Psychological and social factors associated with late pregnancy iron deficiency anaemia in rural Viet Nam: a population-based prospective study

Abstract

Objectives: The aim of this study was to examine the relationships between psychological and social factors and late pregnancy IDA among pregnant women in rural Viet Nam.

Methods: Pregnant women from 50 randomly-selected communes within Ha Nam province were recruited and assessed at 12 - 20 weeks gestation (Wave 1, W1). They were followed up in the last trimester (Wave 2, W2). IDA was defined as Haemoglobin < 11 g/dL and serum ferritin < 15 ng/mL. Symptoms of Common Mental Disorders (CMD) were assessed by the Edinburgh Postnatal Depression Scale-Vietnam (EPDS-V). Persistent antenatal CMD was defined as having an EPDS-V score ≥ 4 in both W1 and W2. Hypothesis models were tested by Structural Equation Modeling analyses.

Results: A total of 378 women provided complete data at both W1 and W2. The incidence risk of IDA in the third trimester was 13.2% (95% confidence interval (CI): 9.8-16.7). Persistent CMD was found in 16.9% (95% CI: 13.1-20.7) pregnant women and predicted by intimate partner violence, fear of other family members, experience of childhood abuse, coincidental life adversity, and having a preference for the sex of the baby. There was a significant pathway from persistent CMD to IDA in late pregnancy via the length of time that iron supplements had been taken. Receiving advice to take iron supplements and higher household wealth index were indirectly related to lower risk of late pregnancy IDA. Early pregnancy IDA and being multi-parous also contributed to late pregnancy IDA.

Conclusions: Antenatal IDA and CMD are prevalent public health problems among women in Viet Nam. The link between them suggests that while direct recommendations to use iron supplements are important, the social factors associated with common mental disorders should be addressed in antenatal care in order to improve the health of pregnant women and their infants.

Figure 1. Scatter plots of ferritin and haemoglobin in early and late pregnancy in 378 women, Ha Nam province, Viet Nam in 2010.

References lines for iron deficiency (ferritin < 15 ng/ml) and anaemia (Hb < 11 g/dL).

Figure 2. Model predicting IDA in pregnant women during the last trimester, Ha Nam province, Viet Nam in 2010.

∙ All of the variables in the diagram (presented in rectangular boxes) are observed except for the unmeasured (latent) variable ‘Intimate partner violence’ (represented as an ellipse). ∙ The dependent variables are: Persistent CMD (yes/no), Length of time taking iron supplements (continuous – percentage points) and IDA at last trimester (yes/no). ∙ Single-headed solid arrows represent statistically significant directional paths, whereas dashed lines indicate hypothesized but non-significant paths. ∙ The values given for the paths from the latent variable (Intimate partner violence) to the 5 variables assessing the quality of the relationship with the intimate partner (e.g. IBM control score) are factor loadings. ∙ Path coefficients in italics are odds ratio and bold path coefficients are the linear regression coefficients representing the variables with direct relationships with Length of time taking iron supplements.