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ORIGINAL / RESEARCH
Fertility Pattern in Anaemic and Non-Anaemic Pregnant Women - Pilot Study
RB Gurav, S Kartikeyan
A pilot study conducted in Thane (Maharashtra) revealed that 73.80% out of 271 pregnant women were anaemic. Early age at marriage and at current pregnancy was associated factors. The pregnant women who were anaemic had more number of children, compared to their non-anaemic counterparts.
INTRODUCTION
It is well recognized that unregulated fertility is associated with anaemia, high incidence of spontaneous abortions, antepartum haemorrhage, high maternal and perinatal mortality and higher prevalence of low birth weight among babies. These health hazards have shown a sharp rise in prevalence, after the fourth pregnancy.2 It is estimated that anaemia affects nearly two thirds of pregnant and about half of non-pregnant women in the developing countries.2 As per guidelines proposed by an Expert Group of the World Health Organisation1, “anaemia should be considered to exist when the haemoglobin level is below 11 grams per decilitre (of venous blood) in pregnant women”. When this criterion is used, it is estimated that more than half of the pregnant women in the developing countries may be anaemic, while the prevalence of anaemia among pregnant women in the developed world may not exceed 20%.4
In developing countries, the most common cause of anaemia in pregnancy is nutritional. An inverse type of relationship indirectly exists between maternal nutritional status and fertility levels. Virtually, in societies where women are well fed, the fertility levels are low, while societies where women are not well fed, the fertility levels are high.2 Poor maternal nutrition may also lead to poor child survival, which increases the overall fertility. The other causes of anaemia in pregnancy include - hookworm infestation, repeated pregnancy inter-current infection, ante - and post-partum haemorrhages, persistent vomiting and spontaneous abortion. Premature labour, low birth weight babies, premature births, puerperal sepsis, thromboembolic phenomenon and high perinatal mortality are associated with anaemia in pregnancy.2.5
Though anaemia is more prevalent among women belonging to lower socio-economic strata of society, it is not uncommon among the well-to-do sections of society.5 Surveys in different parts of India have revealed that about 50-60% women belonging to lower socio-economic groups are anaemic in the last trimester of pregnancy.2
The same set of social factors that affect fertility also affect the prevalence of anaemia. In societies where the status of women is low, women face both covert and overt discrimination in the distribution of food within the family. Even in many well-to-do Indian families, the women eat only after the men folk have finished their meals. Thus the use of iron and folic acid tablets is only a short term intervention. Any long-term strategy should involve social and educational interventions. Since the last few decades, haemoglobin estimation has been routinely used as a screening test during ante-natal care.2
This study was initiated in order to study the relationship between the haemoglobin levels in pregnant women and the fertility patterns.
MATERIAL AND METHODS
This pilot study was conducted at the ante-natal clinic of a referral hospital in Thane (Maharashtra). The study group comprised all the pregnant women (with at least 20 weeks of amenorrhoea), who attended this clinic during the month of February 2001. A pre-tested, formatted proforma was used in this cross-sectional study, to record health and socio-demographic data, which included the current age, at marriage, number of living children and the total number of children borne by these women.
Haemoglobin levels were estimated (using venous blood), by the Sahli’s method, as described by Godkar.3 The haemoglobin levels were also recorded in the proforma. The collected data were tabulated, analyzed and discussed.
RESULTS
271 pregnant women attended the ante-natal clinic during the month of February 2001. All these women willingly participated in this pilot study. 200 (73.80%) had haemoglobin level of less than 11 grams per deciliter of venous blood and were therefore considered as anaemic, as per WHO criteria.
1 85 (42.5%) of the anaemic women had married between 15-19 years of age, and 75 (37.5%) between 20-24 years of age 54.93% of non-anaemic women had married between 20-24 years of age. The mean age at marriage for the anaemic and non-anaemic women was 20.83 years and 22.05 years respectively. The differences in distribution of age at marriage between these two groups was statistically significant at p < 0.05 (Table 1).
Age at marriage
Age at
MarriageHaemoglobin levels Total
< 11 gms/dl ........>11 gms/dl13-15 years 06 (03.00) 02 (02.82) 08 (02.95) 15-19 years 85 (42.50) 16 (22.53) 101 (37.27) 20-24 years 75 (37.50) 39 (54.93) 114 (42.07) 25-29 years 27 (13.50) 11 (15.49) 38 (14.02) 30 years + 07 (03.50) 03 (04.23) 10 (03.69) Total 200 (100.00) 71 (100.00) 271 (100.00) Mean age at
Marriage24.69 yrs 26.89 yrs Figures in parentheses indicate percentages.
Chi Square = 10.82. Significant at p < 0.05.
The current age of 43% of anaemic women was between 20-24 years, while that for 40.85% of the non-anaemic women was between 25-29 years. The mean age at the time of the study for the anaemic and non-anaemic women was 24.69 years and 26.89 years, respectively. The differences in age distribution between these two groups was also statistically significant at p < 0.05 (Table 2).
Age at the time of the study
Age at
GroupHaemoglobin levels Total
< 11 gms/dl ........>11 gms/dl15-19 years 20 (10.00) 06 (08.45) 26 (09.59) 20-24 years 86 (43.00) 15 (21.12) 101 (37.27) 25-29 years 68 (34.00) 29 (40.85) 97 (35.80) 30 years + 26 (13.00) 21 (29.58) 47 (17.34) Total 200 (100.00) 71 (100.00) 271 (100.00) Mean age at
Marriage24.69 yrs 26.89 yrs
Chi Square = 10.82. Significant at p < 0.05.
Among the 200 anaemic pregnant women, 98 (49%) had one or more living children (multi-gravida) and 102 (51%) had not borne a child (primi-gravida). Out of the 71 non-anaemic pregnant women, 65 (83.33%) were multi-gravida and 6 (16.67%) were primi-gravida. The difference in distribution of haemoglobin levels between primigravidous and multigravidous women was statistically significant (Table 3).
Distribution of haemoglobin levels
Age Group
(in years)
Primigravida
< 11 gms/dl
Primigravida
>11 gms/dl
Multigravida
< 11 gms/dl
Multigravida
>11 gms/dl15-19 years 15 (14.70)
05 (83.33) 05 (05.10) 01 (01.54) 20-24 years 75 (73.53)*
01 (16.67)* 11 (11.23) 14 (21.54) 25-29 years 12 (11.77)
— 56 (57.14)** 29 (44.61)** 30 years + —
— 26 (26.53) 21 (32.31) Total 102 (100.00)
06 (100.00) 98 (100.00) 65 (100.00) Mean age at
Marriage24.69 yrs 26.89 yrs
In all the age groups, the number of children borne by the anaemic mothers was significantly higher than that for the non-anaemic mothers (Table 4 and figure). All the children borne by the respondents were alive at the time of the study. The average number of child births per woman for the anaemic and non-anaemic mothers was 1.74 and 1.24, respectively.
Number of child births - pattern among multi-gravidous respondents
Age of the
Mother
Haemoglobin levels of the mothers
< 11 gms/dl ...............>11 gms/dl15-19 yrs 06 (03.55)
01 (01.23) 20-24 yrs 18 (10.65) 15 (18.52) 25-29 yrs *
89 (52.66)* 31 (38.27) 30 years + 56 (33.14)**
34 (41.98)** Total 169 (100.00) 81 (100.00) Mean age at
Marriage24.69 yrs 26.89 yrs
DISCUSSION
In the present pilot study, pregnant women who were “anaemic” as per WHO criteria1, had married earlier, as compared to their “non-anaemic” sisters. More than half (54.93%) of non-anaemic women had married between 20-24 years of age (Table 1). The statistically significant difference in the age at marriage between the two groups suggests that early marriage and conception may be related to low haemoglobin levels in pregnant women.
A majority (77%) of anaemic pregnant women belonged to the age group of 20-29 years and only 13% were over 30 years old. In case of the non-anaemic pregnant women, the age distribution showed a small peak at 25-29 years and 29.58% of these women were over 30 years old (Table 2). This may reveal a significant association between early conception and anaemia in pregnancy.
Out of the 108 primigravidous respondents, 102 (92.33%) were anaemic, while 98 out of 163 (60.12%) multigravidous respondents belonged to this category (Table 3). Since all the respondents had at least 20 weeks of amenorrhoea, it is possible that physiologically-mediated haemodilution may be one of the factors responsible for higher incidence of anaemia among the primigravida. The compliance of the respondents to consumption of iron and folic acid tablets could not be monitored in this pilot study.
The multigravidous women who were anaemic had borne a significantly higher number of children, when compared to their non-anaemic counterparts (Table 4 and Fig. 1). Among multi-gravidous women, higher fertility may be associated with higher prevalence of anaemia in pregnancy.
Fertility in women is affected by a variety of factors like age at marriage, child spacing, level of education, economic status, customs and beliefs and status of women in society.2 A large statistically designed study would be necessary to study the effects of multiple factors on the fertility and haemoglobin levels in pregnant women.
REFERENCES
1. World Health Organization: Nutritional anaemias, Technical Report Series No. 405, WHO Geneva, 1968; 5-27.
2. Park K. Park’s Text Book of Preventive and Social Medicine. 16th edition. Banarsidas Bhanot, Jabalpur. 2000; 352-451.
3. Godkar PB. Text book of Medical Laboratory Technology. First edition. Bhalani Publishing House, Mumbai. 1994; 404-48.
4. Daftary SN, Chakravarti S. Robert Percival, Holland and Brews. Manual of Obstetrics, 15th edition. BI Churchill Livingstone, New Delhi. 1993; 164.
5. Mahajan BK, Gupta MC. Text Book of Preventive and Social Medicine. Second edition. Jaypee Brothers Medical Publishers (P) Limited, New Delhi 1995; 577.
CONTRACEPTIVES AND CANCER
Furthermore, use of oral contraceptives for longer than five years is thought to increase the risk of cervical cancer in women who are HPV-DNA positive.
Lancet Oncol 2003; 4 : 1159.
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