Beyond hemoglobin: uncovering iron deficiency and iron deficiency anemia using serum ferritin concentration among pregnant women in eastern Ethiopia: a community-based study

Abstract

Background Although the high burden of anemia among pregnant women in low-resource settings like Ethiopia is well documented, evidence is scarce on the underlying causes using biochemical tests. Therefore, this study assessed the iron status and factors associated with iron deficiency (ID) using serum ferritin concentration among pregnant women in Haramaya district, eastern Ethiopia. Methods A community-based cross-sectional study was conducted among randomly selected pregnant women in Haramaya district, eastern Ethiopia. The serum ferritin (SF) concentration was measured in the National Biochemical Laboratory of Ethiopia on a fully automated Cobas e411 (German, Japan Cobas 4000 analyzer series) immunoassay analyzer using the electro-chemiluminescence (ECL) method and standard procedures. A log-binomial regression analysis identified variables associated with iron deficiency, and defined as serum ferritin concentration < 15 μg/L (per the World Health Organization recommendation in developing countries). An adjusted risk ratio (aRR), and a 95% confidence interval (CI), were used to report associations. Finally, the p-value < 0.05 was the cut-off point for the significant association. Results A total of 446 pregnant women with a mean age of 24.78 (+ 5.20) were included in the study. A total of 236 (52.91%; 95% CI: 48.16–57.63) had iron deficiency. The overall prevalence of anemia and iron deficiency anemia (IDA) was 45.96% (95% CI: 41.32–50.71) and 28.03% (95% CI: 21.27–32.44), respectively. The risk of iron deficiency was more likely among women with low dietary diversity (aRR = 1.36; 95% CI = 1.07–1.72) and those who skipped meals (aRR = 1.29; 95% CI = 1.05–1.57), but less among women who had antenatal care (aRR = 0.73 (95% CI = 0.61–0.88). Conclusion More than half of the pregnant women in eastern Ethiopia had iron deficiency. Improving dietary diversity, meal frequency, and prenatal follow-up is essential to improve the high burden of ID and the adverse effect on pregnant women and the fetus. Moreover, a prospective study comparing maternal and perinatal outcomes among these spectra—iron depletion, ID, and IDA—is crucial for understanding their impact on maternal and perinatal mortality and morbidity.

Chrononutrition during Pregnancy and Its Association with Maternal and Offspring Outcomes: A Systematic Review and Meta-Analysis of Ramadan and Non-Ramadan Studies

“…Three articles examined the association of meal skipping with maternal nutritional status. Two cross-sectional studies from Ethiopia showed that skipping meals during pregnancy was positively associated with under-nutrition (OR = 3.9, 95% CI: 1.09, 13.53) [ 22 ] and iron deficiency anemia [ 23 ] (RR = 1.29; 95% CI: 1.05, 1.57). The third cross-sectional study from Japan showed that healthy pregnant women who skipped breakfast two or more times per week ( n = 37) had lower intakes of protein after adjusting for energy intakes than those who did not skip breakfast ( n = 60) ( p = 0.019).…”

“…In summary, these results indicate that skipping meals during pregnancy may be related to maternal malnutrition [ 22 , 23 , 24 ], GDM [ 25 ], and weight status [ 26 ]. However, since most studies are cross-sectional in nature, it is unclear whether these associations are causal.…”

“… Associations of meal skipping with maternal and birth outcomes. Regression coefficient: beta estimates ( β ); docosahexaenoic acid (DHA); eicosapentaenoic acid (EPA); gestational diabetes mellitus (GDM); odds ratio (OR); relative risk (RR); postpartum weight retention (PPWR) [ 20 , 21 , 22 , 23 , 24 , 25 , 26 ]. …”

“…In this systematic review, the chrononutrition factors investigated in the original studies could be broadly classified into four categories: meal skipping, night eating, meal frequency, and (Ramadan) fasting. We found that meal skipping and night eating have a potential adverse influence on maternal and birth outcomes, including increased PPWR [ 26 ], GWG [ 30 ], risk of spontaneous preterm delivery [ 20 , 21 ], insomnia [ 28 ], impaired maternal nutritional status [ 22 , 23 ], and impaired glucose metabolism [ 25 , 32 , 33 ]. However, in the meal skipping literature, it is unclear whether these associations were causal, as most studies were cross-sectional in nature.…”

Birth prevalence and risk factors of neural tube defects in Ethiopia: a systematic review and meta-analysis

“…In this regard, the burden is nearly 2–3 times higher in the regions of Tigray, Harari and Somalia as compared with the national estimate 64 96. This variation may be explained by the fact that 78% of women within the reproductive age group had low RBC folate concentrations and the concentrations become much lower among pregnant women 107 108. Additionally, ecologically, the burden is disproportionately concentrated in the highland sorghum khat mixed farming system 109.…”