Rate and predictors of low serum ferritin levels among healthy parturient women in Enugu, Nigeria

Abstract

BackgroundLow serum ferritin levels signify low iron stores and this could predispose to iron deficiency anemia.ObjectiveTo determine the rate and predictors of low serum ferritin levels during the puerperium in Enugu, Southeast Nigeria.Study designA hospital-based prospective longitudinal study involving parturient women who delivered singleton fetuses at term. Venous blood samples were collected to determine the serum ferritin concentration at 48 hours and 6 weeks postpartum. Data analysis involved descriptive and inferential statistics at 95% confidence interval (CI) using Statistical Package for Social Sciences (SPSS) computer software version 20.0.ResultsTwo-hundred and two women who carried singleton pregnancies to term were studied. The mean serum ferritin levels at 48 hours and 6 weeks were 27.82±18.41 µg/L and 36.12±21.53 µg/L, respectively. Forty-eight hours postdelivery, 29.2% had low ferritin levels and this decreased to 12.4% at 6 weeks postpartum. There was a significant positive correlation between the serum ferritin level at 48 hours postdelivery and the serum ferritin level at 6 weeks postpartum (r=0.89, P<0.001). Predictors of the low ferritin level at 6 weeks included age <20 years (odds ratio [OR] =0.70, 95% CI =0.53, 0.93), multiparity (OR =63.7, 95% CI =3.18, 127.5), anemia at 48 hours postpartum (OR =61.7, 95% CI =13.27, 116.6), a low ferritin level at 48 hours (OR =78.1, 95% CI =8.8, 108.3), and intake of antenatal hematinics for <3 months (OR =0.04, 95% CI =0.01, 0.20).ConclusionThere was a significant occurrence of low ferritin levels during the puerperium in the study centers, and this was associated mainly with pregnancy and delivery factors. Efforts to improve the iron stores in parturient women could benefit from early booking and compliance with antenatal hematinics and optimizing hemoglobin and iron levels before delivery.

Randomized Trial of Effect of Energy Dense Biscuits in Under Nourished Pregnant Women on Birth Weight of their Newborns in Low Income Peri-urban Settings of Karachi

“…There was however, a higher maternal Ferritin level, one of the secondary outcomes, in the intervention group suggesting there was a replenishment of iron stores with high energy biscuits. It is widely accepted that serum ferritin remains the best indicator of iron stores in the absence of inflammation [17] and poor compliance to iron supplements during pregnancy are associated anaemia in puerperium even [18]. Though we cannot exclude inflammation as a contributor to the difference, there was no clinical reason to suspect this.…”

Effect of treatment with single total-dose intravenous iron versus daily oral iron(III)-hydroxide polymaltose on moderate puerperal iron-deficiency anemia

“…Two recent studies from our center had shown that the level of anemia at 6 weeks postpartum was high among low risk parturients and that iron-deficiency anemia contributed significantly to this finding 16,30. From anecdotal evidence, it would appear that considerable uncertainty about patient’s compliance with daily oral iron postdelivery existed and that noncompliance with oral therapy could be contributing to this high level of puerperal anemia.…”

“…Two recent studies from our center had shown that the level of anemia at 6 weeks postpartum was high among low risk parturients and that iron-deficiency anemia contributed significantly to this finding. 16 , 30 From anecdotal evidence, it would appear that considerable uncertainty about patient’s compliance with daily oral iron postdelivery existed and that noncompliance with oral therapy could be contributing to this high level of puerperal anemia. In order to address the problem of compliance with oral iron following delivery, we conducted this study to determine if a single total dose of intravenous iron given to parturients 48 hours after delivery would be as effective as the current practice of daily oral doses of ferric iron given for 6 weeks.…”

Frequency of Serum Ferritin Level in Non-Anemic Pregnant Women Presenting at Hospital

“…Pregnancy is associated with physiological changes that results in increased plasma volume and red blood cells and decreased concentration of micronutrients like (iron, folic acid and vitamin B12) [1] . Physiological alterations in plasma volume and red cell mass diminish the reliability of Hb estimation or determination of hematocrit, due to increase demand of iron as a result of fetal and placental growth as well as expansion of blood volume [2] . It is well known fact that hemoglobin concentration falls during pregnancy principally as a result of hemodilution.…”