Anaemia During Pregnancy in Pakistan: An Underdeveloped Country’s Perspective  in COVID-19 Era

Abstract Objective: To determine the frequency of gestational anaemia and compare hematological parameters among pregnant females in Pakistan's major ethnic groups, across four provinces. Study Design: Prospective observational study. Place and Duration of Study: Combined Military Hospital Karachi, Combined Military Hospital Kharian, Combined Military Hospital Mardan and Combined Military Hospital Quetta Pakistan, from Apr to Oct 2021. Methodology: A total of 2099 pregnant females were included from four tertiary level hospitals in Pakistan. Their lab values were collected via an online proforma. Gestational anemia was defined according to World Health Organization definition. Descriptive statistics were applied to evaluate significant differences and associations between various hematological variables. Results: Among 2099 patients, 119(53.0%) had mild to moderate anemia with Hb level more than 11g/dl, while 61(2.9%) suffered from severe anemia with Hb levels less than 8g/dl. Severe anaemia was most frequently reported from Punjab 130(25%), followed by KPK 15(2.9%) and Sindh 15(2.9%). Only 5(1%) mothers from Balochistan experienced severe anemia. Normocytic anaemia was the commonest form of anaemia found (mild to moderate anaemia group), whereas patients with severe anaemia had predominantly microcytic. The mean values of Mean Corpuscular Volume, ferritin, and Mean Corpuscular Hemoglobin Concentration differed significantly between the four locations with almost half of the anaemic study population residing in Punjab 245(21.9%) and 330(29.5%) in Sindh. Conclusion: Gestational anaemia is widely reported from all provinces of Pakistan, where World Health Organization’s definition of anemia may be potentially over-diagnosing gestational anaemia and may not be applicable in our part of the world.