The Relationship of Iron Deficiency Anemia with Preterm delivery in Pregnant Women Referred to Health Centers of Tabriz: A Case-Control Study

Document Type : Original Article

Authors

1 Bachelor student of Midwifery, Student Research Committee, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran.

2 PhD student of Research, Tabriz Health Services Management Research Center, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran.

3 Bachelor of Midwifery, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran.

4 M.Sc. student of Midwifery, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran.

Abstract

Introduction: Preterm delivery is a major cause of neonatal mortality and morbidity. In most studies, preterm delivery has a little increased in pregnant women with anemia, However, not all studies have confirmed this finding. This study was conducted with aim to determine the relationship between iron deficiency anemia and preterm delivery.
Methods: This case-control study was performed on 162 pregnant women with preterm delivery and 162 subjects without preterm delivery referred to health centers of Tabriz from 2011-2014. Iron deficiency anemia was determined by hemoglobin and hematocrit indexes. To investigate the relationship between iron deficiency anemia and preterm delivery, some risk factors with inclusion and exclusion criteria and some through the matching of groups were controlled. Other possible personal and fertility risk factors were controlled through logistic regression and their odds ratio were determined. Data were analyzed using SPSS statistical software (version 19), and Chi-square test, Independent t-test, and Logistic regression. PResults: In the evaluation of 5260 pregnant women, it was found that 214 (4.06%) had preterm delivery. Index of hematocrit between 26-30 weeks (P=0.01 and OR (CI95%)=0.89(0.81­­-­­­­­­­0.97)), anemia in 26-30 weeks (P=0.03 and OR (CI95%)=3.26(1.09-9.72)) and the pattern of weight gain according to BMI (P<0.05) were the risk factors for preterm delivery.
Conclusion: Considering the relationship between preterm delivery and anemia during 26-30 weeks of gestation, educating, prevention and early diagnosis of anemia may have effective role on reducing the risk of preterm delivery.

Keywords


  1. Ratzon R, Sheiner E, Shoham-Vardi I. The role of prenatal care in recurrent preterm birth. Eur J Obstet Gynecol Reprod Bio 2011; 154(1):40-4.
  2. Berkowitz O, Papiernik E. Epidemiology of preterm birth. Epidemiol Rev 1993; 15(2):414-43.
  3. Gervasi MT, Romero R, Bracalente G, Erez O, Dong Z, Hassan SS, et al. Midtrimester amniotic fluid concentrations of interleukin-6 and interferongamma- inducible protein-10: evidence for heterogeneity of intra-amniotic inflammation and associations with spontaneous early (32 weeks) pretermdelivery. J Perinat Med 2012; 40(4):329-43.
  4. Goldenberg RL, Culhane JF, Iams JD, Romero R. Epidemiology and causes of preterm birth. Lancet 2008; 371(9606):75-84.
  5. Masseva A, Dimitrov A, Altankova I, Koycheva E, Nikolov A, Dukovski A, et al. Finding a developing intrauterine infection in preterm birth by using classic and modern infection indices. Akush Ginekol (Sofiia) 2010; 49(7):21-6.
  6. Varma R, James D. Antenatal care of women with previous preterm delivery current. Obstet Gynaecol 2004; 14(2):207-15.
  7. Abu Hamad Kh, Abed Y, Abu Hamad B. Risk factors associated with preterm birth in the Gaza Strip: hospital-based case-control study. East Mediterr Health J 2007; 13(2):1132-41.
  8. Ebrahimi S, Haghbin S, PoorMahmoodi A. Incidence and etiologic factors of prematurity. Armaghane-danesh J 2000; 5(1):35-41.
  9. Heaman M, Kingston D, Chalmers B, Sauve R, Lee L, Young D. Risk factors for preterm birth and small-for-gestational-age births among Canadian women. Paediatr Perinat Epidemiol 2013; 27(1):54-61.
  10. Meis PJ, Michielutte R, Peters TJ, Wells HB, Sands RE, Coles EC, et al. Factors associated with preterm birth in Cardiff, Wales. II. Indicated and spontaneous preterm birth. Am J Obstet Gynecol 1995; 173(2):597-602.
  11. Khader Y, Al-shishani L, Obeidat B, Khassawneh M, Burgan S, Amarin ZO, et al. Maternal periodontal status and preterm low birth weight delivery: a case-control study. Arch Gynecol Obstet 2009; 279(2):165-9.
  12. Dodd JM, Crowther CA, Middleton P. Oral betamimetics for maintenance therapy after threatened preterm labor. Cochrane Database Syst Rev 2012; 12:CD003927.
  13. Berghella V, Haas S, Chervoneva I, Hyslop T. Patients with prior second-trimester loss: prophylactic cerclage or serial transvaginal sonograms? Am J Obstet Gynecol 2002; 187(3):747-51.
  14. Beck S, Wojdyla D, Say L, Betran AP, Merialdi M, Requejo JH, et al. The worldwide incidence of preterm birth: a systematic review of maternal mortality and morbidity. Bull World Health Organ 2010; 88(1):31-8.
  15. Rayamajhi R, Pratap K. A comparative study between nifedipine and isoxuprine in the suppression of preterm labour. Kathmandu Univ Med J (KUMJ) 2003; 1(2):85-90.
  16. Goldenberg R, Rouse DJ. Prevention of premature birth. N Engl J Med 1998; 339(5):313-20.
  17. Cunningham F, Norman F. Williams Obstetric. 21th ed. Landan: Official Publications; 2010.
  18. Gamlbling L, Danzeisen R, Gair S, Lea S, Charania Z, Solanky N, et al. Effect of iron deficiency on placental transfer iron and expression iron transport protein in vivo and in vitro. Biochem J 2001; 356(Pt 3):883-9.
  19. Keyhanian N. Iron deficiency anemia in women of reproductive age and city of Ramsar Tonekabon. J Nurs Midwifery 2008; 6(4):197-203.
  20. Jaime-Perez JC, Gomez-Almaguer D. Iron stores in low-income pregnant Mexican women at term. Arch Med Res 2002; 33(1):81-4.
  21. Bayoumeu F, Subiran-Buisset C, Baka NE, Legagneur H, Monnier-Barbarino P, Laxenaire MC. Iron therapy in iron deficiency anemia in pregnancy: intravenous route versus oral route. Am J Obstet Gynecol 2002; 186(3):518-22.
  22. Scanlon KS, Yip R, Schieve LA, Cogswell ME. High and low hemoglobin levels during pregnancy: differential risks for preterm birth and small for gestational age. Obstet Gynecol 2000; 96(5 Pt 1):741-8.
  23. Bondevik GT, Lie RT, Ulstein M, Kvale G. Maternal hematological status and risk of low birth weight and pretermdelivery in Nepal. Acta Obstet Gynecol Scand 2001; 80(5):404-8.
  24. Scholl TO, Hediger ML, Fischer RL, Shearer JW. Anemia vs iron deficiency: increased risk of preterm delivery in a prospective study. Am J Clin Nutr 1992; 55(2):985-8.
  25. Hill JB, Sheffield JS, McIntire DD, Wendel GD Jr. Acute pyelonephritis in pregnancy. Obstet Gynecol 2005; 105(1):18-23.
  26. Sharma P, Thapa L. Acute pyelonephritis in pregnancy: a retrospective study. Aust N Z J Obstet Gynaecol 2007; 47(4):313-5.
  27. Khalajinia Z, Sadeghi Moghadam P. Incidence of maternal risk factors associated with preterm delivery in Qom. J Qom Univ Med Sci 2007; 1(2):30-6. (Persion).
  28. Patten ML. Questionnaire Research: A practical guide. 2nd ed. Poland: Pyrczak Pub; 2001.
  29. Saberi M, Rahmani SH. The relationship between anemia during pregnancy and birth weight. Iran J Obestet Gynecol Fertil 2015; 18(142):6-10.