AFJOG

African Journal of Obstetrics and Gynaecology | Volume 3 | Issue 3 | 2025 | 14 ORIGINAL RESEARCH African Journal of Obstetrics and Gynaecology | Volume 3 | Issue 3 | 2025 | A cross-sectional study of the prevalence of iron deficiency anaemia in pregnant patients presenting for antenatal care at a secondary level institution, Mowbray Maternity Hospital haemorrhage stands as the primary contributor to maternal mortality, accounting for a third of maternal fatalities in Africa, [14] the burden of anaemia exacerbates this already critical situation. Maternal iron deficiency also impacts the health of newborns, leading to low iron stores in the neonate. [15] This deficiency increases the likelihood of lower birth weight, lower Apgar scores, fetal distress, [9] and an elevated risk of developing retinopathy of prematurity. [16] The period of vulnerability to iron deficiency in fetuses and newborns is believed to occur during critical periods of development, including the late stages of pregnancy and the first two years of life. [17-19] During this crucial time, infants with anaemia are more prone to experiencing a range of negative effects, including a higher prevalence of failure to thrive and delays in intellectual development. [9] These long-term consequences manifest as challenges in school performance, including delays in development, reduced motor activity, impaired social interaction, difficulty in paying attention to tasks, lower intelligence quotient (IQ), and learning and memory difficulties. These difficulties can affect productivity and overall quality of life in adulthood. [20] Notably, adults who experienced iron deficiency as infants are more likely to have children who also suffer from iron deficiency, [21] perpetuating this cycle across generations. Considering the profound impact of developmental delays on neurocognitive function, it is imperative to implement strategies that prevent perinatal iron deficiencies and promote neural plasticity. [21] Breaking this cycle requires focused attention on the prevention of iron deficiency during crucial developmental periods. Antenatal care presents a unique opportunity to intervene and implement simple interventions that can significantly improve the health and well-being of both mothers and their unborn children. [22] To address this pressing issue, it was crucial to determine the prevalence of IDA in pregnancy within the South African context. The primary aim of the study was to establish the prevalence of anaemia among all women who presented for antenatal care at a secondary level institution in the Western Cape, Mowbray Maternity Hospital, during a one- week period. The secondary aims of the study were to categorise the type and severity of anaemia in the study population, comorbidities associated with anaemia, as well as to identify any treatment measures that were instituted. METHODS: Participants and setting A cross-sectional prospective study of all the patients presenting to the antenatal clinic at Mowbray Maternity Hospital, which is a dedicated obstetric secondary-level referral hospital, was conducted over a one-week period from the 31 January 2022 until 4 February 2022. Ethics Ethics approval was provided by the Human Research Ethics Committee of the Faculty of Health Sciences of the University of Cape Town (ref. no. 636/2021) and the trial was registered on ClinicalTrials.gov (ref. no. NCT 05157828). Approval was granted by the Western Cape Department of Health and the individual hospitals to conduct the study (provincial approval ref. no. WC_202111_029) Study design The patients included in this study were recruited by convenience sampling, the inclusion criteria were all consenting women, over the age of 18 years, presenting for antenatal care at Mowbray Maternity Hospital. Prior to recruitment, signed, informed consent was obtained from each patient. Consent forms were available in English and discussed with all participants in their native language when necessary. The interview was conducted in the participant’s language of choice and a translator assisted with interpretation if required. Definitions and tests Patients were classified as anaemic or not anaemic according to the WHO definition of anaemia in pregnancy, a Hb<11g/ dL.The WHO further classifies anaemia in pregnancy as mild (Hb 10– 10.9g/dL), moderate (Hb7–9.9g/dL) or severe (Hb<7g/dL). [23] A serum ferritin concentration < 30μg/L, together with an Hb concentration <11g/dL, is diagnostic for absolute IDA during pregnancy. [15,24] Measurement of patient ferritin concentration is the most accurate test in patients without underlying inflammation.[24] It is recommended to measure serum ferritin at least once early in pregnancy. [15] A ferritin of between 30-100ug/L requires analysis of transferrin saturation (TS) for functional iron deficiency. [25] We did not use Mean Corpuscular Volume (MCV) because it is not an adequate test and only indicates advanced stage iron deficiency. MCV can also be affected by other conditions like concomitant vitamin B12 or folate deficiency and chronic inflammation or infection, such as HIV. Data Collection A data collection sheet designed for the study was completed by the researchers for each patient attending antenatal care over the period of the study. Each patient had routine finger- prick point-of-care Hb (Haemocue ® ) as a screening test. Patients who were anaemic on screening had formal laboratory testing with a blood specimen taken for full blood count (FBC) in order to establish the severity of their anaemia. Ferritin and transferrin saturation were measured in patients with Hb<11g/dL. Patients diagnosed with anaemia on formal laboratory testing, were identified and the results were filed for follow up at their next antenatal visit. In severe cases, or where there was evidence of a more complex diagnosis, the patient was to be flagged to allow immediate contact to be made for appropriate referral. Information was also collected on patient demographics, comorbidities, presence of anaemia symptoms, and compliance with iron supplementation as per data collection sheet. Patients were specifically asked about symptoms of anaemia and compliance with supplementation. Oral iron supplementation was routinely prescribed to patients