Maternal Dietary Intakes, Red Blood Cell Indices and Risk for Anemia in the First, Second and Third Trimesters of Pregnancy and at Predelivery

Abstract

As anemia remains a major public health problem in Ghana, we examined the effect of dietary intakes, and antenatal care (ANC) practices on red cell indices and anemia prevalence during the pregnancy continuum for 415 women. Dietary history was taken using the Food and Agriculture Organization minimum dietary diversity indicator for women (MDD-W). Intake of ≥5 food groups was a proxy for micronutrient adequacy. Odds for anemia and meeting the MDD-W were estimated using ordinal and binary logistic regressions respectively. Intakes of 41.4% were micronutrient inadequate. At any time point in pregnancy, 54.4% were anemic (mild = 31.1%; moderate = 23.1%; severe = 0.2%) with 10%-point variation across the first (57.3%), second (56.4%) and third (53.3%) trimesters and pre-delivery (47.7%); 27.8% were anemic throughout pregnancy while 17.1% were never anemic. Morphologically, microcytic (79.4%) and hypochromic (29.3%) anemia were most prevalent, indicating nutritional deficiencies. Planning the pregnancy was a significant determinant for meeting the MDD-W. Overall, adolescence, poor diet, suboptimum ANC and underweight were associated with moderate and severe anemia. In specific time-points, dietary counselling, malaria, iron-folic acid supplementation, sickle cell disease and preeclampsia were observed. Decline of anemia during pregnancy suggests the positive impact of ANC services and supports strengthening education on dietary diversification during ANC.

Keywords: Ghana; anemia in pregnancy; dietary diversity; dietary iron; food intakes; hemoglobin; iron deficiency anemia; malnutrition; micronutrients; red blood cell.

Figure 1

Inter-quartile and mean values for hemoglobin and other red blood cell indices classified according to the adequacy of micronutrient intake. ^*RBC indices were measured only in the second trimester. Footnote: Hemoglobin in the (A) first, (B) second, (C) third trimesters of pregnancy and (D) at the point of admission for labor and delivery, (E) mean hemoglobin during pregnancy, (F) red blood cells (G) hematocrit, (H) mean corpuscular volume, (I) mean corpuscular hemoglobin, (J) mean corpuscular hemoglobin concentration, (K) red cell distribution width and (L) white blood cells.

Figure 2

Prevalence and severity of anemia in the(A) first, (B) second and (C) third trimesters of pregnancy and (D) at the point of admission for delivery stratified according to the adequacy of micronutrient intake. Footnote: *Multiple comparison shows the categories that differed significantly (p < 0.05). Anemia classified as mild (10.0–10.9 g/dL), moderate (7.0–9.9 g/dL) and severe (<7.0 g/dL) (WHO, 2011).