Anemia status is associated with insufficient iodine levels in pregnant women in rural settings: a two-centre observational study

Adequate maternal hemoglobin and iodine are essential for optimal fetal-placental oxygenation, and, fetal brain development respectively. Intra-pregnancy anemia and iodine insufficiency are associated with adverse fetal-maternal outcomes. This study explored the potential association between intra-pregnancy anemia and iodine insufficiency and identified factors associated with third-trimester anemia. This study recruited pregnant women attending antenatal care in two rural health centres in the Ellembelle District, Ghana. Participants were followed from first-trimester visit until delivery. Demographic information, iodized salt usage, birth outcomes, urinary iodine concentration, and hemoglobin levels were collected per trimester; statistical significance was set at p < 0.05. Despite 97.0% of participants reporting iodized salt use, 48.0%, 54.0%, and 51.0% had iodine insufficiency in trimesters 1, 2, and 3, respectively. Anemia rates were 44.0%, 32.0%, and 41.0% in trimesters 1, 2, and 3, respectively, with higher prevalence among pregnant teenagers. In all trimesters, anemic individuals had iodine insufficiency [T1: 141.4 vs 158.7 μg/L (p = 0.1173); T2: 135.1 vs 155.3 μg/L (p = 0.0327); T3: 139.2 vs 156.8 μg/L (p = 0.0325)], or reduced gestational weight [T1: 55.35 vs 58.20 kg (p = 0.4272); T2: 55.50 vs 63.25 kg (p = 0.0094); T3: 60.0 vs 68.2 μg/L (p = 0.0388)] than non-anemic individuals. Logistic regression analyses found that third-trimester anemia was prevalent in pregnant teenage women (aOR: 1.264, p = 0.772), women with non-formal (aOR: 11.531; p = 0.013), basic (aOR: 4.687; p = 0.095), or secondary (aOR: 4.232; p = 0.096) education. Further research is needed to determine any potential causal relationship between insufficient iodine levels and anemia status during pregnancy.