Prevalence, Associated Risk Factors, and Pregnancy Outcomes of anaemia Among Omani Pregnant Women in South AL Sharquia, in Oman: A Retrospective Cohort Study, 2022

Anaemia is a global public health problem that mostly affects young children, menstruating adolescent girls, and pregnant women[1]. Anaemia is defined as the number of red blood cells or the hemoglobin concentration lower than normal[1]. According to the World Health Organization (WHO),  anaemia in pregnancy is defined as a hemoglobin level below 11 g/dl[1]. Anaemia in pregnancy is classified into mild (10 - 10.9 g/dl), moderate (9.9 - 7 g/dl), severe (6.9 - 4 g/dl), and very severe which is below 4 g/dl.(1) The commonest symptoms of anaemia in pregnancy are headache, fatigue, lethargy, pallor, tachycardia, and sometimes tachypnea. In 2019, WHO estimated that 37% of pregnant women worldwide are anaemic[1]. Anaemia during pregnancy is a key contributor to adverse outcomes for the fetus and mother[1]. It increases the risk of miscarriage, stillbirth, preterm labor, intrauterine growth restriction, low birth weight, and mortality[1]. For that, the World Health Assembly targets by 2025, to reduce the prevalence of anaemia in women of reproductive age by 50% and this target aligns with the 2030 Sustainable Development Goals (SDGs). However, the prevalence of anaemia has stagnated and the world is not on track to reach these targets[2]. According to the Oman National Nutrition Survey in 2017, the prevalence of anemia in Omani pregnant women was 29.3%[3]. Furthermore, according to the Global Health Observatory Data Repository, the prevalence of anaemia among pregnant women in Oman in 2019 was 30%[4].

We conducted a study in South AL Sharquia in Oman to determine the prevalence of anaemia among pregnant women registered for antenatal care at Primary Health Centers, in 2022. Also, to determine the association between anaemia in pregnancy and certain sociodemographic, obstetric risk factors, and pregnancy outcomes.

We conducted a retrospective cohort study at primary health centers in the South Sharqiyah region among Omani pregnant women attending antenatal care clinics in 2022. We collected from the booking registry and electronic health system in Oman for demographic, obstetric history, and pregnancy outcomes. The calculated sample size was 485 participants. After data collection, we analyzed the data by SPSS version 23.

485 pregnant women were included in our study. The average age of participants was (30.7±6.1 years) ranging from 16 to 44 years. Most of them fall in the age group 30-40 years (48.9%). The mean hemoglobin level in the first trimester was 11.4±1.2 whereas 10.6±1.2 and 10.8±1.3 were in the second and third trimesters respectively. Our study found that the highest prevalence of anaemia among Omani pregnant women was in the second trimester (58%) and most of them had mild anaemia 32.4%. The prevalence of anaemia in the first trimester was 32.8% and 51.3% in the third trimester. To assess the association between the severity of maternal anaemia and associated risk factors or adverse neonatal outcomes, we compared the risk of risk factors or risk of neonatal outcomes for each anaemia status (mild anaemia and moderate/sever anaemia) to the risk in women without anaemia (Hb≥11 g/dl).  Therefore, we studied the association between hemoglobin levels in the third trimester and sociodemographic factors, obstetric factors, and neonatal outcomes.(Table1) There was no association between maternal anaemia in the third trimester and sociodemographic factors (age, level of education, and employment status).  Furthermore, obesity in pregnant women at booking showed a higher risk of moderate/severe anaemia in the third trimester in comparison to normal weight and overweight. In addition, the pregnant women who had short birth spacing as the age of the last child was between 1-3 years had a higher risk of moderate/severe anaemia in comparison to more than 3 years. In addition, there was an association between the severity of maternal anaemia in the third trimester and adverse neonatal outcomes. Our study showed there was a risk of preterm labor and low birth weight with moderate/severe maternal anaemia in the third trimester. However, there was no association with other neonatal outcomes (cesarean section, postpartum hemorrhage, and fetal anomaly).

In conclusion, our study showed that the prevalence of anaemia among Oman pregnant women is high and still considered a health issue in Oman. The study showed that anemia during pregnancy is significantly associated with some factors, including high BMI and short spacing between pregnancies. In addition, it is of concern that anaemia during late pregnancy may significantly increase the risk of neonatal outcomes such as preterm birth and low birth weight.

Table 1: The association between the severity of maternal anaemia with socio-demographic factors, obstetric factors, and neonatal adverse outcomes.

References:

1. Accelerating anaemia reduction: a comprehensive framework for action [Internet]. Who.int.World Health Organization; 2023 [cited 2024 Jul 14]. Available from: https://www.who.int/publications/i/item/9789240074033

2. Al-Jawaldeh A, Taktouk M, Doggui R, Abdollahi Z, Achakzai B, Aguenaou H, et al. Public Health. Int J Environ Res Public Health. 2021;18:2449.

3. Oman National Nutrition Survey. 2017.

4. Prevalence of anemia among pregnant women (%) - Oman [Internet]. World Bank Open Data. [cited 2024 May 23]. Available from: https://data.worldbank.org/indicator/SH.PRG.ANEM?locations=OM