ORIGINAL ARTICLE

PREVALENCE OF ANAEMIA IN PREGNANCY IN HOSPITAL BASED

POPULATION IN BIJAPUR, KARNATAKA.
Mohammed Arifulla K1, A.M. Patil2, B. B. Sajjanar, Sayeed M Yendigeri3, Vivek P. Honakeri4, Nasheen
Fathima5, Nida Nausheen6

HOW TO CITE THIS ARTICLE:

Mohammed Arifulla K, AM Patil, B. B. Sajjanar, Sayeed M. Yendigeri, Vivek P. Honakeri, Nasheen Fathima, Nida
Nausheen. “Prevalence of anaemia in pregnancy in hospital based population in Bijapur, Karnataka”. Journal of
Evolution of Medical and Dental Sciences 2013; Vol2, Issue 35, September 2; Page: 6673-6682.

ABSTRACT: BACKGROUND: Anaemia is a major public health problem during the pregnancy
throughout the world. Globally almost half of the pregnant mothers are anemic. The hematological
data representative of anaemia among Asian countries, India has highest prevalence and continues
to be serious health problem. Studying the prevalence of Anemia in pregnancy aids in establishing
the magnitude of the problem and helps the antenatal health providers in early detection and
management. In a teaching hospital based a population study of Anemia in pregnancy is strong
indication of true Anemia prevalence in the community, as large numbers of patients from different
backgrounds attend the hospital. OBJECTIVES: The study was conducted to know the prevalence of
Anemia in pregnancy in and around Bijapur, Karnataka. This study related with the Prevalence of
Anemia in pregnancy in relation to age, gravida, parity, trimester and morphological types of
Anemia. MATERIAL AND METHODS: The material for this study is obtained from in-patient and
out-patients attending the OBG department at Al-Ameen Women’s and children’s hospital, Bijapur
Automated hematology analyzer – Sysmex-Kx21 and peripheral smear study were used to study the
anaemia in pregnancy. 100 blood samples of those pregnant women whose hemoglobin was less
than 11gm/dl were selected for study over a period of one year from January, 2012 to December
2012. The study was according to predesigned and Prescheduled proforma which includes detailed
obstetrics history and systemic examination. LIMITATIONS OF STUDY: Serum iron, Serum Folic
Acid, Serum ferritin, and Vitamin B12 assays, total Iron Binding Capacity (TIBC), Zinc, were not done
because they are costly and most of patients were from poor socioeconomic backgrounds. RESULTS:
Blood samples of 100 pregnant women were analyzed & were found to be anaemic. This study
includes magnitude of anaemia according to age, gravida and parity wise distribution of anaemia.
degree, types of anaemia. Out of 100 pregnant cases, 70 had moderate degree, 12 cases had severe
degree and 18 were mild degree anemia’ Microcytic hypochromic were – 70 (70 %), Macrocytic
Normochromic - 17 (17 %) and dimorphic anaemia- 13 (13 %).
KEYWORDS: Anaemia, Pregnancy, prevalence, severity, grade, parity, and lower socio economic
status, India and preventive.

INTRODUCTION: Anaemia is a global health problem. In Anemia, the lower limit of normality during
the pregnancy is reduced. (1). In the pregnancy, anemia accounts for 40 – 70 percent cases with the
increasing incidence of parity(2), Anemia is the most common nutritional deficiency disorder, &
prevalence of anaemia in pregnancy is 51 percent in developing countries like India ( 65 – 75
percent ) . In developed countries, it is 14 percent according to recent WHO estimation.
In developing countries, prevalence of anaemia is higher. & in India has 80 percent of
maternal deaths due to it.(3) Inadequate dietary iron, foliate intake due to low vegetable

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 ORIGINAL ARTICLE
consumption, perhaps low B12 intake and poor bioavailability of dietary iron from the fibre, phytate
rich Indian diets are the major factors responsible for high prevalence of anaemia. Increased
requirement of iron during growth and pregnancy and chronic blood loss contribute to higher
prevalence in specific groups. In India, anaemia is directly or indirectly responsible for 40 per cent of
maternal deaths, which comprises of 80 percent of villages, where majority of people live, and are
ignorant of the hemopoietic principles of the diet and ignorant of regular antenatal checkup, so the
incidence is high,

Depending upon the level of hemoglobin (HGB) concentration anaemia is graded (Degree) into
1. Mild degree – HGB percentage is 8gm/dl to 11 gm/dl,
2. Moderate degree - HGB percentage is 6.5gm/dl to 8.0 gm/dl,
3. Severe degree - HGB percentage is 6.5gm/dl and less. (6).

If severe degree of anemia in pregnancy is left undiagnosed and untreated, it leads to

consequence like preterm labor, pre-eclampsia, cardiac failure, intrauterine death (IUD) and the risk
of developing anemia in infancy, intrauterine growth retardation (IUGR) defective mental and
psychomotor development in the infant. (7).
Survey and detection of anaemia in pregnancy is most important to prevent maternal and
perinatal morbidity and mortality. Five major surveys (National Family Health Survey (NFHS) and
District Level Household Survey (DLHS), Indian Council of Medical Research (ICMR) Micronutrient
Survey and Micronutrient Survey conducted by National Nutrition Monitoring Bureau(NNMB) were
undertaken to estimate prevalence of anemia in the country. All these showed that over 70 percent
of preschool children were anemic. NNMB, DLHS and ICMR survey showed that over 70 percent of
pregnant women and adolescent girls in the country were anaemic (Table- 1). Anaemia begins in
childhood, worsens during adolescence in girls and gets aggravated during pregnancy. NFHS 2 and 3
reported lower prevalence of anaemia in women and pregnant women as compared to DLHS, NNMB
and CMR Micronutrient surveys a teaching Hospital patient based study is helpful in assessing true
nature of problem in the community. Prevalence studies help in assessing the magnitude of anaemia
in pregnancy and aid in devising preventive measures. Bijapur in northern Karnataka is an
underdeveloped district with a large agrarian population. This study was undertaken to estimate the
burden of anaemia in pregnancy in this part of the country, compare the prevalence rates in
different part of India and to understand the dynamics of anaemia in pregnancy.

MATERIAL AND METHODS: The study was carried out at Al- Ameen medical college and Hospital,
Bijapur, Karnataka state from January 2012 to December 2012. Subjects includes for the study were
pregnant women attending the inpatients and out patients for antenatal checkup. Only selected 100
pregnant women having hemoglobin less than 11gm% dl and regularly attended antenatal checkup
at Al-Ameen medical college and Women’s Hospital, Bijapur, District, Karnataka State, hemoglobin
(HGB) less than 11g/dl selected for the study those attended antenatal checkup regularly from IST to
IIIrd trimester, Along with detailed prescheduled and redesigned examination proforma of all the
pregnant women, including obstetrics’ clinical history includes age, gravida, and parity etc were
included in the study. Permission was obtained from the Institution Ethics Committee. 2ml of
pregnant Blood sample collected in a EDTA K3 bulb and samples are analyzed in Automated

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 ORIGINAL ARTICLE
Hematology Analyzer Sysmex Kx 21 (Tran Asia) hematological parameters used in this study are
hemoglobin, Hematocrit, Mean corpuscular volume, Mean corpuscular haemoglobin, Mean
corpuscular haemoglobin concentration, red cell distribution width in coefficient variation and
peripheral smear study was done to know the morphological types of anaemia. All those pregnant
women with clinical infections, chronic diseases haemo-globinopathies, multiple pregnancies and
not attended regular antenatal checkup were excluded from the study.

RESULTS: Present series of study includes 100 cases of anaemia in pregnancy,

The age wise distribution of anaemic cases, prevalence is high in the age group of 21-25 yrs
is 41 ( 41.0% ) and prevalence is lowest in the age group of 15- 20 yrs is 11 (11.0 ) - (Table 1).

Degrees of anaemia according to age in pregnancy are,

Mild degree of anemia in age group of 21 – 25 yrs is seen in 8 cases, moderate degree of
anemia in the age group of 21- 25 yrs in 30 cases and severe degree of anemia is seen in 31 – 35 yrs
of age – 6 cases (Table–2).

Gravida and Degree of anaemia (Table -3)

The degree of anemia is seen to increase with the gravida of the patient
Maximum number of mild degree anaemia is seen in 4th gravida of pregnancy. (9 cases);
Maximum number of moderate degree of anemia is seen in 4th gravida of pregnancy. (29 cases);
Maximum number of severe degree of anemia is seen in 2nd and 4th gravida of pregnancy. (4 cases)

Parity and degree of anemia (Table – 4)

The degree of anemia is seen to increase with the parity of the patient.
Maximum number of mild degree anaemia is seen in para 3 of pregnancy. (07 cases);
Maximum number of moderate degree of anemia is seen in para 2 & Para 3 of pregnancy. (29 cases);
Maximum number of severe degree of anemia is seen in para – 3 of pregnancy. (5 cases)

Trimester and Anemia (table -5)

Mild degree of anemia is seen high in 1st Trimester and low in 3rd Trimester; moderate degree of
anemia is seen high in 3rd Trimester and low in 1st trimester; severe degree of anemia is seen high in
3rd trimester and low in 1st trimester

Socioeconomic status play a important role in development of anaemia in pregnancy specially in

developing counties like India, due to ignorant of hemopoietic principles of diet and poverty and
ignorance. (Table – 6)
Low income group patients shows more cases of moderate degree anaemia cases are 40 and
Middle income group patients’ shows more cases of moderate degree of anemia are 21
High income group patients show more cases of moderate degree of anemia are 09.

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 ORIGINAL ARTICLE
Different types of anemia’s seen in pregnancy are – (Table – 7)
Microcytic hypochromic anemia – 70 cases (70 .0 %)
Macrocytic normochromic anemia – 17 cases (17 %),
Dimorphic anemia – 13 cases (13 %)

Table-1: Age wise distribution of 100 anaemic cases in pregnancy

15-20 21-25 26-30 31-35
AGE
yrs yrs yrs yrs

No. 11 41 33 15

% 11 41 33 15

Table-2: Degree of anaemia with age.

21-25 26-30 31-35
Degree of anaemia 15-20 yrs Total
yrs yrs yrs
Mild 03 08 06 01 18
Moderate 12 30 24 04 70
Severe 00 03 03 06 12
X2 = 5.2, P < 0.05, df = 2

Table-3: Gravida and Degree of anaemia.

Degree of Anaemia G1 G2 G3 G4 Total

Mild 01 04 04 09 18
Moderate 18 06 17 29 70
Severe 02 04 02 04 12
X2 = 1.32, P< 0.05, df = 2

Table-4: Parity and grade of anaemia.

Parity (P)
Grade of Anaemia
P0 P1 P2 P3
Mild 04 03 04 07
Moderate 09 10 29 22
Severe 02 03 02 05
X2 = 1.39, P<0.05, d f = 2.

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Table- 5: Trimester and anemia.
Degree of I st
II nd III rd Total
Anaemia
Mild 11 04 03 18
Moderate 13 25 32 70
Severe 00 03 09 12

Table- 6: Socioeconomic status and anaemia.

Degree of
LIG MIG HIG Total
Anaemia
Mild 10 05 03 18
Moderate 40 21 09 70
Severe 07 03 02 12

LIG=Low Income Group.

MIG=Middle Income Group.
HIG = High Income Group

Table-7: Type of anaemia according to peripheral smear.

No. of
Types %
Cases
Microcytic Hypochromic 70 70%
Macrocytic Normochromic 17 17%
Dimorphic anemia 13 13%

DISCUSSION: Prevalence of anaemia is highest in India, and also throughout the world. In our
hospital based population study, Anaemia is one of the most common medical conditions met during
pregnancy. Microcytic hypochromic anaemia accounts for 70% and dimorphic anaemia 17% and
megaloblastic anaemia accounts for 13% of cases. Since majority of women enter pregnancy with
partially or completely depleted iron reserves, the prophylactic use of iron has been advocated by
most workers. Iron therapy not only prevents iron deficiency, but also reduces the incidence of
dimorphic anaemia. Iron deficiency is more predominant due to poor intake and poor availability of
iron in food. Anaemia would be more common if patient is infested by parasites like malaria,
hookworm and who suffers from gastrointestinal diseases, like chronic dysentery and diarrhea. As a
result of physiological anaemia in pregnancy there is disparity in red cell mass and plasma volume.
The routine investigations of anaemia are helpful to detect the anaemia type. Although a reduction of
circulating haemoglobin is relatively late development of iron deficiency anaemia, the measurement
of haemoglobin RBC, indices hematocrit and RDW-CV, are done by Automated hematology analyzer
SysmexKx 21 is the simple, noninvasive and time saving and accurate, reproducible (6 , 8,7). In all
these series maximum number of cases were observed between the age group of 21 to 30 years.
Trimester wise distribution of present study 34% cases were in Ist trimester, 32% of cases were in II

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 ORIGINAL ARTICLE
nd Trimester and 44% of cases were in the III rd Trimester, L.P. Dutta et al 1972 (9, 10).
Satyanarayan M and Ali, 1985, found in his series 115 of cases were in II nd trimester and 89 % of
cases were in III rd trimester. C. Sexena et al1970: found in his series 19% cases were in IInd
trimester and 24 cases in III trimester (11), Comparing various authors study it is seen that majority
of cases are found in III trimester. Gravida and anemia of present study nearly correlated to the
Menendez C., 2000. (12). Sexena C. et al 1970; (13).“ found 9.80% cases was primi gravida and
60.78% cases was in gravida two to gravida three and 29.41% were grandmultipara. Sidhu G.S1988;
(14) had 15.15% of primi gravida, 57.57% cases was gravida two to gravida three and 27.27 % were
grand multi. M. Satyanarayana et al, 1985 had 16% primi gravida, 74% were grand multi (15); had
16% cases was primi gravida, 74% of cases were in multi gravida and 10% cases were in grand
multi.
In present it is found that keeping haemoglobin standard as 11gm/dl, found 18% of cases
mild anaemia, 70% cases moderate and 12% was severe degree anaemia. Rajaratnam et al 2000; in
his study Keeping standard haemoglobin as 11gm/dl found 30.2% cases was mild anaemia, 35.8%
cases of moderate anaemia and 3.3% cases of severe anaemia L.P. Dutta et al (16,17); Keeping
haemoglobin standard as 10gm/dl found 20% of cases was mild anaemia, 30% of case was moderate
and 42% of case was severe anaemia. It is obvious that in our patients the moderate and mild
anaemia are maximum. Hence our study closely correlated with the study of Rajaratnam and Dutta
L.P (17). In our present study, morphological types of anemia’s in pregnancy were 70% of cases are
microcytic hypochromic, 17 % of cases were dimorphic anaemia and 13% of cases were
megaloblastic anaemia. Raja Ratnam et al in his study he was found 845 cases of iron deficiency, 9%
cases of dimorphic anaemia 6% cases were of megaloblastic anaemia. Dutta L.P. in his series found
76% of cases were iron deficiency, 14% of cases were dimorphic anaemia and 10 % of cases were
megaloblastic anaemia. So present hospital based study correlates with Raja Ratnam and Dutta L.P.
(16, 17, 18);

Preventive Measures of anemia: The various methods that are used to health education reduce the
prevalence of anaemia during pregnancy (25). Health education is an important approach to
increase awareness about anaemia in terms of exposure, risk factors, essential nutrition ingredients
and the importance of iron supplementations. The health education is the responsibility of both
women and healthcare providers (18). Health education is an essential factor and most common
approach of great importance to reduce the prevalence of anaemia (2519S). Many women are not
aware about their medical condition or the risk factors which is threat their life .Women play an
important role in the family as the main health providers and very eager to find information
regarding their health condition
Health education and preventive measure during pregnancy are crucial factor for both
mother and their offspring health because each pregnant woman is at risk during pregnancy.
Therefore, it is important to raise the level of awareness for all women specially women in the
reproductive age through effective and well organized health education and campaigns, with focus
on major health problems that might occur during pregnancy, in particular anaemia. Therefore, for
the success and effectiveness of health education, it is better that the information is provided to
women in groups, where they feel more comfortable, satisfied and interact to benefit from each
other (23).

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Ethical committee clearance: The ethical committee clearance obtained from ethical committee of
Al-Ameen Medical College, Bijapur.

Recent Diagnostic methods:

1. Serum Vitamin B12, Serum iron, Folic Acid, Total Iron Binding capacity,
2. Bone Marrow Examination, with special stains like Pearl’s stain
3. Serological methods to predict the risk of HDN – Rh Antibodies; cold antibodies, PNH.
Although the methodology and serological testing have improved significantly, the ability of
these tests to predict hemolytic disease of Newborn with certainty is far from perfect.
Such tests will always be considered (20)

Supplementary to obstetric monitoring: Routine Hemoglobin , ABO and Rh D group, of all

pregnant women should be determined as early as possible during each pregnancy, when they first
attend for antenatal care.–
Blood groups antibody detection is to be considered when there is history of miscarriage.
Mother’s serum should also be screened for any IgG antibodies to red cells, which can cause HD (21).

Quantification of antibodies: Once detected, the ability of an antibody to cause HDN is generally
estimated by antibody quantification. Serial testing (at least once monthly) Provides useful
information regarding the antibody trend through pregnancy. Rising levels may be indicative of HDN
developing in the fetus, but not confirm the blood group of the fetus or the severity of hemolysis.
Detection of fetal red cells in the maternal circulation, one of the earliest methods used to detect
fetal red cells in maternal circulation was described by Kleihauer and Betke. The rosette test, There
are many different methods in use for the detection of a larger than usual fetal to maternal
hemorrhage. The enzyme-linked antiglobulin test. The test with fluoresce in-labeled antibodies, and
for evaluation of the feto-maternal hemorrhage. Nowadays Functional cellular assays tests are used.
Serological tests indicate whether an antibody is of clinical importance, but they do not predict its
functional activity. Antibody-dependent cellular cytotoxicity- (ADCC) assay and the
chemiluminescence test Using maternal plasma and real time PCR with its automation opened the
possibility for examining a large number of samples. (22).

Obstetric monitoring: Amniocentesis: The level of bilirubin in the amniotic fluid gives an indirect
assessment of the severity of fetal heterolysis. -Ultrasound examination Ultra-sonography is a non-
invasive method that can be used to study fetal hemodynamics and show physical indications of
developing anaemia before hydrops develops.

Fetal blood sampling: The best method to assess s hemolytic disease is the direct determination of
fetal haemoglobin, (HbF) hematocrit, and blood groups by testing a blood sample (23).

Prevention and management of chronic anaemia in pregnancy: The prevention of chronic

anaemia needs blood transfusion during pregnancy can be reduced by adequate antenatal care.

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 ORIGINAL ARTICLE
Blood Transfusion: It is important to remember that transfusion does not treat the cause of
anaemia or correct the non-hematological effects of iron-deficiency. The decision to transfuse blood
must not be based on patient’s haemoglobin concentration alone, but also on her clinical needs,
including stage of pregnancy and clinical conditions. Where iron and foliate deficiency is common, in
countries prophylactic administration of hematinic is strongly indicated.
The optimum daily doses to prevent anaemia in pregnant women are: 500 µg folate, 120 mg
elemental iron: e.g. 200 mg tablet of ferrous sulfate (24).

CONCLUSION: In our study of hospital based population of the prevalence of anaemia in pregnancy,
the incidence of anaemia is in pregnancy is high. Moderate to severe degree anaemia common in
IIIrd trimester. In 100 cases studied for anaemia in pregnancy, 70% cases is microcytic hypochromic
category.17% cases of megaloblastic anaemia seen in third trimester of pregnancy, 13% Of
dimorphic anaemia is seen in this study. Anaemia is common in age group between 21 -30 yrs, due
to repeated and short interval pregnancies. SysmexKx 21 automated hematology analyzer is simple
and reproducible instrument used during this study period the results are accurate and tally with
conventional methods and P S.
During Pregnancy there is need for mandatory regular supply of Iron, folic acid and vitamin.
B12 because prevalence of anaemia in pregnancy is very high in teaching based hospital population.
To reduce the prevalence of anaemia and reduce magnitude of its problem, it is essential that
antenatal health workers and qualified dietician should reinforce the daily iron, folic acid and
vitamin B12 tablets to adolescent and pregnant women from 4th month onwards till 3-6 months of
post-partum period along with correction of other nutritional deficiencies and timely intervention
for reducing the burden of related diseases and food aid program towards illiterate domestic
pregnant women is advised to reduce the prevalence and consequences of anaemia, not only this the
antenatal care workers in teaching institute must be detected early and treat the anemia to reduce
the prevalence rate of anemia in pregnancy .We hypothesize that this may be due to better
awareness of risk of anaemia in pregnancy in city dwellers. The patients attending our hospital
represent cross section of Bijapur population with mix of poor and rich as well as urban and rural.
Therefore this study highlights the prevalence of anemia in pregnancy in this part of the country and
shall provide reference to future studies on anaemia.

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AUTHORS:
1. Mohammed Arifulla K. 6. Assistant Professor, Department of
2. A.M. Patil Pathology, Al-Ameen Medical College and
3. B. B. Sajjanar, Hospital, Bijapur.
4. Sayeed M. Yendigeri 7. Assistant Professor, Department of
5. Vivek P. Honakeri Pathology, Al-Ameen Medical College and
6. Nasheen Fathima Hospital, Bijapur.
7. Nida Nausheen

PARTICULARS OF CONTRIBUTORS: NAME ADRRESS EMAIL ID OF THE

1. Assistant Professor, Department of Pathology, CORRESPONDING AUTHOR:
Al-Ameen Medical College and Hospital, Dr. Mohammed Arifulla. K,
Bijapur. Assistant Professor,
2. Professor & Head, Department of Pathology, Department of Pathology,
Al-Ameen Medical College, Bijapur.
Al-Ameen Medical College and Hospital,
Email –[email protected]
Bijapur.
3. Professor, Department of Pathology, Al-
Ameen Medical College and Hospital, Bijapur. Date of Submission: 18/06/2013.
4. Associate Professor, Department of Pathology, Date of Peer Review: 18/06/2013.
Al-Ameen Medical College and Hospital, Date of Acceptance: 23/08/2013.
Bijapur. Date of Publishing: 27/08/2013
5. Assistant Professor, Department of Pathology,
Al-Ameen Medical College and Hospital,
Bijapur.
6.

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