Investigation On Incidence Of Anemia And Serum Ferritin Level Among 3262 Women During Second And Third Trimester

Objective:Maternal blood volume during pregnancy than non pregnancy increased by about 40%-45%, the plasma volume increased more than red blood cells, blood appears relatively dilute states, easy to cause the occurrence of anemia, especially iron deficiency anemia. Domestic regional data show that the incidence of anemia associated with the level of economic development. Nanjing situated in the center of the low reaches of the Yangtze River, economy is more developed, people’s living conditions also richer, to understand how the prevalence of maternal anemia and iron deficiency during pregnancy and their relationship with adverse pregnant outcomes, so this research is designed.Methods:Date of 3262 gravidas, who received prenatal care and delivered at Drum Tower Hospital from October 1,2013 to October 31,2014.were retrospectively collected and analyzed. Blood routine test was performed for all subjects both at the second (20-22 weeks) and third trimesters (38 weeks of gestation or before delivery) using automatic blood analyzer. Moreover, serum ferritin level was determined at the second trimester with microparticle chemiluminescence immunoassay.Treatment was offered to those diagnosed as iron deficiency anemia or severe iron deficiency, and the adverse pregnancy outcomes were analyzed. chi-square test and Trend chi-square test were performed for statistics.Result:1.601(18.42%) anemia patients were found among 3262 mid-trimester pregnant women,345 cases among anemia in mid-trimester pregnancies were iron deficiency anemia and accounted for 57.40%(345/601). There were 285 new-onset anemia pregnancies in last trimester, With 206 cases is iron deficiency anemia, accounted for 72.28% of new-onset anemia (206/285).The total prevalence of anemia in pregnancy was 27.16%(886/3262), and the proportion of iron deficiency anemia was 62.19% (551/886).2. The mean serum ferritin level in 3262 pregnancies at the second trimester was (29.4±30.12) ng/ml, and 1565 (47.98%) were diagnosed as iron deficiency at the same period.3.73.88% (444/601) of anemia in mid-trimester pregnancies was cured at last trimester, similar, the cure rate of iron deficiency anemia was 72.46% (250/345).4. Most anemia is normocytic normochromic anemia in the second trimester of pregnancy.There were more women with microcytic hypochromic anemia in the late-trimester than in the mid-trimester [19.93% (60/301) vs 4.93% (17/345),χ2= 34.478, P<0.01].5. Among women with serum ferritin≥30、≥20～ <30、≥10～<20 and <10 ng/ml, the prevalence of mild anemia in mid-trimester were 13.33% (142/1065),14.40%(91/632),14.71% (130/884) and 24.82%(169/681), the prevalence of new-onset anemia in the third trimester was 3.94%(42/1065),5.85% (37/632),12.78%(113/884) and 13.66%(93/681) respectively. The lower the serum ferritin level, the higher the prevalence of anemia in the mid-trimester(trend χ2= 30.697, P<0.01) and the new-onset anemia in last trimester(trend χ2= 69.871, P<0.01).6. The Age ≤23 years and the body mass index<18.5 in pre-pregnancy or first trimester, anemia prevalence rate increased during the second and third trimester of pregnancy, the body mass index ≥24-≤30 and maternal weight gain< 10kg,anemia prevalence rate decreased, P<0.05.7. The lower the serum ferritin level, the higher the proportion of red blood cell volume distribution width increased, the proportion of red blood cell volume distribution width increased significantly in pregnant women with serum ferritin < 20 ng/ml at the third trimester. The mid-trimester pregnancy normal group 12.82%(130/1014) vs the last trimester normal group 44.87%(455/1014),χ2= 253.754, P<0.001, The mid-trimester anemia group 19.78% (109/551) vs the last trimester anemia group 73.50% (405/551),χ2= 319.466, P<0.001.8. The incidence of postpartum hemorrhage in pregnancies with serum ferritin level at ≥10 but<20ng/ml was significantly higher than those normal one [20.39%(52/255) vs 11.92%(75/629),χ2=10.577, P<0.01].9. Neither serum ferritin level nor anemia was associated with other adwerse pregnancy outcomes. Iron deficiency and anemia in pregnant women with untreated group, the incidence of gestational hypertension and preeclampsia[6.77%(13/192) vs 3.17%(22/694), χ2 =5.139, P<0.05], premature rupture of membrane [28.65%(55/192) vs 21.33% (148/694),χ2=4.563, P<0.05], postpartum hemorrhage[22.92%(44/192) vs 15.42%(107/694),χ2=5.982, P<0.05] higher than the treatment group.Conclusions:In the second and third trimester of pregnancy anemia total prevalence rate of 27.16%, iron deficiency anemia total prevalence rate of 16.89%, and 1565 (47.98%) were diagnosed as iron deficiency in the second trimester. The lower the serum ferritin level at mid-trimester, the higher the incidence of anemia, the lower the serum ferritin level, the higher the proportion of red blood cell volume distribution width increased. The pregnancy increased serum ferritin and routine blood test, for treatment of iron deficiency and iron deficiency anemia during pregnancy have important practical significance, for iron deficiency and anemia during pregnancy pregnant women to give positive iron supplement, can effectively improve the pregnancy outcome and promote maternal and infants health.