Anaemia in pregnancy : its prevalence and maternal and neonatal outcomes in Malta

Abstract

Aim: Anaemia in pregnancy has been associated with adverse maternal and perinatal outcomes. This study aims to determine the prevalence of anaemia in Maltese pregnant women at three specific stages in pregnancy; at booking appointment (first hospital consultation), at 34-36 weeks of gestation (third trimester) and at delivery. In addition, the factors associated with maternal anaemia, including socio-demographic factors and BMI will be analysed. Finally, the association between maternal anaemia at booking, at the third trimester and at delivery and maternal and neonatal outcomes will also be examined. Method: An observational longitudinal prospective study was carried out, whereby all the pregnant women who had their booking appointment at Mater Dei Hospital from the 1st of July, 2021 till the 8th of August, 2021 were asked to participate. During this period, 432 patients had their booking appointment. 46 patients did not agree to participate, whilst 75 patients met the exclusion criteria (multiple pregnancies, developement of medical disorders of pregnancy and pregnancy losses). Inclusion criteria included willingness to participate and planned delivery at Mater Dei Hospital. The final sample consisted of 311 participants. At booking appointment, a complete blood count (CBC) was taken and data including socio-demographic data and BMI was obtained. These women were followed up at 34-36 weeks of pregnancy whereby CBC was repeated. Another CBC was taken at delivery. The WHO criteria were used to classify patients who were anaemic; a haemoglobin concentration less than 11.0 g/dl was diagnostic of anaemia. At delivery, maternal and fetal outcomes were assessed, including need for transfusion, postpartum haemorrhage, length of hospital stay, ITU admission, postpartum sepsis, maternal and neonatal mortality, type of delivery, gestation at delivery, birth weight and Apgar score. This data was obtained from medical records. The IBM SPSS software (Version 23) was used to analyse the data. The Chi-square test (χ2) was used to examine relationships whereby a p-value of less than 0.05 (95% confidence) indicated a statistical significance between associations. Results: The prevalence of anaemia was found to be 11% at booking, 21% during the third trimester and 29% at delivery. Maternal anaemia was significantly associated with nationality (p-value less than 0.001, 0.011 and 0.004, at booking, third trimester and delivery, respectively) and nulliparity (p-value 0.022, 0.022 and 0.018, at booking, third trimester and delivery, respectively). Increasing gravidity was found to decrease risk of anaemia at booking (p-value 0.014) and at the third trimester (p-value 0.007), but not at delivery. Those women with higher level of education were found to be less likely to be anaemic at booking (p-value 0.001), whilst those women who were employed were found to be more likely to be anaemic at booking (p-value 0.024). Married women were more likely to be anaemic at the third trimester when compared to their single counterparts (p-value 0.049). Booking at first trimester was linked with decreased rates of maternal anaemia (p-value less than 0.001). Short pregnancy interval of less than 2 years increased risk anaemia, whilst longer intervals decreased likelihood of developing maternal anaemia (p-value 0.006). No statistical significance was found between age and BMI and anaemia in pregnancy. Significant associations between anaemia at the third trimester and the need for blood transfusion (p-value 0.001), as well as anaemia at delivery and increased length of hospital stay were found (p-value 0.006). Likelihood of anaemia decreased in women who had a vaginal delivery and increased in those who had elective caesarean section (p-value 0.005). No significant relationships were found between maternal anaemia and postpartum haemorrhage, gestation at delivery, birth weight of newborns and APGAR score. Conclusion: This study showed that in Malta anaemia in pregnancy is a public health problem. The development of local policies and guidelines for the detection, screening, treatment and prevention of anaemia in pregnant women is crucial