Prevalence and Factors Associated with Anemia Pregnancy in a Group of Moroccan Pregnant Women
Author(s)
Nadia Hasswane1,
Amal Bouziane2,
Mustapha Mrabet3,
Fatima Zahra Laamiri4,
H. Aguenaou5,
Amina Barkat1
Affiliation(s)
1 Faculty of Medicine and Pharmacy/Research Team in Maternal and Child Health and Nutrition, Mohammed V University, Rabat, Morocco. 2 Biostatistics and Clinical Research Laboratory and Epidemiology, Faculty of Medicine and Pharmacy of Rabat, Rabat, Morocco. 3 Laboratory of Hygiene and Community Medicine, Military Hospital of instruction Mohamed V in Rabat, Rabat, Morocco. 4 Health Research Team Nutrition for Mothers and Children, Mohammed V University, Rabat, Morocco. 5 Mixed Research Unit in Nutrition and Food URAC 39, (University Ibn Tufail-CNESTEN) Designated Regional Center of Nutrition Associate AFRA/IAEA, Kenitra, Morocco.
1 Faculty of Medicine and Pharmacy/Research Team in Maternal and Child Health and Nutrition, Mohammed V University, Rabat, Morocco. 2 Biostatistics and Clinical Research Laboratory and Epidemiology, Faculty of Medicine and Pharmacy of Rabat, Rabat, Morocco. 3 Laboratory of Hygiene and Community Medicine, Military Hospital of instruction Mohamed V in Rabat, Rabat, Morocco. 4 Health Research Team Nutrition for Mothers and Children, Mohammed V University, Rabat, Morocco. 5 Mixed Research Unit in Nutrition and Food URAC 39, (University Ibn Tufail-CNESTEN) Designated Regional Center of Nutrition Associate AFRA/IAEA, Kenitra, Morocco.
ABSTRACT
Background: Pregnancy is typically accompanied by an increase of micronutrient requirements in general and especially iron. This increased need may be an additional risk factor for developing anemia. Purpose of the study: The aim of this study is to provide data on the prevalence of anemia of pregnancy in the maternity ward of the regional hospital in the city of Temara, and examine risk factors that may expose women to anemia during pregnancy. Materiel and Methods: A prospective cross-sectional study of a year was conducted to the hospital Sidi Lahcen in the city of Temara. Sociodemographic and nutritional data were collected through a questionnaire, obstetric and medical histories of women in labor and the results of biological tests were recorded from the patient obstetric file. Results: Among the 849 women surveyed, 690 (82%) had performed a blood count, and among these 117 (16.8%) were found anemic, with the following proportions: 57.6% had mild anemia, 41.5% had moderate anemia and a minority (0.8%) had severe anemia. The pregnant women aged over 35 years were the most exposed to anemia during pregnancy (47%) compared with younger women (p < 0.001). Women who had a history of anemia aside from pregnancy and those who had anemia in earlier pregnancies were more prone to developing anemia in the current pregnancy with a statistically significant difference (p < 0.001). The number of pregnancies, number of previous abortions and place of residence had no influence on the occurrence of anemia of pregnancy. The consumption of fortified flour with iron and vitamins as well as consuming iron rich foods was not a protective factor against the development of anemia of pregnancy. Tea consumption near the meal was not a factor exposing to anemia during pregnancy. Conclusion: Anemia is a public health problem in Morocco. Evidence from our study emphasizes the need to implement educational programs to improve the nutritional knowledge and sensitization of women.
Background: Pregnancy is typically accompanied by an increase of micronutrient requirements in general and especially iron. This increased need may be an additional risk factor for developing anemia. Purpose of the study: The aim of this study is to provide data on the prevalence of anemia of pregnancy in the maternity ward of the regional hospital in the city of Temara, and examine risk factors that may expose women to anemia during pregnancy. Materiel and Methods: A prospective cross-sectional study of a year was conducted to the hospital Sidi Lahcen in the city of Temara. Sociodemographic and nutritional data were collected through a questionnaire, obstetric and medical histories of women in labor and the results of biological tests were recorded from the patient obstetric file. Results: Among the 849 women surveyed, 690 (82%) had performed a blood count, and among these 117 (16.8%) were found anemic, with the following proportions: 57.6% had mild anemia, 41.5% had moderate anemia and a minority (0.8%) had severe anemia. The pregnant women aged over 35 years were the most exposed to anemia during pregnancy (47%) compared with younger women (p < 0.001). Women who had a history of anemia aside from pregnancy and those who had anemia in earlier pregnancies were more prone to developing anemia in the current pregnancy with a statistically significant difference (p < 0.001). The number of pregnancies, number of previous abortions and place of residence had no influence on the occurrence of anemia of pregnancy. The consumption of fortified flour with iron and vitamins as well as consuming iron rich foods was not a protective factor against the development of anemia of pregnancy. Tea consumption near the meal was not a factor exposing to anemia during pregnancy. Conclusion: Anemia is a public health problem in Morocco. Evidence from our study emphasizes the need to implement educational programs to improve the nutritional knowledge and sensitization of women.
Cite this paper
Hasswane, N. , Bouziane, A. , Mrabet, M. , Laamiri, F. , Aguenaou, H. and Barkat, A. (2015) Prevalence and Factors Associated with Anemia Pregnancy in a Group of Moroccan Pregnant Women. Journal of Biosciences and Medicines, 3, 88-97. doi: 10.4236/jbm.2015.310012.
Hasswane, N. , Bouziane, A. , Mrabet, M. , Laamiri, F. , Aguenaou, H. and Barkat, A. (2015) Prevalence and Factors Associated with Anemia Pregnancy in a Group of Moroccan Pregnant Women. Journal of Biosciences and Medicines, 3, 88-97. doi: 10.4236/jbm.2015.310012.
References
[1] El Guindi, W., Pronost, J., Carles, G., et al. (2004) Anémies maternelles sévères et issues de grossesse. Journal de Gynécologie Obstétrique et Biologie de la Reproduction, 33, 506-509.
http://dx.doi.org/10.1016/S0368-2315(04)96563-5 [2] Bonnies, W.R. and Sue, R.W. (1993) Nutrition in Pregnancy and Lactation. Mosby-Year Book, 5-1993, p. 537. [3] Recommandations OMS (2003) Soins liés à la grossesse, accouchement et période prénatale. Guide des pratiques essentielles. Dépister une anémie. [4] MS (2000) Enquête nationale sur l’anémie par carence en fer, la supplémentation et la couverture des ménages par le sel iodé. Ministère de la Santé Rabat Maroc. [5] Goldwater, P.N., Giles, N. and Bettelheim, K.A. (1998) An Unusual Case of Microangiopathie Heamolytic Anaemia Associated with Enteroheamorrhagic Escherichia coli 0113: H21 Infection, a Verocytotoxin-2/Shiga Toxin-2 Producing Serotype. Journal of Infection, 37, 302-304.
http://dx.doi.org/10.1016/S0163-4453(98)92324-6 [6] Ramirez-Mateos, C., Loría, A., Nieto-Gómez, M., Malacara, J.M. and Piedras, J. (1998) Anemia and Iron Deficiency in 490 Mexican Pregnant Women. Revista de Investigacion Clinica, 50, 119-126. [7] Szarfarc, S.C. and De Souza, S.B. (1997) Prevalence and Risk Factors in Iron Deficiency and Anemia. Archivos Latinoamericanos de Nutrición, 47, 35-38. [8] Assami, M., Hercberg, S., et al. (1987) Evaluation de l’état nutritionnel de femmes algériennes en age de procréer vivant en zones urbaine, rurale et semi-rurale. Annals of Nutrition & Metabolism, 31, 237-244.
http://dx.doi.org/10.1159/000177274 [9] Ould Dehah, C.M.H., Guiro, A.T. and Cisse, D. (1999) Effets de deux variétés de thé sur la biodisponibilité du fer d’aliments mauritaniens. [10] Coulibaly, M., Costagliola, D., Zittoun, J. and Mary, J.Y. (1987) évaluation de l’état nutritionnel de femmes enceintes à partir de paramètres hémato biologiques, suite à un déplacement de populations au nord du Cameroun. IIIème Journées Scientifiques Internationales du GERM, p. 46. [11] Baidy, B.L.O., Kone, Y. and ET Bassirou, L.Y. (1996) Anémie nutritionnelle de la grossesse à Nouakchott. Médecine d’Afrique Noire, 43, 355-359. [12] Fleming, A.F. (1990) Malaria Deficiencies of Iron and Folates, and Anemia in Pregnancy in the Guinea Savanna of Nigeria. In: Hercberg, S., Galan, P. and Dupin, H., Eds., Aspect actuel des carences en fer et folates dans le monde, Ed. Colloque INSERM, 197, 71-74. [13] Fleming, A.F. (1990) Anemia in Pregnancy in Ndola, Zambia: Frequency and Etiology. In: Hercberg, S., Galan, P. and Dupin, H., Eds., Aspect actuel des carences en fer et folates dans le monde, Ed. Colloque INSERM, 197, 75-77. [14] Hamdaoui, M., Sakly, R., Alguemi, C.C., Bennour, A., Jallouli, K. and Doghri, T. (1990) Anémie nutritionnelle de la femme enceinte dans la région de Kairouan (Tunisie). In: Hercberg, S., Galan, P. and Dupin, H., Eds., Aspect actuel des carences en fer et folates dans le monde, Ed. Colloque INSERM, 197, 83-85. [15] Dop, M.C., Blot, I., Dyck, J.L., Assimadi, K., Hodonou, A.K.S. and Doh, A. (1987) L’anémie à l’accouchement à Lomé (Togo): Prévalence, causes et répercussions chez le nouveau-né. IIIème Journées Scientifiques Internationales du GERM, 37. [16] Dyck, J.L., Blot, C., Dop, M.C., Schneider, D., Hodonou, A.F.K. and Doh, A. (1987) Anémie, carence martiale et grossesse chez la femme enceinte loméenne. IIIème Journées Scientifiques Internationales du GERM, 43. [17] Demmouche, A. and Moulessehoul, S. (2011) Anémie maternelle pendant la grossesse et la supplémentation en fer. Antropo, 24, 21-30. [18] Scholl, T., Hediger, M. and Belsky, D. (1994) Prenatal Care and Maternal Health during Adolescent Pregnancy: A Review and Meta-Analysis. Journal of Adolescent Health, 15, 444-456.
http://dx.doi.org/10.1016/1054-139X(94)90491-K [19] Galan, P., Yoon, H.-C., Preziosi, P., Viteri, F., Valeix, P., Fieux, B., et al. (1998) Determining Factors in the Iron Status of Adult Women in the SU.VI.MAX Study. European Journal of Clinical Nutrition, 52, 383-388.
http://dx.doi.org/10.1038/sj.ejcn.1600561 [20] Abel, R., Rajaratman, J., Kiruba Karan, S. and Kalaiman, S. (2000) Can Iron Status Be Improved in Each of Three Trimesters? A Community-Based Study. European Journal of Clinical Nutrition, 54, 490-493.
http://dx.doi.org/10.1038/sj.ejcn.1601044 [21] Wang, H., Chen, X.C. and Wang, W.G. (1990) Nutritional Status of Gestating Chinese Women and Its Influence upon Neonates, with Emphasis on Iron. Nutrition Research, 10, 493-502.
http://dx.doi.org/10.1016/S0271-5317(05)80059-4 [22] Chen, X.C. (1990) Iron Deficiency Anemia of Pregnant Women in China. In: Hercberg, S., Galan, P. and Dupin, H., Eds., Aspect actuel des carences en fer et folates dans le monde, Ed. Colloque INSERM, 197, 65-68. [23] Yameogo, B. (1993) Les anémies chez les femmes en age de procréer au burkina Faso: Prévalence et connaissance de la population. Th Méd Ouagadougou, 9, 75. [24] Dop, M., Blot, I., Dyck, J., Assimadi, K., Hodonou, A. and Doh, A. (1992) Anémie à l’accouchement à Lomé (Togo). Prévalence, facteurs de risque, et répercussions chez le nouveau-né. Rév Epidémiol Santé Publique, 40, 259-267. [25] Ministère de la Santé Publique (2001) Les carences en micronutriments: Ampleur du Problème et stratégies de lutte Programme de lutte contre les troubles dus aux carences en micronutriments. Rabat, Maroc. [26] Coudray, C. and Hercberg, S. (2001) Apports nutritionnels conseillés pour la population française. Tec et Doc, Paris. [27] Aboussaleh, Y., Farsi, M., El Hioui, M. and Ahami, A. (2009) Transition nutritionnelle au Maroc: Coexistence de l’anémie et de l’obésité chez les femmes au Nord Ouest Marocain. Antropo, 19, 67-74. [28] Banque Mondiale (2007) Un parcours non encore achevé: La réforme de l’éducation au Moyen-Orient et en Afrique du Nord—Résumé analytique. Banque Mondiale (World Bank), Washington. [29] Farkas, C.S. and Harding Le Riche, W. (1987) Effect of Tea and Coffee Consumption on Non-Haem Iron Absorption. Human Nutrition: Clinical Nutrition, 41C, 161-163.
[1] El Guindi, W., Pronost, J., Carles, G., et al. (2004) Anémies maternelles sévères et issues de grossesse. Journal de Gynécologie Obstétrique et Biologie de la Reproduction, 33, 506-509.
http://dx.doi.org/10.1016/S0368-2315(04)96563-5 [2] Bonnies, W.R. and Sue, R.W. (1993) Nutrition in Pregnancy and Lactation. Mosby-Year Book, 5-1993, p. 537. [3] Recommandations OMS (2003) Soins liés à la grossesse, accouchement et période prénatale. Guide des pratiques essentielles. Dépister une anémie. [4] MS (2000) Enquête nationale sur l’anémie par carence en fer, la supplémentation et la couverture des ménages par le sel iodé. Ministère de la Santé Rabat Maroc. [5] Goldwater, P.N., Giles, N. and Bettelheim, K.A. (1998) An Unusual Case of Microangiopathie Heamolytic Anaemia Associated with Enteroheamorrhagic Escherichia coli 0113: H21 Infection, a Verocytotoxin-2/Shiga Toxin-2 Producing Serotype. Journal of Infection, 37, 302-304.
http://dx.doi.org/10.1016/S0163-4453(98)92324-6 [6] Ramirez-Mateos, C., Loría, A., Nieto-Gómez, M., Malacara, J.M. and Piedras, J. (1998) Anemia and Iron Deficiency in 490 Mexican Pregnant Women. Revista de Investigacion Clinica, 50, 119-126. [7] Szarfarc, S.C. and De Souza, S.B. (1997) Prevalence and Risk Factors in Iron Deficiency and Anemia. Archivos Latinoamericanos de Nutrición, 47, 35-38. [8] Assami, M., Hercberg, S., et al. (1987) Evaluation de l’état nutritionnel de femmes algériennes en age de procréer vivant en zones urbaine, rurale et semi-rurale. Annals of Nutrition & Metabolism, 31, 237-244.
http://dx.doi.org/10.1159/000177274 [9] Ould Dehah, C.M.H., Guiro, A.T. and Cisse, D. (1999) Effets de deux variétés de thé sur la biodisponibilité du fer d’aliments mauritaniens. [10] Coulibaly, M., Costagliola, D., Zittoun, J. and Mary, J.Y. (1987) évaluation de l’état nutritionnel de femmes enceintes à partir de paramètres hémato biologiques, suite à un déplacement de populations au nord du Cameroun. IIIème Journées Scientifiques Internationales du GERM, p. 46. [11] Baidy, B.L.O., Kone, Y. and ET Bassirou, L.Y. (1996) Anémie nutritionnelle de la grossesse à Nouakchott. Médecine d’Afrique Noire, 43, 355-359. [12] Fleming, A.F. (1990) Malaria Deficiencies of Iron and Folates, and Anemia in Pregnancy in the Guinea Savanna of Nigeria. In: Hercberg, S., Galan, P. and Dupin, H., Eds., Aspect actuel des carences en fer et folates dans le monde, Ed. Colloque INSERM, 197, 71-74. [13] Fleming, A.F. (1990) Anemia in Pregnancy in Ndola, Zambia: Frequency and Etiology. In: Hercberg, S., Galan, P. and Dupin, H., Eds., Aspect actuel des carences en fer et folates dans le monde, Ed. Colloque INSERM, 197, 75-77. [14] Hamdaoui, M., Sakly, R., Alguemi, C.C., Bennour, A., Jallouli, K. and Doghri, T. (1990) Anémie nutritionnelle de la femme enceinte dans la région de Kairouan (Tunisie). In: Hercberg, S., Galan, P. and Dupin, H., Eds., Aspect actuel des carences en fer et folates dans le monde, Ed. Colloque INSERM, 197, 83-85. [15] Dop, M.C., Blot, I., Dyck, J.L., Assimadi, K., Hodonou, A.K.S. and Doh, A. (1987) L’anémie à l’accouchement à Lomé (Togo): Prévalence, causes et répercussions chez le nouveau-né. IIIème Journées Scientifiques Internationales du GERM, 37. [16] Dyck, J.L., Blot, C., Dop, M.C., Schneider, D., Hodonou, A.F.K. and Doh, A. (1987) Anémie, carence martiale et grossesse chez la femme enceinte loméenne. IIIème Journées Scientifiques Internationales du GERM, 43. [17] Demmouche, A. and Moulessehoul, S. (2011) Anémie maternelle pendant la grossesse et la supplémentation en fer. Antropo, 24, 21-30. [18] Scholl, T., Hediger, M. and Belsky, D. (1994) Prenatal Care and Maternal Health during Adolescent Pregnancy: A Review and Meta-Analysis. Journal of Adolescent Health, 15, 444-456.
http://dx.doi.org/10.1016/1054-139X(94)90491-K [19] Galan, P., Yoon, H.-C., Preziosi, P., Viteri, F., Valeix, P., Fieux, B., et al. (1998) Determining Factors in the Iron Status of Adult Women in the SU.VI.MAX Study. European Journal of Clinical Nutrition, 52, 383-388.
http://dx.doi.org/10.1038/sj.ejcn.1600561 [20] Abel, R., Rajaratman, J., Kiruba Karan, S. and Kalaiman, S. (2000) Can Iron Status Be Improved in Each of Three Trimesters? A Community-Based Study. European Journal of Clinical Nutrition, 54, 490-493.
http://dx.doi.org/10.1038/sj.ejcn.1601044 [21] Wang, H., Chen, X.C. and Wang, W.G. (1990) Nutritional Status of Gestating Chinese Women and Its Influence upon Neonates, with Emphasis on Iron. Nutrition Research, 10, 493-502.
http://dx.doi.org/10.1016/S0271-5317(05)80059-4 [22] Chen, X.C. (1990) Iron Deficiency Anemia of Pregnant Women in China. In: Hercberg, S., Galan, P. and Dupin, H., Eds., Aspect actuel des carences en fer et folates dans le monde, Ed. Colloque INSERM, 197, 65-68. [23] Yameogo, B. (1993) Les anémies chez les femmes en age de procréer au burkina Faso: Prévalence et connaissance de la population. Th Méd Ouagadougou, 9, 75. [24] Dop, M., Blot, I., Dyck, J., Assimadi, K., Hodonou, A. and Doh, A. (1992) Anémie à l’accouchement à Lomé (Togo). Prévalence, facteurs de risque, et répercussions chez le nouveau-né. Rév Epidémiol Santé Publique, 40, 259-267. [25] Ministère de la Santé Publique (2001) Les carences en micronutriments: Ampleur du Problème et stratégies de lutte Programme de lutte contre les troubles dus aux carences en micronutriments. Rabat, Maroc. [26] Coudray, C. and Hercberg, S. (2001) Apports nutritionnels conseillés pour la population française. Tec et Doc, Paris. [27] Aboussaleh, Y., Farsi, M., El Hioui, M. and Ahami, A. (2009) Transition nutritionnelle au Maroc: Coexistence de l’anémie et de l’obésité chez les femmes au Nord Ouest Marocain. Antropo, 19, 67-74. [28] Banque Mondiale (2007) Un parcours non encore achevé: La réforme de l’éducation au Moyen-Orient et en Afrique du Nord—Résumé analytique. Banque Mondiale (World Bank), Washington. [29] Farkas, C.S. and Harding Le Riche, W. (1987) Effect of Tea and Coffee Consumption on Non-Haem Iron Absorption. Human Nutrition: Clinical Nutrition, 41C, 161-163.