AFJOG

African Journal of Obstetrics and Gynaecology | Volume 3 | Issue 3 | 2025 | 16 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 This study’s strengths lie in being one of the few studies examining anaemia during pregnancy in South Africa, particularly in the Western Cape and our focus on iron deficiency, which is a seldom-studied factor in pregnancy- related anaemia. A recent South African study conducted in pregnant women attending a regional hospital in KZN showed a lower overall prevalence of anaemia (42,7%). In the majority the anaemia was normocytic and normochromic (68.9%) and only 1.4%had hypochromic microcytic anaemia. Iron studies however were not done to establish iron status. The prevalence of anaemia was significantly higher in HIV-positive (71.3%) compared with HIV-negative (28.7%) pregnant women, 42,2% of study population being HIV positive. [40] The far lower prevalence of HIV in pregnant women in Mowbray Maternity Hospital was a major difference between the two study populations (42,2% vs 21,9%.) However, there are several limitations that should be acknowledged. The study's cross-sectional design only provides a snapshot of the prevalence of anaemia at a specific point in time and does not capture longitudinal changes or causality. [34] Convenience sampling might introduce selection bias, potentially influencing the generalisability of the findings. [35] Additionally, the study was of a small sample size and conducted over a one-week period, which may not capture the true prevalence and fluctuations of IDA in this population. Moreover, the lack of a control group of non-pregnant individuals or individuals attending a different healthcare setting limits the ability to make direct comparisons. Another potential limitation is that patient fasting times were not noted which may lead to an overestimation of TS in non-fasting patients, in the group with serum ferritin 30–100, where TS was used to confirm iron deficiency. In addition, another limitation is that compliance to iron supplementation was per patient reporting only, as this could be subject to recall bias. Notably, our study addressed formal Hb investigation and iron deficiency in patients who were found anaemic on Haemocue ® screening test. This limitation was imposed by the hospital's protocol, which mandated blood sampling only for patients found anaemic on screening Haemocue ® testing. Future studies should be conducted to address this gap and inform evidence-based practices, guide policy development and improve interventions. Comparing the findings of this study to existing literature, the prevalence of anaemia in pregnancy observed here aligns with the higher rates reported in LMIC, particularly within sub-Saharan Africa. [36] The prevalence of IDA found in this study is consistent with existing evidence that iron deficiency is a prominent contributor to anaemia during pregnancy. [37] The high prevalence of IDA and the evident connection between absolute iron deficiency and anaemia highlighted in this study, emphasizes the pressing need for the implementation of effective strategies in both, preventing and treating, iron deficiency anaemia during pregnancy. Addressing iron deficiency during pregnancy not only benefits maternal health but also holds the potential to positively impact neonatal outcomes, breaking the cycle of intergenerational iron deficiency. [9,20,21] The American College of Obstetricians and Gynaecologists’ recommendations provide a clear pathway. They propose anaemia screening through full blood counts in the first trimester and again between 24 0/7 and 28 6/7 weeks of gestation. They also advice early low-dose iron supplementation, with the potential consideration of parenteral iron for non-responders or severe deficiency. [38] Pregnant individuals may require additional supplemental iron beyond standard dose to meet requirements in later pregnancy. A study conducted in Canada showed that despite almost all patients achieving 100% Recommended Dietary Allowance (RDA) of iron intake with iron supplement (27mg) and diet, 28% of women were iron-deficient at baseline (8-21 weeks) and 81% at endline (24-38 weeks). [43] Therefore, screening with a full blood count, appropriate supplementation, health education and counselling should be an integral part of antenatal care. [38,39] While offering valuable insights into IDA among pregnant patients, this study acknowledges its limitations. To determine the true prevalence, a larger study encompassing all pregnant individuals is crucial. Further research could explore the longitudinal changes in haemoglobin levels and iron status during pregnancy, as well as the impact of interventions on maternal and neonatal outcomes. Addressing these aspects will provide a more comprehensive understanding of iron deficiency in pregnancy, contributing to enhanced healthcare strategies. CONCLUSION: This study reveals a high prevalence of IDA in pregnant patients attending antenatal care at Mowbray Maternity Hospital. The findings emphasise the need for comprehensive strategies to prevent and manage IDA in this vulnerable population. By addressing this issue at the antenatal stage, clinicians and policymakers have a unique opportunity to improve maternal and neonatal health, break the cycle of intergenerational IDA, and contribute to healthier outcomes for generations to come. Implementing protocols and guidelines for the identification, testing, referral, and treatment of IDA within antenatal care settings is crucial to improving maternal and child health outcomes. Declaration The research for this study was done in fulfilment of the requirements for Pawel Scislowski’s MMed degree at the University of Cape Town. Acknowledgements The authors thank Margot Flint, Gerdien Kritzinger, Jaqui Ras for assisting with data collation, and Mowbray Maternity Hospital Antenatal Clinic staff members, for logistical support. Author contributions PS: protocol development, data collection, data collation, data analysis, writing the manuscript. Margot Flint, Gerdien Kritzinger, Jaqui Ras: data collection. Christella Alphonsus: protocol development, data analysis, reviewed drafts of the manuscript. Vernon Louw: protocol development,