Pregnancy-related anemia is a global health issue that affects high-, middle-, and low-income nations and has multiple effects on socioeconomic development and health. Anaemia was estimated to affect approximately 40.1% of pregnant women worldwide [1]. Anemia is characterized by a hemoglobin content that is below normal, according to the World Health Organization (WHO) [2]. Due to the increased iron demand during pregnancy, lactation, and monthly blood loss, anemia is common in females [3]. In order to prevent anemia in pregnant women, India was the first developing nation to implement the National Nutritional Anemia Prophylaxis Program (NNAPP). In order to lower the prevalence of anemia to 25%, NNAPP was started in 1970 as part of the fourth 5-year health plan [4]. Iron deficiency is the main cause of anemia, which can be caused by a decrease in red blood cells, insufficient synthesis of hemoglobin, or increased breakdown of red blood cells [5]. Numerous causes are known to be linked to anemia, but among pregnant women, the following are common: low socioeconomic position, high parity, short birth interval, poor diet in terms of quantity and quality, lack of knowledge about nutrition and health, and a high prevalence of infectious infections [6]. The World Health Organization states that anemia during pregnancy is defined as hemoglobin levels below 11.0 g/dL and can be classified into three severity categories: mild anemia, which is defined as hemoglobin levels between 9 and 10.9 g/dL, moderate anemia, which is defined as hemoglobin levels between 7 and 8.9 g/dL, and severe anemia, which is defined as hemoglobin levels below 7 g/dL [7]. Pregnancy-related anemia in low-income nations can be caused by a number of factors, such as parasite infections, persistent HIV and TB infections, and nutritional deficiencies in iron, folate, vitamins A, and B12 [8]. These variables influence the onset and course of anemia in pregnancy to differing degrees. In practically every developing nation, anemia during pregnancy is one of the main causes of illness and mortality for both the mother and the fetus. In a pregnant woman who is anemic, even mild bleeding may increase the likelihood of an early birth. Furthermore, a decrease in hemoglobin increases the risk of low birth weight and fetal development limitation. Additionally, infants' cognitive, behavioral, and physical development is negatively impacted by maternal anemia. Additionally, anemia weakens the immune system and raises the risk of infection in newborns [9]. Red blood cell size and hemoglobin content can be used to classify anemias. They are separated into normochromic or hypochromic anemias according to hemoglobinization levels, and Normocytic, Microcytic, or Macrocytic anemias according to size. These divisions provide information about possible reasons. Small, pale cells are a hallmark of microcytic hypochromic anemias, which are mostly brought on by problems with hemoglobin synthesis such as iron shortage. On the other hand, problems with the bone marrow that prevent red cell maturation cause macrocytic anemias. The causes of normocytic and normochromic anemias are many. Anaemia's clinical manifestations are ambiguous and nonspecific. Physical examinations and laboratory tests, such as measurements of hemoglobin, hematocrit, and red blood cell indices, should be part of the work-up. The cell count, mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), red cell distribution width (RDW), and MCV should all be included in the red blood cell indices [10]. The clinical consequence of long term anemia is significant and hence proper diagnosis and management is important to avoid untoward complications. Though there are many screening programs available for screening of anemia in general population, a clear cut data regarding the prevalence and morphological categorization of the anemia in females in India is still lacking.

Aim: To determine the morphological kinds of anemia in pregnant women during first trimester as well as the prevalence of anemia in these patients.

This cross-sectional observational hospital-based study was conducted on the ANC patients attending OPD and IPD of the OBGY department in an Indian medical college. Duration of study was 06 months (January 2024 to June 2024).

The written consent of the pregnant women was obtained prior to the collection of the blood sample. Data was collected with the help of proforma.

Inclusion criteria:

• Pregnant women age ranged 18-40 years
• First trimester of pregnancy
• Pregnant women who provided written informed consent for the study

Exclusion criteria:

• Pregnant women <18 or >40 years of age
• Pregnant women in second and third trimester
• ANC patients with other complications related to pregnancy, obesity, diabetes, multiple pregnancies
• Patients not provide consent for the study

For the purposes of PBS analysis, blood index estimation, and hemoglobin estimation, a sample of blood was drawn in an EDTA vacationer. Hb estimate and blood index estimation are used to diagnose anemia. Leishman stain-stained peripheral blood smears are used to perform morphological typing.

The mean minimum acceptable hemoglobin level during pregnancy by WHO criteria are taken to be 11.0 g/dL. WHO and ICMR (Indian Council of Medical Research) further divides anemia in pregnancy into: mild anemia (hemoglobin 10-10.9 g/dL), moderate anemia (hemoglobin7.0-9.9 g/dL) and severe anemia (hemoglobin <7 g/dL) [11].

A proforma sheet that had been developed and needed to be filled out was used to collect data. This comprises the patient's biodata, obstetric history, personal history, including food habits, past medical history, treatment history, family history, and any planned investigations.

Statistical analysis: The collected data were transferred to the Statistical Package for Social Sciences (SPSS) Version 24. The mean age ± standard deviation, distribution and frequencies of the characteristics were calculated, in addition to differences in the severity of anaemia among morphological patterns, using the chi-squared test. P-values <0.05 were considered significant

A total of 650 pregnant women in first trimester were enrolled and investigated for anemia in this study, out of them the prevalence of anemia was 400 (61.5%).

Graph 1: Prevalence of anemia

Majority of the women (57%) were found to be mild anemic followed by moderately anemic (31%) and 12% had severely anemic

Graph 2: Showing grading of anemia amongst anemic subjects

A highly significant association of anemia was found with rural residence, illiteracy, vegetarian diet, birth interval, and awareness of anemia and ANC (p<0.05).

Table 1: Factors associated with anemia in pregnancy

PBS examination of anemic women shows Microcytic hypochromic anemia (54%), Normocytic normochromic (19.5%), Macrocytic anaemia (10.5%), Dimorphic anemia (9%), Microcytic normochromic (4%), and Normocytic hypochromic (3%).

Table 2: Distribution of Morphological pattern of anemia among study subjects

Pregnancy-related anemia is a major global public health concern, particularly in underdeveloped nations. Anemia starts in childhood, worsens in puberty for girls, and becomes more severe during pregnancy. In the world, it is the most prevalent nutritional deficient condition. Anemia is more common in India across all age groups than in other emerging nations.

In the present study, the prevalence of anemia in pregnant women is found to be 61.5%.Similar findings were reported by Suryanarayana et al [12], Sharma et al [13], and Bisoi et al [14] shows the prevalence of anemia 64%,63%, and 67.8% respectively. Whereas the study conducted by Kaul et.al [15] prevalence of anemia is observed to be very high (91%). Different prevalence of anemia in various geographical regions could be due to their living pattern, diet pattern and various other regions

It is observed that in the present study the majority of the anemic pregnant women belong to the age group 21-30 years, in agreement with the Patil J.D. et al [16].

In our study majority of the anemic women resided in rural area and belong to lower socio-economic class, similar results found by Mangla M, et al [17] and Wadgave HV, et al [18].

Rural and low-income women lack access to a diet high in iron and folic acid, and because of unsanitary surroundings, they are more likely to get infections that lead to long-term blood loss.

A highly significant association of anemia was found with vegetarian diet and birth interval. These findings correspond to the study conducted by Bhirud AK et al [19] and Claire, et al [20]. Poverty and ignorance cause people to omit meat, poultry, and fish—all of which are excellent sources of iron—from their diets. Even vegetarianism is rarely healthful, which exacerbates nutritional deficits in low-income women. Less than two years between births depletes a woman's body's iron reserves

We discovered that pregnant women's anemia was substantially correlated with illiteracy, ignorance about anemia, and antenatal care. Similar factors were also identified in the studies by Khandat M, et al. [22] and Ramya G, et al. [21] as the cause of anemia.

Predisposing variables for anemia and nutritional deficiencies include adolescent pregnancy, illiteracy, and rural pregnant women's ignorance of anemia.

Current study observed that most of the women had mild anemia followed by moderate to severe anemia, consistent findings reported by Abusharib AB, et al [23] and P Burdak, et al [24].

Microcytic hypochromic (mean hemoglobin and packed cell volume is found to be lowered) is the most common morphological type in the current investigation. Normocytic normochromic is the next most common type. Our findings are similar to those of Yakoob MY et al. [25] and Choudhary R et al. [26]. Therefore, accurate knowledge, prenatal care, monitoring, and attentive prenatal therapy will enhance the outcomes for both the mother and the fetus.

Pregnant women who live in rural areas, have poor socioeconomic position, are pure vegetarians, and are largely illiterate are likely to have a higher prevalence of anemia in this study. This could potentially affect their nutritional status. The majority of the blood images in this study are microcytic hypochromic, which suggests low iron consumption and ignorance of a healthy diet. The outcomes for both the mother and the fetus will be much improved by appropriate interaction, information, medicine, a healthy diet that includes all the nutrients, cooking with iron utensils, fortifying food and salt with iron, and using birth control to space out pregnancies.

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