The Prevalence of Anemia in First, Second and Third Trimester of Pregnancy in Iran: a systematic review and Meta-analysis

Document Type : Original Article


1 Associate Professor, Department of Biostatistics, Prevention of Psychosocial Impairment

2 Clinical Microbiology Research Center, Ilam University of Medical Sciences , Ilam, Iran

3 Medical Student, Student Research Committee, Ilam University of Medical Sciences , Ilam, Iran

4 Department of Cardiology, School of Medicine, Ilam University of Medical Sciences , Ilam,iran


Introduction: Anemia is a common health problem during pregnancy worldwide. The studies performed in Iran have reported different prevalence of anemia in various gestational age, and there is no overall estimate of it. This study was performed with aim to evaluate the prevalence of anemia in Iranian pregnant women by systematic review and Meta-analysis method.
Methods: This systematic review study was performed based on information databases of Magiran, Iran medex, SID, Medlib, IranDoc, Scopus, Pubmed, Science Direct, Cochrane, Embase, Web of Science, Springer, Online Library Wiley and also search engine of Google Scholar using standard key words from 1991 to 2015. All reviewed papers which had inclusion criteria were evaluated. Random effect model by meta-analysis method was used to combine the studies' results. Data was analyzed using Stata software (Version 11.1). PResults: In systematic review, 12 studies with sample volume of 7087 pregnant woman were entered to the meta-analysis. The prevalence of anemia in first, second, and third trimester of pregnancy was estimated 19.6% (CI: 95%, 8.4-30.9), 10.1% (CI: 95%, 3.7-16.4) and 16.1% (CI: 95%, 10.2-22), respectively.
Conclusion: The prevalence of anemia in first trimester of pregnancy is more than second and third trimester. This shows that pregnant women require more care including proper nutrition and supplements of iron and folic acid during first trimester of pregnancy.


1-       Kisioglu, NN, Ozturk M, Cakmak ZA, Ozguner F. Anemia prevalence and its affecting factors in pregnant women of Isparta Province. Biomed Res 2004; 16(1):11-4.
2-        Stevens GA, Finucane MM, De-Regil LM, Paciorek CJ, Flaxman SR, Branca F, et al. Global, regional, and national trends in haemoglobin concentration and prevalence of total and severe anaemia in children and pregnant and non-pregnant women for 1995-2011: a systematic analysis of population representative data. Lancet Glob Health 2013; 1(1):e16-25.
3-       Kabiri AA, Sheioleslam H. Prevalence of iron deficiency anemia in women who referred to Qazvin public health center. J Qazvin Univ Med Sci 1999; 3(1):62-6. (Persian).
4-        Steketee RW, Nahlen BL, Parise ME, Menendez C. The burden of malaria in pregnancy in malaria-endemic areas. Am J Trop Med Hyg 2001; 64(1-2 Suppl):28-35.
5-        Sayehmiri K, Darvishi K, AzamiM. Helicobacter pylori infection is associated with anemia in pregnant women-a meta-analysis study. Iran J Med Microbiol 2015; 9(1):1-5.
6-       Idowu OA, Mafiana CF, Dopu S. Anaemia in pregnancy: a survey of pregnant women in Abeokuta, Nigeria. Afr Health Sci 2005; 5(4):295-9.
7-        Balser MJ. Helicobacter pylori and related organisms. In: Mandel GL, Bennett JE, Dolin R, editors. Principles and practice of infectious diseases. 5th ed. New York: Churchill Livingstone; 2000. P. 941-7.
8-       Pena-Rosas JP, Viteri FE. Effects and safety of preventive oral iron or iron+folic acid supplementation for women during pregnancy (Review). Cochrane Database Syst Rev 2009; 4:CD004736.
9-        Rush D. Nutrition and maternal mortality in the developing world. Am J Clin Nutr 2000; 72(1 Suppl):212-40S.
10-    Haider BA, Olofin I, Wang M, Spiegelman D, Ezzati M, Fawzi WW, et al. Anaemia, prenatal iron use, and risk of adverse pregnancy outcomes: systematic review and meta-analysis. BMJ 2013; 346:f3443.
11-     Lowdermilk DL, Perry SE. Maternity & woman’s health care. 8th ed. St Louis: Mosby; 2004. P. 1219.
12-     Earl R, Woteki CE. Iron deficiency anemia: recommended guidelines for the prevention, detection, and management among US children and women of childbearing age. Washington, DC: National Academies Press; 1994.
13-     Soofizadeh N, Farhadifar F, Kalantar E, Shahsavari S. Evaluating the prevalence of asymptomatic urinary tract infection and anemia in pregnant women in first trimester. Iran J Obestet Gynecol Infertil 2012; 15(8):11-6. (Persian).
14-     Jalali M, Siassi F, Ghiasvand R, Jarollahi N, Gheibi F, Fatehi F, et al. Iron deficiency anemia in pregnant women in Eslamshahr. J Kerman Univ Med Sci 2005; 12(4):271-7. (Persian).
15-     Faraji R, Mirbolok F, Sharemi SH, Asgharnia M, Jouafshani MA, Gholamzadeh M. Relationship between maternal hemoglobin concentration and BMI during the first trimester in primiparous women and her neonatal's birth weight. Iran J Surg 2010; 18(1):62-8. (Persian).
16-    Riahinejad S, Ghasemi-Tehrani H, Alipour-Hafshejani E, Ghasemi M, Nourizadeh-Dehkordi F. Valuation of vitamin D level at the end of first trimester and its relation with anemia, bacterial vaginosis, and toothache in pregnant mothers. J Isfahan Med Sch 2015; 32(311):2015-24. (Persian).
17-    Rahbar N, Ghorbani R, Fariba RA. Prevalence of iron deficiency anemia and its complications in pregnant women referred to medical-health centers in Semnan. Iran J Obestet Gynecol Infertil 2014; 17(128):12-7. (Persian).
18-     Khademi Z, Shahi A, Farshidfar G, Zare S, Vaziri F. The prevalence of iron deficiency anemia in pregnant women who referred to health care centers of Shariati hospital in Bandar Abbas, Iran. J Hormozgan Univ Med Sci 2004; 1(8):27-31. (Persian).
19-    Kalantari N, Samadanian F, Karim AN, Valaei N. The efficacy of Iron supplementation during pregnancy in Isfahan province, 1999. Pajouhandeh 2003; 8(3):161-70. (Persian).
20-    Karimi M, Kadivar R, Yarmohammadi H. Assessment of the prevalence of iron deficiency anemia, by serum ferritin, in pregnant women of Southern Iran. Med Sci Monit 2002; 8(7):488-92.
21-     Alizadeh L, Salehi L, Ramzi M. Maternal hemoglobin level and birth outcomes in pregnant adolescents. Sci J Iran Blood Transfus Organ (Khoon) 2013; 9(4):455-62. (Persian).
22-     Navidian A, Tabas EE, Sarani H, Ghalge M, Yaghobinia F. The prevalence of Iron-deficiency anemia in the pregnant women referring to health centers in Zahedan. J Reprod Infertil 2006; 7(2):132-8. (Persian).
23-    Rahbar N, Ghorbani R, Khansoltani S, Rashmekarim M. Prevalence of anemia and some of the related individual factors in the third trimester of the pregnancy in women referred to Semnan University of Medical Sciences clinics, 1999. Koomesh 2000; 1(3):31-8. (Persian).
24-     Borna S, Borna H, Ghanbari Z, Khezrdoost S. Anemia and factors that affect it in pregnancy. Tehran Univ Med J 2005; 63(6):448-52. (Persian).
25-     Von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP, et al. The Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Int J Surg 2014; 12(12):1495-9.
26-    Levy A, Fraser D, Katz M, Mazor M, Sheiner E. Maternal anemia during pregnancy is an independent risk factor for low birthweight and preterm delivery. Eur J Obstet Gynecol Reprod Biol 2005; 122(2):182-6.
27-    Sayehmiri K, Azami M. The prevalence of Iron deficiency anemia among Iranian pregnant women: a systematic review and meta analysis. Int J Epidemiol Res 2015; In Press.
28-    de Benoist B, McLean E, Egli I, Cogswell M. Worldwide prevalence of anaemia 1993–2005, WHO Global Database on Anemia. Geneva: World Health Organization; 2008. P. 21.
29-     Bagchi K. Iron deficiency anaemia--an old enemy. East Mediterr Health J 2004; 10(6):754-60.
30-    Levy A, Fraser D, Katz M, Mazor M, Sheiner E. Maternal anemia during pregnancy is an independent risk factor for low birthweight and preterm delivery. Eur J Obstet Gynecol Reprod Biol 2005; 122(2):182-6.
31-    Bondevik GT, Ulstein M, Lie RT, Rana G, Kvale G. The prevalence of anemia in pregnant Nepali women--a study in Kathmandu. Acta Obstet Gynecol Scand 2000; 79(5): 41-9.
32-     Bentley DP. Iron metabolism and anaemia in pregnancy. Clin Haematol 1985; 14(3):613-28.
33-     Pasdar Y, Heidari N, Safari Y, Safari Faramani R, Izadi N, Jamshidpour M, et al. Prevalence of some risk factors in pregnant women. Iran J Obstet Gynecol Infertil 2012; 15(21):14-23. (Persian).