan Referral Hospital, Ethiopia.

Results

Prevalence of anemia was 2.8% and that of thrombocytopenia was 10.2%. Out of the anemic pregnant mothers, 5 (62.5%) were mildly anemic and 2 (25%) were severely anemic. The factor age < 20 years of mothers was significantly associated with anemia (P < 0.05). In addition, the occurrence of anemia in mothers who visited antenatal clinic two times is two times higher than those mother who visited the antenatal clinic three times. Moreover, the prevalence of anemia is two times more likely to occur in pregnant mothers who did not take iron supplements as compared to their counter parts. According to pregnancy periods; mean white blood cells count was (8.48 ± 3.09, 8.83 ± 2.73, 8.86 ± 2.67) × 109/L for the first, second and third trimesters, respectively. Red blood cells and platelet counts in the first trimester were significantly higher than their corresponding values in third trimester (P < 0.01), whereas mean hemoglobin and hematocrit values were not statistically significant within trimesters (P > 0.05).

Introduction

Change in hematological profiles is one of the factors affecting pregnancy and its outcome. As a result, hematological profiles are measured all over the world to estimate general health status of individuals because of its reliability and cost-effectiveness [1]. Severe anemia during pregnancy is associated with prematurity, spontaneous abortions, low birth weight, operative delivery, postpartum hemorrhage and fetal death [1, 2].

Anemia is the most common hematological problem during pregnancy followed by that of thrombocytopenia [1, 3]. The global prevalence of anemia in pregnant women is 41.8%. In Africa, the prevalence of anemia is 55.8% which is comparably greater than its prevalence in Asia (41.6%), and Europe (18.7%) [3]. These figures reflect that the burden of anemia is more in pregnant women living in the poorest region of the world.

The common causes of anemia are malnutrition, pregnancy, infections with malaria, hook worm, HIV, haemoglobinopathies and obstetrical complications causing abnormal blood loss [4, 5]. Socioeconomic status of the family, traditional eating habits of the region, fear of weight gain and irregular eating habits are major behavioral risk factors for the development of anemia in adolescent [6].

In addition, family illiteracy, malaria, and duodenal ulcer bleeding are predisposing factors of anemia in pregnant women [7]. Moreover, low family income, high family size, living with HIV/AIDS, residence in rural area, intestinal parasitic infection, walking bare foot, and history of heavy menstrual cycle (> 5 days of menses) are known to be the predictors of anemia among pregnant women in Ethiopia [8, 9]. Despite its decline through time, anemia is still the major health problem in women of reproductive age [10].

Even though various studies have been conducted in developed countries to determine the hematological profiles of pregnant women, little is known in developing countries like Ethiopia, particularly in the selected study area. Thus, purpose of this study was to determine the prevalence of anemia and other hematological profiles and associated factors among pregnant women attending antenatal care clinic in Debre Berhan Referral Hospital (DBRH), Ethiopia.

Main text

Study design, period and setting

Institution based cross sectional study design was employed in pregnant women who visited antenatal care (ANC) clinic at Debre Berhan Referral Hospital (DBRH). The study was conducted from October to January 2015 GC.

The study was conducted in DBRH which is found in Debre Berhan town located in the North East of Addis Ababa at a distance of 123 Kms. The hospital provides ANC services together with other maternal and child health care and medical services.

Sample size determination

Actual sample size for the study was determined using the formula for single population proportion by assuming 5% margin of error and 95% confidence interval (α = 0.05) and using the previous prevalence of 21.3% [11]. The actual sample size with 10% contingency was 284.

Sample recruitment and sampling procedure

All pregnant women who came to DBRH for ANC in maternal and child health department were screened for eligibility in the study. Pregnant women who were sick during data collection, those having bleeding in the pregnancy, recently transfused, having known chronic diseases and diagnosed with haemoglobinopathies were excluded. Based on the previous 3 months record, the target pregnant mothers were selected by systematic sampling technique at a sampling interval of three. The first interviewed participant was randomly selected by a lottery system.

Data collection procedure

Data on socio-demographic variables and obstetric characteristics were collected by trained nurses using structured interviewer administered questionnaire. Venous blood was collected once from each pregnant women as they visit the ANC clinic during the data collection period regardless of their gestational age by well-trained laboratory technologists. The collected venous blood was tested in DBRH hematology laboratory and results were collected timely.

Data analysis

Data were entered into Epi-Info version 3.1 and analyzed using SPSS version 21. Bivariate logistic regression was computed to assess statistical association between anemia and independent variables. Significance of statistical association were tested at P-value < 0.05. After bivariate logistic regression analysis, variables with P-value < 0.3 were entered to multivariate logistic regression analysis. The Mann–Whitney U test was utilized to compare mean of hematological values in different trimesters.

Results

Hematological profiles of pregnant women

Overall hematological parameters of 284 pregnant women were described as mean ± SD. Among the pregnant women, 46, 100, 138 were in the first, second and third gestational age (Additional file 1: Table S2). White blood cells (WBC) and neutrophil count were (8.79 ± 2.76 and 6.14 ± 2.41) × 109/L, respectively. Red blood cells (RBC) count (4.53 ± 0.73 × 1012/L), hemoglobin (14.89 ± 2.45 g/dL), hematocrit (Hct) (42.50 ± 6.59%), and platelet (PLT) count (242.85 ± 83.90 × 109/L) were recorded in pregnant women participated in the study (Table 1).

Table 1 Overall and trimester based hematological profiles of pregnant women (mean ± SD) in Debre Berhan Referral Hospital, North Shoa, Ethiopia, October to January 2015

According to pregnancy periods; mean WBCs count has been shown to increase with gestational age. RBCs and platelet counts in the first trimester were significantly higher than their corresponding values in third trimester (P < 0.01), whereas mean hemoglobin and hematocrit values were not statistically significant within trimesters (P > 0.05). The mean MCV and MCH values had been shown to increase with the advancement of pregnancy period. There was significant MCV differences between first and second trimesters, second and third trimesters, and first and third trimesters of pregnant women (P = 0.012, 0.02, and 0.00, respectively). In addition, there was also significant MCH differences between first and second trimesters, second and third trimesters, and first and third trimesters of pregnant women (P = 0.02, 0.03, and 0.00, respectively) (Table 1).

Prevalence of anemia and thrombocytopenia

Based on WHO criteria, hemoglobin value of less than 11.0 g/dL is considered as indicative of anemia for pregnant women. Accordingly, in the present study, 8 (2.8%) of study participants were anemic. Out of 284 pregnant women, 29 were thrombocytopenic (Platelet count < 150 × 109/L) with a prevalence of 10.2%. Out of the anemic pregnant mothers, 5 (62.5%) were mildly anemic and 2 (25%) were severely anemic (Table 2).

Table 2 Distribution of anemia and thrombocytopenia by severity among anemic and thrombocytopenic pregnant women at Debre Berhan Referral Hospital, North Shoa, Ethiopia, October to January 2015

Bivariate and multivariate analysis

Prevalence of anemia among pregnant women with age groups of less than 20 years were 29.5 times higher than those with age groups of greater or equals to 26 years. The occurrence of anemia in mothers who visited ANC clinic two times is two times higher than those mothers who visited the ANC clinic three or more times. In addition, the prevalence of anemia is two times more likely to occur in pregnant mothers who did not take iron supplements as compared to their counter parts (Table 3). However, by adjusting potential confounders in multivariate logistic regression analysis, only age groups < 20 years old was significantly associated with anemia (P < 0.05) (Table 3).

Table 3 Prevalence of anemia by socio-demographic, obstetric and other characteristics of pregnant women at Debre Berhan Referral Hospital, North Shoa, Ethiopia, October to January 2015

Discussion

Monitoring hematological profiles is essential to diagnose or monitor illness in pregnant woman. Prevalence of anemia in this study is very low compared with the findings of various studies conducted in Ethiopia and foreign countries. For instance, the prevalence of anemia in India, Nigeria, Kenya, Mexico and other regions of Ethiopia [8, 9, 11,12,13,14,15,16,17,18,19,20] was higher than that of the finding of the present study. This discrepancy might be due to difference in socioeconomic and educational status, food selection habits, multi-factorial causes of anemia, prevalence of malaria and other intestinal parasites in some study area, access to health care services, access to iron supplementation, awareness in pregnant women to ANC follow and methods used to determine hemoglobin where some might be exposed to bias compared with automated hematology analyzers used in the present study.

In addition, the low prevalence of anemia observed in the present study might also be due to the high altitude (2780 m) and low prevalence of malaria of the study area [21]. Moreover, as indicated on the sociodemographic data (Additional file 1: Table S1), majority of participants were urban resident and wearing shoes which prevents the participants from being affected by parasites which could in turn affect the level of RBC of participants.

Even though the overall anemia prevalence is low in this study, the level of severe anemia was high compared with previous studies in Bahir Dar [20], south east Ethiopia [16], Gilgel Gibe dam area [9], Kenya [14] and in Addis Ababa [11]. The reasons for the differences might be associated with differences in socioeconomic and awareness of pregnant women to symptoms and outcomes of anemia on maternal and fetal health among the target regions and countries.

According to the present study, pregnant woman with age groups < 20 years old were 29.5 times more likely to develop anemia than age groups > 26 years old. This finding was consistent with studies in Kenya where low age was more likely to develop anemia [14]; but did not agree with studies in Addis Ababa where higher age groups [39–45 years] had significant association with anemia [11]. This discrepancy between the findings of these studies and the present study might be due to difference in time of study, life style and access to health care facilities among study participants. Although other variables were not significantly associated with anemia, in the present study, low BMI, being in second trimester gestational status, and low frequency of ANC follow up were the factors that prone women to develop anemia. Whereas urban residence, having secondary and above educational level, being nulliparous, women with iron supplement were the less likely associated factors to develop anemia.

Prevalence of thrombocytopenia was high in third trimester. This finding is relatively consistent with studies in Iraqi [22, 23] and India [24, 25]. In this study, the platelet count was much lower in third trimester than that in the first and second trimester as that of the findings obtained in studies conducted in Lagos, Nigeria, Abia State, Nigeria and Jamaica [1, 26, 27]. The lower platelet count with gestational age might be due to hemodilution secondary to expansion of plasma volume during pregnancy. The declining trend of platelet with increasing gestational age predispose pregnant women to risk of hemorrhage [25]. Thus, platelet count should be routinely performed during antenatal visit for timely diagnosis and to obtain good feto-maternal outcome in all types of thrombocytopenia during pregnancy.

The mean total WBCs count progressively increased from first to third pregnancy period. This might be due to physiologic stress induced by pregnancy, and the needs of the developing fetus. The increased WBCs count with gestational age was in line with the finding of a study done in Port Harcourt [27]. However, the present finding is inconsistent with study in Nigeria and Jamica where WBCs count significantly varied between trimesters [26, 27]. The discrepancy might be because of time, life style and population differences between study groups.

RBCs count was significantly higher in the first trimester compared with the third (4.68 ± 0.52 versus 4.48 ± 0.71, P < 0.01) but changes in Hgb and Hct values were not significant between all the trimesters. This finding did not agree with the findings obtained in studies conducted in Port Harcourt and Nigeria, where Hct values significantly decreased as gestational age increases [1, 28]. A study conducted in Nigeria indicated that most RBC indices were significantly changed across trimesters [11]. Moreover, a study in Jamaica revealed that RBCs count significantly changed between 1st–2nd and 2nd–3rd trimesters [27]. These discrepancies might be due to geographical, educational, economical, health care facility and behavioral differences among study areas.

MCV and MCH values significantly increased from first to third trimester while MCHC was relatively constant in the present study. This is relatively consistent with a study in Jamaica [27]. However, a study done in Nigeria revealed that MCV declined from first to third trimesters, MCH remained relatively stable through all trimesters and MCHC was stable in the first and second trimester but dropped in third [1]. This might reflect the difference in existence of iron deficiency among the study participants of the studied countries. In addition, the increased level of MCV and MCH with gestational age might be associated with the low prevalence of anemia in the participants and that of well controlled supply of micronutrients like iron for the normal maintenance of hematologic profiles of the majority of the study participants of this study relative to the dilution effect of their plasma volume.

Conclusions

The prevalence of anemia is more common in pregnant mothers with younger age, in those who have relatively less frequent ANC follow up and in those who do not take iron supplements regularly. There are variations of the count of RBCs, MCV, MCH and platelets values during the whole trimesters of pregnant mothers. Therefore, complete blood count has to be done to diagnose and prevent the potential development of anemia, thrombocytopenia and other hematologic abnormalities in pregnant mothers during antenatal care.

Limitations

The study did not use cohort techniques to assess the hematologic profiles of the pregnant mothers across the gestational period because of time and budget constraints.

Abbreviations

AAU:

Addis Ababa University

ANC:

antenatal care

DBRH:

Debre Berhan Referral Hospital

Hct:

hematocrit

Hgb:

hemoglobin

MCH:

mean corpuscular hemoglobin

MCHC:

mean corpuscular hemoglobin concentration

MCV:

mean corpuscular volume

PLT:

platelet

RBC:

red blood cell

RDW:

red cell distribution width

SPSS:

Statistical Package for Social Sciences

WBC:

white blood cell

WHO:

World Health Organization

References

  1. Akinbami AA, Ajibola SO, Rabiu KA, Adewunmi AA, Dosunmu AO, Adediran A, Osunkalu VO, Osikomaiya BI, Ismail KA. Hematological profile of normal pregnant women in Lagos, Nigeria. Int J Women’s Health. 2013;5:227–32.

    Article  CAS  Google Scholar 

  2. Sifakis S, Pharmakides G. Anemia in pregnancy. Ann N Y Acad Sci. 2000;900(1):125–36.

    Article  CAS  Google Scholar 

  3. WHO. Worldwide prevalence of anaemia 1993–2005: WHO global database on anaemia. Geneva: WHO; 2008. http://apps.who.int/iris/handle/10665/43894. Accessed 10 Oct 2015.

  4. Cheesbrough M. District laboratory practice in tropical countries. Part 2. 2nd ed. Cambridge: Cambridge University Press; 2006.

    Book  Google Scholar 

  5. Perkins S. Diagnosis of anemia: practical diagnosis of hematologic disorders. Chicago: ASCP Press; 2006. p. 3–16.

    Google Scholar 

  6. Balcı YI, Karabulut A, Gürses D, Çövüt İE. Prevalence and risk factors of anemia among adolescents in Denizli, Turkey. Iran J Pediatr. 2012;22(1):77.

    Google Scholar 

  7. Argaw B, Argaw-Denboba A, Taye B, Worku A, Worku A. Major risk factors predicting anemia development during pregnancy: unmatched-case control study. J Community Med Health Educ. 2015;5:353.

    Google Scholar 

  8. Melku M, Addis Z, Alem M, Enawgaw B. Prevalence and predictors of maternal anemia during pregnancy in Gondar, Northwest Ethiopia an institutional based cross-sectional study. Cairo: Hindawi Publishing Corporation; 2014.

    Google Scholar 

  9. Getachew M, Yewhalaw D, Tafess K, Getachew Y, Zeynudin A. Anemia and associated risk factors among pregnant women in Gilgel Gibe dam area, Southwest Ethiopia. Parasit Vectors. 2012;5(1):1–8.

    Article  Google Scholar 

  10. Stevens GA, Finucane MM, De-Regil LM, Paciorek CJ, Flaxman SR, Branca F, Peña-Rosas JP, Bhutta ZA, Ezzati M, Nutrition Impact Model Study Group. 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.

    Article  Google Scholar 

  11. Jufar AH, Zewde T. Prevalence of anemia among pregnant women attending antenatal care at tikur anbessa specialized hospital, Addis Ababa Ethiopia. J Hematol Thromboembol Dis. 2014;2:125.

    Google Scholar 

  12. Wadgave HV. Burden of anemia among the pregnant women in rural Area. Health Line. 2011;2:76–7.

    Google Scholar 

  13. Ugwuja EI, Ogbonnaya LU, Obuna AJ, Awelegbe F, Uro-Chukwu H. Anemia in relation to body mass index (BMI) and socio-demographic characteristics in adult Nigerians in Ebonyi state. J Clin Diagn Res. 2015;9(1):4–7.

    Google Scholar 

  14. Siteti MC, Namasaka SD, Ariya OP, Injete SD, Wanyonyi WA. Anemia in pregnancy: prevalence and possible risk factors in Kakamega County, Kenya. Sci J Pub Health. 2014;2(3):216–22.

    Article  Google Scholar 

  15. Shamah-levy T, Villalpando S, Rivera JA, Mejía-Rodríguez F, Camacho-Cisneros M, Monterrubio EA. Anemia in Mexican women: a public health problem. Salud Pública de México. 2003;45:499–507.

    Article  Google Scholar 

  16. Kefiyalew F, Zemene E, Asres Y, Gedefaw L. Anemia among pregnant women in Southeast Ethiopia: prevalence, severity and associated risk factors. BMC Res Notes. 2014;7(1):771.

    Article  Google Scholar 

  17. Obse N, Mossie A, Gobena T. Magnitude of anemia and associated risk factors among pregnant women attending antenatal care in Shalla Woreda, West Arsi Zone, Oromia Region, Ethiopia. Ethiop J Health Sci. 2013;23(2):165–73.

    PubMed  PubMed Central  Google Scholar 

  18. Gebremedhin S, Enquselassie F. Correlates of anemia among women of reproductive age in Ethiopia: evidence from Ethiopian DHS 2005. Ethiop J Health Dev. 2011;25(1):22–30.

    Article  Google Scholar 

  19. Haidar J. Prevalence of anemia, deficiencies of iron and folic acid and their determinants in Ethiopian women. J Health Popul Nutr. 2010;28(4):359–68.

    Article  Google Scholar 

  20. Melku M, Agmas A. Maternal anemia during pregnancy in Bahr Dar Town, Northwestern Ethiopia: a facility-based retrospective study. Appl Med Res. 2015;1:2–7.

    Article  Google Scholar 

  21. Tadesse S, Ashenafi H, Aschalew Z. Seroprevalence study of newcastle disease in local chickens in central Ethiopia. Intern J Appl Res Vet Med. 2005;3(1):25–9.

    Google Scholar 

  22. Thanoon AM. Thrombocytopenia in Iraqi pregnant women. J Fac Med. 2011;53(2):171.

    Google Scholar 

  23. Shamoon RP, Muhammed NS, Jaff MS. Prevalence and etiological classification of thrombocytopenia among a group of pregnant women in Erbil City, Iraq. Turk J Hematol. 2009;26:123.

    Google Scholar 

  24. Dwivedi P, Puri M, Nigam A, Agarwal K. Fetomaternal outcome in pregnancy with severe thrombocytopenia. Eur Rev Med Pharmacol Sci. 2012;16(11):1563–6.

    CAS  PubMed  Google Scholar 

  25. Nisha S, Amita D, Uma S, Tripathi AK, Pushplata S. Prevalence and characterization of thrombocytopenia in pregnancy in Indian women. Indian J Hematol Blood Transf. 2012;28(2):77–81.

    Article  Google Scholar 

  26. Ifeanyi OE, Ndubuisi OT, Leticia EOB, Uche EC. Haematological profile of pregnant women in Umuahia, Abia State, Nigeria. Int J Curr Microbiol App Sci. 2014;3(1):713–8.

    Google Scholar 

  27. James TR, Reid HL, Mullings AM. Are published standards for haematological indices in pregnancy applicable across populations: an evaluation in healthy pregnant Jamaican women. BMC Pregn Childbirth. 2008;8(1):8.

    Article  CAS  Google Scholar 

  28. Queen E, Ifeanyi OE, Chinedum OK. Evaluation haematological parameters among pregnant women attending antenatal clinic in College of Health Demonstration Clinic, Port Harcourt. J Dental Med Sci. 2014;13(9):122–7.

    Google Scholar 

Download references

Authors’ contributions

DS designed and conducted all data collection procedures, analyzed and interpreted the results. DS, YM and TZ participated in proposal development and final paper write up. YM prepared the manuscript. All authors read and approved the final manuscript.

Acknowledgements

The authors would like to acknowledge the laboratory and ANC staffs of DBRH for their support and involvement in data collection processes. In addition, our special thanks and appreciation goes to all pregnant women who voluntarily participated in this study.

Competing interests

The authors declare that they have no competing interests.

Availability of data and materials

The data is available in public library of Addis Ababa University in a form of hard copy as part of graduate student thesis document.

Consent for publication

Not applicable.

Ethics approval and consent to participate

This study was carried out after ethical approval was obtained from ethical and research committee of Physiology Department, Addis Ababa University and permission was obtained from DBRH administration for data and sample collection. Then, verbal consent (approved by the ethical and research committee) was obtained from each participant before starting the interview and taking blood samples for research purpose. All study subjects were given orientation regarding the aims, risks and benefits associated with the study. In addition, each participant were informed about their right of withdrawing the study without restriction whenever necessary.

The verbally obtained informed consent was documented as that of the individual data collection questionnaire because it was filled as ‘agree’ or ‘disagree’ alternatives by the interviewer.

Funding

Addis Ababa University was the source of financial support for the completion of this work.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Yalew Molla.

Additional file

Additional file 1.

Socio-demographic characteristic of pregnanat women at Debre Birhan Referral Hospital, North Shoa, Ethiopia, October to January, 2015.

Rights and permissions

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shitie, D., Zewde, T. & Molla, Y. Anemia and other hematological profiles of pregnant women attending antenatal care in Debre Berhan Referral Hospital, North Shoa, Ethiopia. BMC Res Notes 11, 704 (2018). https://doi.org/10.1186/s13104-018-3805-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s13104-018-3805-8

Keywords