Psychological and Social Factors Associated with Late Pregnancy Iron Deficiency Anaemia in Rural Viet Nam: A Population-Based Prospective Study

Abstract

ObjectivesThe aim of this study was to examine the relationships between psychological and social factors and late pregnancy IDA among pregnant women in rural Viet Nam.MethodsPregnant women from 50 randomly-selected communes within Ha Nam province were recruited and assessed at 12 - 20 weeks gestation (Wave 1, W1). They were followed up in the last trimester (Wave 2, W2). IDA was defined as Haemoglobin < 11 g/dL and serum ferritin < 15 ng/mL. Symptoms of Common Mental Disorders (CMD) were assessed by the Edinburgh Postnatal Depression Scale-Vietnam (EPDS-V). Persistent antenatal CMD was defined as having an EPDS-V score ≥ 4 in both W1 and W2. Hypothesis models were tested by Structural Equation Modeling analyses.ResultsA total of 378 women provided complete data at both W1 and W2. The incidence risk of IDA in the third trimester was 13.2% (95% confidence interval (CI): 9.8-16.7). Persistent CMD was found in 16.9% (95% CI: 13.1-20.7) pregnant women and predicted by intimate partner violence, fear of other family members, experience of childhood abuse, coincidental life adversity, and having a preference for the sex of the baby. There was a significant pathway from persistent CMD to IDA in late pregnancy via the length of time that iron supplements had been taken. Receiving advice to take iron supplements and higher household wealth index were indirectly related to lower risk of late pregnancy IDA. Early pregnancy IDA and being multi-parous also contributed to late pregnancy IDA.ConclusionsAntenatal IDA and CMD are prevalent public health problems among women in Viet Nam. The link between them suggests that while direct recommendations to use iron supplements are important, the social factors associated with common mental disorders should be addressed in antenatal care in order to improve the health of pregnant women and their infants.

Maternal Morbidity and Co-morbidity During and After Pregnancy in Women in Low- and Middle-Income Countries: A Systematic Literature Review

“…Four studies were observational prospective cohort studies . 13,17,18,19 One study was a case control study. 20 All 25 studies used faceto-face interviews or consultations to collect self-reported primary data from women using questionnaires.…”

“…In four studies, clinical examination and/or laboratory tests were also conducted. 6,18,21,22 Three studies extracted data using secondary data analysis of large databases of hospital admissions, discharges or birth registers. 23,24,25 In these secondary data analyses authors used their own data collection tool, with little details of the variables extracted.…”

“…Nine studies assessed <500 women per study ; [22][23][24][25][26][27][28][29][30][31][32][33][34] thirteen studies assessed 500-999 women per study. 13,16,18,19,[35][36][37][38][39][40][41][42] Nine studies assessed 1000-1999 women per study; 17,20,25,26,[43][44][45][46][47] and five studies had a sample size of ≥2000 women ( Supplementary Table 2). 6,23,24,48,49…”

“…A total of 23 studies collected data from women during pregnancy: in the second trimester; 14,17,30,39,46 in the third trimester; 18,22,36 or at any time during pregnancy. 19,29,32,33 In 11 of the 23 studies, the gestation was not given .…”

“…27,31,33,41 In 12 studies, data collection took place in the community or home of women ( Supplementary Table 2). 6,17,18,20,22,28,36,39,41,44,45,48,49 Data collection…”