Perinatal Outcomes of Anemia and Its Predictors Among Pregnant Women Admitted For Labor and Delivery, At Jimma Medical Center, Ethiopia, 2022

Abstract

Background: Anemia is a leading cause of maternal deaths and adverse pregnancy outcomes in developing countries. Overall, 42.7% of women experienced anemia during pregnancy in low- and middle-income countries. Studies have shown that, there were significantly higher risks of low birth weight, preterm birth, perinatal and neonatal mortality in pregnant women with anemia. There is paucity of information regarding the perinatal outcomes among anemic pregnant mothers both in the study area and Ethiopia. So, the study aimed at to identify the perinatal outcomes of anemia and its predictors among pregnant women admitted to labor ward at Jimma medical center, southwestern Ethiopia, 2022. Methods: A cohort study was conducted among 256 pregnant mothers admitted to labor ward for delivery with updated CBC but Sixteen (16) of them lost from follow up and data was analyzed for 240 study participants. Using WHO definition of anemia during pregnancy, each 120 anemic and non-anemic pregnant women were identified as study cohort or as exposed group and test cohort or unexposed group respectively. The minimum calculated sample size using Epi info software sample calculator was 240. Purposive sequential enrolment of the test cohort after each study cohort was conducted and face to face interviews and patients chart reviews was conducted using pretested structured questionnaire by trained residents. Perinatal outcomes of the study participants were observed at admission, intrapartum, at discharge and at 7 days following delivery. Telephone based interview was used to complete data on 7 days postpartum for those discharged earlier. After complete information obtained and data were entered to EPI Info and cleaned and analyzed using SPSS 20. X 2 test, ANOVA and independent t-test were used for comparisons and logistic regression analysis done to control cofounder and determine the predictors of anemia. A 95% CI and P value < .05 were used to determine the level of statistical significance. Results: The present study found that the adjusted odds of having anemia among pregnant women was 2.43(95%CI 1.45,4 p=.000), 3.24 (95% CI 1.78,5.92 p=.000), 4.3(95%CI 1.19,15 p=.016), 6(95%CI 2.4,15 p=.001), 2(95%CI 1.09,3.9 p=.024) and 5.7(95%CI 2.88,10.88 p=.0001, for those who were from rural, having no or 10 education, unbooked, no iron supplementation, interpregnancy interval (< 24 months) and grand multigravida respectively. When regressed for age, income, marital status and occupational status, the odds of having anemia were similar with the general population. Around 53.3%, 30% and 17.7% of anemic 2 group had mild, moderate and severe degree of anemia respectively. Of 42.5% (102/240) who has had obstetric complication, more than two third (70/102) were among anemic group (X2 = 24.6, OR=3.85 95% CI 2.24-6.6 p= .000). All specified obstetric complications were more common in anemic pregnant women than non-anemic, APH (23.5% vs 5.8%), PTL (8.8%vs3.9%), HDP (7.8%vs3.9%) and PROM (4%vs 0%). Anemic group were more likely to have preterm delivery (mean difference= -5wks, P= .000), SB (X2 = 16.7, aOR=7.3, 95%CI 2.5-23.8, p= .000), LBW (X2 = 18.9, aOR=4, 95%CI 2.2-7.8, p= .000), NICU admission (X2 = 17,OR=2, 95% CI 1.1-3.9 p= .000), EONS (X2 = 22,OR=5.6, 95%CI 2-13 p= .000) and ENND (X2 = 4, OR=9.55, 95%CI 1.2-75) p= .004). Anemia had no statistically significant association on risks of C/D (X2 = 1, OR 1.2, 95% CI .8-1.7 p= .235), PPH (X2 = 1, OR 1.6 ,95% CI .07-3.78 p= .253) and puerperal sepsis (X2 = 1, OR 2.5, 95% CI .5-12 p= .12). Conclusion: This short term follows up study identified that, the risks of having at least one of obstetric complication was found in at least two third of anemic pregnant women as primary outcomes which could lead to unfavorable maternal and fetal outcomes. The odds of the need for transfusions, maternal death, SB, preterm birth, LBW, NICU admission and EONNS were higher and statistically significant among anemic pregnant women when compared to their counterparts as a secondary outcome. Rural residency, no or 10 education, lack of ANC contacts, interpregnancy interval (less than 24 months), grand multiparity and lack of iron supplementation were strong predictors having anemia. To prevent these grave adverse pregnancy outcomes, quality ANC contact for early screening and treatments of anemia, universal oral iron supplementation and family planning counseling and education for adequate birth spacing is found to be imperative.