Journal of Reproduction & Infertility

Journal of Reproduction & Infertility

Prevalence of Iron Deficiency Anemia among Iranian Pregnant Women; a Systematic Review and Meta-analysis

Authors
1 Department of Obstet . and Gynecol Faculty of Medicine, Shahid Beheshti Medical Sciences University, Tehran, Iran
2 Medical Students Research Center, Vice-Chancellor for Research, Kerman University of Medical Sciences, Kerman, Iran
3 Neuroscience Research Center, Kerman University of Medical Sciences, Kerman, Iran
4 School of Veterinary, Shahid Bahonar University, Kerman, Iran
5 Women's Health Affairs Office, Ministry of Health and Medical Education, Tehran, Iran
6 Physiology Research Center, Department of Epidemiology & Biostatistics, Kerman University of Medical Sciences, Kerman, Iran
Abstract
Introduction: Anemia, particularly Iron Deficiency Anemia (IDA), is the most common hematological disorder during pregnancy with considerable complications in both mothers and fetuses. The estimation of anemia prevalence is an important step for health policy makers. Despite being considered a hot topic in epidemiological studies in Iran for the last twenty years, lack of a comprehensive overview on the findings encouraged the authors to carry out this study.Materials and Methods: All published papers in main national and international databases were systematically searched for some specific keywords to find the related studies between the years 1993 and 2007. All published studies which had reported the prevalence of anemia were included in the study except studies on refugees, patients undergoing hemodialysis, patients with thalassemia or cancer or other selective subpopulations. Two trained reviewers independently assessed the inclusion/exclusion criteria and the quality of the selected papers, summarized them and eventually analyzed the data.Results: Ten eligible papers including 11,037 participants were entered into the analysis. The maximum and minimum reported prevalence rates of anemia during pregnancy were 4.3% and 21.5%, respectively. The overall estimate of anemia prevalence in Iranian pregnant women was 13.6 (95% CI: 8.3 - 18.9). Excluding the only out-layer from the meta-analysis, the overall estimated prevalence was 12.4% (95% CI: 9.6% - 17.9%).Conclusion: The prevalence of anemia in Iranian women during pregnancy is considerably lower than that of most EMRO countries or the one reported by WHO for Iran (> 40%) which had been performed on a small group 16 years ago. The lower prevalence rate of anemia in pregnant women versus the regional rates could be due to the improvements of the national health system and prenatal programs in recent years.
Keywords

  1. Gautam CS, Saha L, Sekhri K, Saha PK. Iron defi-ciency in pregnancy and the rationality of iron sup-plements prescribed during pregnancy. Medscape J Med. 2008;10(12):283.
  2. Malee M. Anemia in Pregnancy. Obstet Gynecol. 2008; 112(1):201-7.
  3. De Benoist B, McLean E, Egli I, Cogswell M. Worldwide prevalence of anaemia 1993–2005, WHO Global Database on Anemia. Geneva: World Health Organization; 2008. p. 21.
  4. Safavi M, Sheykh Aleslam R, Naghavi M, Abdol-lahi Z, Sadeghian Sharif S, Sadegh zadeh E, et al. [Prevalence of Iron deficiency anemia among Iranian Pregnant woman, Spring 2001]. Iran J Epidemiol. 2006;1(4):1-10. Persian.
  5. Khademi Z, Shahi A, Farshid Far GhR, Zare Sh, Vaziri F. [Prevalence of iron deficiency anemia in pregnant women referred to Shariati hospital in Bandar Abbas, Iran]. Hormozgan Med J. 2004;8(1): 27-31. Persian.
  6. Navidian A, Ebrahimi Tabas E, Sarani H, Ghalge M, Yaghobinia F. [The prevalence of Iron-deficiency anemia in the pregnant women referring to health centers in Zahedan]. J Reprod Infertil. 2006;7(2): 132-8. Persian.
  7. Borna S, Borna H, Ghanbari Z, Khezrdoost S. Anemia and factors that affect it in pregnancy. Tehran Univ Med J. 2005;63(6):448-52.
  8. Davaritanha F, Kaveh M, Salehi B. [Incidence of anemia in pregnancy and its relationship with maternal characteristics and pregnancy outcome]. Hayat. 2005;11(24,25):23-31. Persian.
  9. Haghdoost AA, Sadeghirad B, Hajarizadeh B, Mirzazadeh A. The Application of Systematic Review and Meta-analysis Concepts in Summar-izing the Findings of Observational Studies. Iran J Psychiatry. 2007;2(4):132-6.
  10. Baig-Ansari N, Badruddin SH, Karmaliani R, Harris H, Jehan I, Pasha O, et al. Anemia preva-lence and risk factors in pregnant women in an urban area of Pakistan. Food Nutr Bull. 2008;29 (2):132-9.
  11. Khosla AH, Dahiya P, Dahiya K. Burden of chronic severe anemia in obstetric patients in rural north India. Indian J Med Sci. 2002;56(5):222-4.
  12. Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. JAMA. 2000;283(15):2008-12.
  13. Moher D, Tetzlaff J, Tricco AC, Sampson M, Altman DG. Epidemiology and reporting charac-teristics of systematic reviews. PLoS Med. 2007;4 (3):e78.
  14. Heidarnia MA, Entezari A, Moein M, Mehrabi Y, Pourpak Z. [Prevalence of asthma symptom in Iran: a meta-analysis]. J Res Med Sci. 2007;31(3): 217-25. Persian.
  15. Haghdoost AA, Rezazadeh-Kermani M, Sadghirad B, Baradaran HR. Prevalence of type 2 diabetes in the Islamic Republic of Iran: systematic review and meta-analysis. East Mediterr Health J. 2009;15(3): 591-9.
  16. Haghdoost AA, Sadeghirad B, Rezazadehkermani M. Epidemiology and heterogeneity of hyperten-sion in Iran: a systematic review. Arch Iran Med. 2008;11(4):444-52. Review.
  17. Mirzazadeh A, Sadeghirad B, Haghdoost AA, Bahrein F, Rezazadeh Kermani M. The prevalence of obesity in Iran in recent decade; a systematic review and meta-analysis study. Iran J Public Health. 2009;38(3):1-11.
  18. Entezari A, Mehrabi Y, Varesvazirian M, Pourpak Z, Moin M. A systematic review of recent asthma symptom surveys in Iranian children. Chron Respir Dis. 2009;6(2):109-14.
  19. Ma AG, Schouten E, Wang Y, Xu RX, Zheng MC, Li Y, et al. Anemia prevalence among pregnant women and birth weight in five areas in China. Med Princ Pract. 2009;18(5):368-72.
  20. Ebrahimi Tabarsi A. [Prevalence of iron deficiency anemia in Zahedan pregnant women referred to health centers of Zahedan University of medical science] [Medical Doctor's thesis]. Kerman (Iran): Kerman University of Medical Sciences; 1994. Results 5; p. 96-9. Persian.
  21. Gopalan C. Current food and nutrition situation in south Asian and south-east Asian countries. Biomed Environ Sci. 1996;9(2-3):102-16.
  22. Levy A, Fraser D, Katz M, Mazor M, Sheiner E. Maternal anemia during pregnancy is an independ-ent risk factor for low birthweight and preterm delivery. Eur J Obstet Gynecol Reprod Biol. 2005; 122(2):182-6.
  23. van den Broek N. Anaemia in pregnancy in devel-oping countries. Br J Obstet Gynaecol. 1998;105 (4):385-90. Review.
  24. Toteja GS, Singh P, Dhillon BS, Saxena BN, Ahmed FU, Singh RP, et al. Prevalence of anemia among pregnant women and adolescent girls in 16 districts of India. Food Nutr Bull. 2006;27(4):311-5.
  25. Bagchi K. Iron deficiency anaemia--an old enemy. East Mediterr Health J. 2004;10(6):754-60.Review.
  26. Nejat S, Majdzadeh SR, Heshmat R, Noorizadeh F, Etemadi A. [A practical guide for assessing prior-ities in health research and interventions on risk factors]. Payesh. 2004;3(3):177-84. Persian.
  27. Salarilak S, Rabiipoor S, Ebrahimpoor-Azar F, Noori-Saidloo S. [Assessing the role of gaps between pregnancies on iron storage of pregnant mothers referred to health centers of Uremia city]. Urmia Med J. 1999;10(4):293-300. Persian.
  28. Jalali M, Siassi F, Ghiasvand R, Jarollahi N, Gheibi F, Fatehi F, et al. [Iron deficiency anemia in pregnant women in Eslamshahr]. J Kerman Univ Med Sci. 2005;12(4):271-7. Persian.
  29. Kalantari N, Samadanian F, Karim abadeh N, Valaei N. [The efficacy of Iron supplementation during pregnancy in Isfahan province, 1999]. Pajoohandeh. 2003;8(3):161-70. Persian.
  30. Asnafi N, Sina S, Miri S. [Prevalence of anemia and its relationship with mother’s age and gesta-tional age in pregnant women visiting Yahyanejad hospital of Babol in 2000]. J Reprod Infertil. 2003; 4(3):213-9. Persian.
  31. Hajian KO, Asnafi N. [The relationship between maternal hemoglobin and hematocrit levels with neonatal pregnancy complication at birth]. Danesh-var Med. 2006;13(64):33-8. Persian.
  32. Latifzadeh SZ, Kazemi A. [Prevalence of iron defi-ciency in pregnant women and their neonate in teaching hospitals of Tehran]. J Iran Univ Med Sci. 1998;5(1):56-62. Persian.
  33. Ghasemzadeh S, Markazimoghadam N, Aminian M. [Erythrocyte parameters changes through out pregnancy in women referred to gynecology and obstetrics clinic at Khanevadeh medical center at 2004-2005 year]. J Army Univ Med Sci. 2006;4 (3):915-22. Persian.
  34. Rahbar N, Ghorbani R, Khansoltani S, Rashme-karim M. [Prevalence of anemia and some of the related individual factors in the third trimester of the pregnancy in women referred to Semnan university of medical sciences clinics, 1999]. Koomesh. 2000;1(4):31-7. Persian.
  35. Karimi M, Kadivar R, Yarmohammadi H. Assess-ment of the prevalence of iron deficiency anemia, by serum ferritin, in pregnant women of Southern Iran. Med Sci Monit. 2002;8(7):CR488-92.
  36. Yazdani M, Tadbiri M, Shakeri S. Maternal hemo-globin level, prematurity, and low birth weight. Int J Gynaecol Obstet. 2004;85(2):163-4.
  37. Fararooei M, Vakili M, Akbartabar M. [Prevalence of pregnancy risk factors in pregnant women referred to Fars province health centers]. Armagha-ne Danesh. 1999;4(15,16):9-14. Persian.
  38. Amolae Kh, Ehsani MA, Ahmadi D. [Prevalence of Iron deficiency anemia in full-term pregnant women in Kermanshah, 1999]. Behbood. 2001;5 (2):36-42. Persian.
  39. Soheili Azad AA, Jalali M, Jazayeri A, Golestan B. [Nutritional anemia in pregnant women]. J Kerman Univ Med Sci. 1997;4(1):14-9. Persian.
  40. Vahidinia AA, Shamse vala S. [Study on Iron as well as Iron-deficiency anemia in pregnant women of Hamadan city]. J Ilam Univ Med Sci. 2003;11 (38,39):9-16. Persian.