Main Article Content
Background: One of common complications of pregnancy is an anemia which is effected by various causes. Anemia can develop throughout the pregnancy period and increase in severity upon the gestation times. WHO recommends all pregnant women should attend an antenatal care (ANC) unit in the first trimester of gestation for healthy promotion and complication prevention during pregnancy and after birth.
Objectives: The aim of this preliminary study is to find out the prevalence and causes of anemia in pregnant women who start attending an ANC program at different time points of gestation.
Materials and methods: Cross-sectional study was performed during May 2015 -February 2016. Hematological parameters were examined in all 190 pregnant women attended the ANC unit at Nayong Hospital. Participants were divided into three groups according to period of gestation at the first time of ANC admission. Serum ferritin, thalassemia screening, and hemoglobin typing were determined in anemia cases to analyze causes of anemia. Prevalence of anemia at each time point ANC attended groups were calculated. Mann-Whitney U test was used to compare the different of parameters between the groups.
Results: Prevalence of anemia in all attended pregnant women was 22.1%. According to the period of gestation at the first time of ANC admission, the prevalence of anemia was 17.2% (15 of 87) at the first trimester group, 22.5% (20 of 89) at the second trimester, and 50.0% (7 of 14) at the third trimester group. Levels of hemoglobin and hematocrit of the second and the third groups were significantly different from the first trimester group with p<0.05. MCHC of the third trimester group showed significantly different from both the first and second trimester groups, p<0.05. Causes of anemia were thalassemia/abnormal hemoglobin carriers in 11 cases (5.8%), Iron deficiency anemia (IDA) in 10 cases (5.3%), IDA with thalassemia/abnormal hemoglobin carriers in 6 cases (3.2%), and anemia with other causes in 15 cases (7.9%). For thalassemia cases, HbE trait without α-thalassemia had the highest prevalence (44.4%). There were two cases of severe anemia, which were Hb H-CS disease and IDA.
Conclusion: Prevalence of anemia in pregnant women in this presentation was still high and increased throughout the period of gestation. Causes of anemia, such as IDA, can be prevented by early attention to an ANC unit. The promotion of an ANC program for married couples and adolescent women should be considered to improve maternal and fetal health quality during pregnancy and after-birth.
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Personal views expressed by the contributors in their articles are not necessarily those of the Journal of Associated Medical Sciences, Faculty of Associated Medical Sciences, Chiang Mai University.
 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.
 Gupta PM, Hamner HC, Suchdev PS, Flores-Ayala R, Mei Z. Iron status of toddlers, non-pregnant females, and pregnant females in the United States. Am J Clin Nutr 2017; 106 (Suppl 6): S1640-6.
 Krafft A, Murray-Kolb L, Milman N. Anemia and iron deficiency in pregnancy. J Pregnancy 2012; 2012: 241869. doi: 10.1155/2012/241869
 Milman N. Iron and pregnancy--a delicate balance. Ann Hematol 2006; 85(9): 559-65.
 Sharma JB, Shankar M. Anemia in pregnancy. JIMSA 2010; 23(4): 253-260.
 Chandra S, Tripathi AK, Mishra S, Amzarul M, Vaish AK. Physiological changes in hematological parameters during pregnancy. Indian J Hematol Blood Transfus 2012; 28(3): 144-6.
 Milman N. Iron in pregnancy: How do we secure an appropriate iron status in the mother and child? Ann Nutr Metab 2011; 59(1): 50-4.
 Petrakos G, Andriopoulos P, Tsironi M. Pregnancy in women with thalassemia: challenges and solutions. Int J Womens Health 2016; 8: 441-51.
 Leelahavarong P, Chaikledkaew U, Hongeng S, Kasemsup V, Lubell Y, Teerawattananon Y. A cost-utility and budget impact analysis of allogeneic hematopoietic stem cell transplantation for severe thalassemic patients in Thailand. Bmc Health Serv Res 2010; 10: 209. doi: 10.1186/1472-6963-10-209.
 Gulino FA, Vitale SG, Fauzia M, Cianci S, Pafumi C, Palumbo MA. Beta-Thalassemia major and pregnancy. Bratisl Lek Listy 2013; 114(9): 523-5.
 WHO. WHO recommendations on antenatal care for a positive pregnancy experience. World Health Organization 2016.
 Cao C, O'Brien KO. Pregnancy and iron homeostasis: an update. Nutr Rev 2013 Jan; 71(1): 35-51.
 WHO. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. World Health Organization 2011.
 Fucharoen S, Winichagoon P. Haemoglobinopathies in Southeast Asia. Indian J Med Res 2011; 134(4): 498-506.
 Banyatsuppasin W, Jindadamrongwech S, Limrungsikul A, Butthep P. Prevalence of Thalassemia and Glucose-6-Phosphate Dehydrogenase Deficiency in Newborns and Adults at the Ramathibodi Hospital, Bangkok, Thailand. Hemoglobin 2017; 41(4-6): 260-6.
 Sirichotiyakul S, Jatavan P, Traisrisilp K, Tongsong T. Pregnancy Outcomes Among Women with Homozygous Hemoglobin E Disease: A Retrospective Cohort Study. Matern Child Health J 2016; 20(11): 2367-71.
 Punyanuch J, Suchada R, Waraporn G, Yaowapa S, Sangkae C, Kitti T, et al. Diagnostic applications of newborn screening for α-thalassaemias, haemoglobins E and H disorders using isoelectric focusing on dry blood spots. Ann Clin Biochem 2013; 51(2): 237-47.
 Fucharoen S, Winichagoon P. Clinical and hematologic aspects of hemoglobin E beta-thalassemia. Curr Opin Hematol 2000 Mar; 7(2): 106-12.
 Nuntakarn L, Fucharoen S, Fucharoen G, Sanchaisuriya K, Jetsrisuparb A, Wiangnon S. Molecular, hematological and clinical aspects of thalassemia major and thalassemia intermedia associated with Hb E-beta-thalassemia in Northeast Thailand. Blood Cells Mol Dis 2009; 42(1): 32-5.
 Engwa GA, Unaegbu M, Unachukwu MN, Njoku M-GC, Agbafor KN, Mbacham WF, et al. Low serum ferritin and G6PD deficiency as potential predictors of anaemia in pregnant women visiting Prime Care Hospital Enugu Nigeria. BMC Res Notes 2017; 10(1): 721. doi: 10.1186/s13104-017-3051-5