Prevalence of anaemia and iron deficiency in pregnant women and the effect of different iron supplements on third trimester maternal iron status: A prospective cohort study in Bope – Poddala Health Division in Galle District

Iron deficiency (ID) is still a significant health problem in Sri Lankan pregnant women. Recent national data showed that the prevalence of anaemia during pregnancy is about 30%. Usage of iron supplements to prevent ID in pregnancy is part of the routine antenatal care programmes in Sri Lanka. This study aimed to assess the prevalence of anaemia and the effect of different iron supplements on maternal iron status at the end of the third trimester (T3). In this prospective cohort study, 425 pregnant women attending antenatal clinics in Bope-Poddala health division in Galle were enrolled during the booking visit. Anaemia and ID were determined by haemoglobin (Hb <11.0g/dL) and serum ferritin (SF <15.0ng/mL) levels respectively at the study entry and the end of T3. Details of iron supplements were also obtained. In this sample 20 (4.8%) women were anaemic in the first trimester (T1) and the number increased to 49 (13.8%) at the end of the T3 (p<0.001). The mean Hb level at the study entry was 12.4 ± 0.92 g/dL and it dropped to 12.1 ± 1.1 g/dL by T3 (z test =4.47; p<0.001). In contrast, 178 (42.1%) pregnant women were iron deficient (SF <15.0 ng/mL) in T1, but iron deficiency has been significantly (p<0.001) reduced as only 64 (17.5 %) subjects having SF <15.0 ng/mL at T3. The median SF level was 17.5 ng/mL (IQR 9.2; 30.0 μg/L) at the study entry and it improved to 30.3 ng/mL (17.4; 50.8 μg/L) at the T3 (z test = 9.2; p<0.001). Total iron intake during pregnancy was adequate and there was no significant difference (p=0.92) in the iron status (by both Hb and SF levels) of pregnant women depending on the type of iron supplements obtained. Although the prevalence of anaemia was low in T1, it was increased significantly with the advancement of the pregnancy and comparable with many of the regional studies. However, iron deficiency was high in early pregnancy according to SF and it was significantly decreased at T3. Generic and commercial iron preparations did not show any significant difference in effect on the iron status at the end of T3 and the generated results did not prove any benefit over the generic preparations given from the government clinics.