Determinants of Anemia in Pregnancy at Booking, at 36 Weeks and Postpartum

Background: Anemia is very common during pregnancy, especially in West Africa where malaria is endemic, coupled with poor nutrition and intake of hematinics, and poor antenatal attendance, Objectives: This study intends to unravel the determinants of anemia in pregnant women: at booking, at 36 weeks gestation, and after delivery. It would also determine the prevalence of anemia, and the social-demographic characteristics of the women. Methodology and subjects: This was a retrospective analytic cross-sectional study of pregnant women who booked for antenatal care (ANC), and delivered vaginally at Niger Delta University Teaching Hospital (NDUTH), from January 2018 to December 2022. During the study period, a total of 900 eligible women were identified. Data collected at booking was: bio-data, gestational age at booking, and PCV at booking. At 36 weeks, data collected was: PCV at 36 weeks, presence of risk factors for anemia (mostly antenatal complications). At delivery, data collected was: gestational age at delivery, mode of vaginal delivery, and PCV within 24 – 48 hours after delivery. Data on risk factors for postpartum hemorrhage (PPH) were: presence of uterine atony, episiotomy incision, cervical laceration, perineal tear, and use of instrumental vaginal delivery. Fetal data collected was: birth weight for fetal macrosomia, fetal status and sex. Results: The prevalence of anemia was 66.7% at booking, 79.4% at 36 weeks, and 80.0% postpartum; with overall prevalence was 75.4%. The significant determinants of anemia at booking were: teenage pregnancy, odds ratio = 0.40[0.01, 0.20], p = 0.0005, and living in a rural area, odds ratio = 0.37 [14, 0.95], p = 0.03. At 36 weeks gestation, women who registered late for antenatal care were 3 times more likely to be diagnosed with anemia, odds ratio = 3.30[1.89, 5.75] p = 0.0001. The odds of anemia was twice higher in women with malaria, odds ratio = 2.58[0.69, 9.60], and 3 times higher in women with multiple gestation, odds ratio = 3.86[0.75, 19.94]. Regarding postpartum anemia, the chances were 3 times higher in women who were anemic before delivery, odds ratio = 3.85[0.87, 17.03], p = 0.05. Other factors were uterine atony, odds ratio = 4.05 [1.71, 9.35], p = 0.0005, cervical laceration, odds ratio = 6.00[1.15, 31.41], p = 0.01, minor degree placenta praevia (p = 0.04), and assisted vaginal breech delivery (p = 0.04). Conclusion: The prevalence of anemia in pregnancy in NDUTH is unacceptably high; however it could be mitigated via advocacy. Especially against late booking for ANC, teenage pregnancy, and malaria prevention; by use of insecticide treated nets, insect repellants, and intermittent preventive therapy (as recommended by WHO).