ORIGINAL ARTICLE
REVISTA DE LA FACULTAD DE MEDICINA HUMANA 2020 - Universidad Ricardo PalmaDOI 10.25176/RFMH.v20i2.3192
RELATIONSHIP BETWEEN PREGNANT WOMEN WITH ANEMIA IN MATERNAL AGE AT RISK AND LOW BIRTH WEIGHT IN A HOSPITAL OF SOCIAL SECURITY OF THE PERU
RELACIÓN ENTRE GESTANTES CON ANEMIA EN EDAD MATERNA DE RIESGO Y BAJO PESO AL NACER EN UN HOSPITAL DE LA SEGURIDAD SOCIAL DEL PERÚ
Jose L. Villalva-Luna1,a, Jhonattan J. Villena- Prado2,a
1Hospital Hipólito Unanue de Tacna - MINSA, Tacna-Perú.
2Hospital Aurelio Díaz Ufano y Peral- EsSalud, Lima-Perú.
aSurgeon.
ABSTRACT
Objective: To determine the association between anemia in pregnant women with risk maternal age and low birth weight in the Obstetrics-Gynecology service of the Guillermo Almenara Irigoyen Hospital, in the period from October to
December of the year 2018.
Methods: A non-experimental, retrospective, cross-sectional, analytical, case-control study was carried out. In the period from October to December 2019, a total of 312 pregnant women with maternal age at risk (adolescent and elderly pregnant women) were registered, of which 72 were anemic (Hb <11 g / dl), this being the number of cases, and to improve the statistical power, the relationship between cases and controls was established as 1: 2, with the number of controls or non-anemic pregnant women with maternal age at risk 142. General characteristics were analyzed by a group of anemic pregnant women and not anemic, and its association with maternal age at risk. The association of anemia in adolescent and elderly pregnant women with low birth weight was determined using the Chi-square test and Odds ratio. Results: Among the variables studied, anemic pregnant women had a higher frequency of nulliparity and vaginal delivery, and a lower frequency of a history of abortion and adequate prenatal control. Adolescent pregnant women with anemia were not associated with a higher risk of low birth weight (p = 0.056). Elderly pregnant women with anemia were associated with 6 times higher risk of low birth weight (95% CI: 2.219 to 18.026; p = 0.000).
Conclusions: Elderly pregnant women have a higher risk of presenting low birth weight products.
Keywords: anemia in adolescent pregnant women, anemia in elderly pregnant women, low birth weight.
INTRODUCTION
The World Health Organization (WHO) has defined anemia in pregnancy as serum hemoglobin <11 g / dl, with its respective variations according to altitude and geographic space.(1)
The most common cause of anemia in pregnancy is iron deficiency. Anemia is a disorder in which the number of erythrocytes is decreased and, consequently, the oxygen transport capacity in the blood is insufficient to meet the body's needs. Physiological changes in pregnancy associated with the inadequate intake of foods rich in iron can worsen the final outcome of maternal hemoglobin, leading to alterations in fetal growth, such as low birth weight and pre-term delivery.(2-6)
Low birth weight, has been defined by the WHO as a weight below 2500 grams, whose weight is of importance because it is associated with greater perinatal morbidity, cognitive development deficits, and chronic diseases in the future (7).
Regarding the maternal age at risk, made up of elderly pregnant women, according to FIGO ≥ 35 years of age,(2) and pregnant adolescent. The age of pregnant adolescents is important because they are associated with perinatal pathologies such as growth restriction intrauterine, prematurity and low birth weight(8,9).
To allow the economic and social progress of our country, the Peruvian Government has the objective of improving the state of health and development, prioritizing vulnerable populations such as pregnant women and infants under 3 years of age.(10)
Therefore, this work aims to determine the association between anemia in pregnant women with maternal age at risk and low birth weight at the Guillermo Almenara Irigoyen National Hospital, for this analysis, it has been considered to take the main maternal variable as anemia status and low birth weight as a neonatal variable, even more so this variable because it is an important cause of perinatal morbidity and mortality.
METHODS
Design and study area: A non-experimental, retrospective, cross-sectional, analytical, case-control study was carried out at the Guillermo Almenara Irigoyen National Hospital. The information was collected based on the laboratory history of the Hospital Management System and the birth record book of the High-Risk Obstetrics Service in the period from October to December 2019. The data collected were: Maternal age at risk (maternal age <19 years and> 35 years), gestational age by weeks, maternal hemoglobin level, history of abortion, adequate prenatal control, nulliparity, marital status, method of delivery, and birth weight of the product.
A total of 312 pregnant women with maternal age at risk (adolescents and old women) were registered, of which, reviewing the laboratory history, a total of 72 anemic pregnant women were obtained.
Based on the above, no sample size calculation was performed as our population was small for the time proposed by this study. Thus, the number of anemic cases or pregnant women is 72, and to improve the statistical power, a case-control ratio of 1: 2 was used, requiring 144 controls, but the use of 142 controls was spared. not anemic.
The following inclusion and exclusion criteria are taken according to groups of cases and controls.
Group of cases:
Inclusion criteria: Anemic pregnant women with maternal age at risk who have completed their pregnancy in the period from October to December 2019 at the Hospital National Guillermo Almenara Irigoyen in Lima.
Exclusion criteria:
Inclusion criteria: Non-anemic pregnant women with maternal age at risk who have completed their pregnancy in the period from October to December 2019 at the Guillermo Almenara Irigoyen National Hospital in Lima.
Exclusion criteria:
The information obtained was recorded in Excel tables and transferred to a database of the SPSS version 25.0 program; where the different variables were tabulated, summarized, and represented in frequency distribution tables, proceeding to the statistical analysis, comparing the results of the "anemic pregnant women" and the "non-anemic pregnant women", determining the Odds Ratio (OR) for the variables raised in our study, as well as the limits of the 95% confidence interval (CI) and its statistical significance (p-value). For this analysis, it was considered to take the main maternal variable as the state of anemia and as a neonatal variable low birth weight, even more so this variable because it is an important cause of perinatal morbidity and mortality. The respective institutional permissions were obtained to obtain the file information and the identity of the people was respected at all times.
RESULTS
At the Guillermo Almenara Irigoyen National Hospital in Lima, during the period from October to December 2019, approximately 312 childbirth care was performed by pregnant women with maternal age at risk, of which 72 care corresponded to anemic pregnant women. For the study, all anemic pregnant women were taken as a group of cases, after which the selection criteria were applied, obtaining a final sample of 72 cases and 142 controls.
In Table 1, the general characteristics of the group distribution are observed (categorized as anemic and nonanemic pregnant). The group of cases with 72 pregnant women corresponds to 33.64% of the total sample, while the group of controls has 142 pregnant women (66.36%). Concerning gestational age, the mean gestational age of anemic pregnant women (38.46 ± 1.1 weeks) is higher than the mean age of non-anemic pregnant women (37.75 ± 2.5 weeks), being the difference between both groups statistically significant (p = 0.025). Regarding the serum hemoglobin level, the mean in the group of anemic pregnant women was 10.4 ± 0.7 g / dl, while in the group of non-anemic pregnant women it was 12.5 ± 0.9 g / dl, being this statistically significant difference (p = 0.000). There was no significant difference in terms of the history of abortion, adequate prenatal check-ups, and nulliparity.
In Table 2, it is observed that, in the group of anemic and non-anemic pregnant women, the marital status of cohabitation predominated (44.4% and 38.7%, respectively); in the marital status of single and cohabiting, anemic pregnant women predominated (31.9% and 4.4%, respectively), while in the marital status of married women predominated in non-anemic pregnant women. (36.6%). However, there was no statistically significant difference between the two groups (p = 0.259).
In Table 3, it is observed that in the group of non-anemic pregnant women a slight predominance of cesarean delivery compared to anemic pregnant women (69.7% vs. 68.1%), while anemic pregnant women were observed slightly predominance of vaginal delivery in contrast to non-anemic pregnant women (31.9% vs. 30.3%). However, there was no statistically significant difference between both groups (p = 0.803).
In Table 4, the distribution of anemic and nonanemic pregnant with maternal age at risk is shown by a diagnosis of low birth weight to the, which was present in 72.5% of cases of anemia. Through statistical analysis using the chi-square test, it was found that anemic pregnant women are associated with a 6,476 times greater risk of their products having low birth weight (95% CI: 2,410 to 17,403), compared to the control group (p = 0.000). In the analysis according to the degree of anemia, it was observed that pregnant women with mild anemia are associated with a 9.240 times greater risk that their products have low birth weight (95% CI: 3.407 to 25.061), compared to the control group (p = 0.000). On the other hand, the moderate and severe degree of anemia did not show an association with low birth weight.
In Table 5, the distribution of anemic and nonanemic pregnant adolescents shown by a diagnosis of low birth weight to the, which was in 100% of cases of anemia. Through statistical analysis using the chi-square test, no association was found that anemic pregnant adolescents have the risk of presenting low-birth-weight products compared to the control group (p = 0.056).
In Table 4, the distribution of anemic and nonanemic pregnant añosas shown by a diagnosis of low birth weight to the, which was present in 66.7% of cases of anemia. Through statistical analysis using the chi-square test, it was found that anemic elderly pregnant women are associated with 6,324 times greater risk of their products having low birth weight (95% CI: 2,219 to 18,026), compared to the group control (p = 0.000).
DISCUSSION
The present study was carried out at the Guillermo Almenara Irigoyen National Hospital in Lima, as it is a high-complexity hospital that is a national reference, with an exclusive service for high-risk pregnant women, which can shed some light on our problems. country, since pregnant women come from various regions of Peru.
Table 1 – A, B, C the general characteristics of the distribution of groups (categorized as anemic and non-anemic pregnant women) were observed. Regarding the gestational age at the end of pregnancy, it was observed that the mean gestational age of anemic pregnant women (38.46 ± 1.1 weeks) is higher than the mean of non-anemic pregnant women (37.75 ± 2 , 5 weeks), the difference between both groups being statistically significant (p = 0.025).
Results that differ from the study by Urdaneta et al(11), where the mean of anemic and non-anemic pregnant women was similar (38.4 weeks), so no statistically significant difference was found (p = 1,000). Our results show that anemic pregnant women have a higher gestational age at the end of pregnancy than non-anemic pregnant women, a fact that does not contrast with that found by Villegas(12), where there is an association between anemia in third-trimester pregnant women and pre-term delivery with a probability ratio (OR) of 2.03 (95% CI: 1.30 to 3.17; p = 0.002). Our results are probably influenced by the lower frequency of preterm deliveries in our study.
Regarding the serum hemoglobin level, the mean in the group of anemic pregnant women was 10.4 ± 0.7 g / dl while in the group of non-anemic pregnant women it was 12.5 ± 0.9 g / dl, this being a statistically significant difference (p = 0.000). According to Urdaneta et al(11), hemoglobin values in anemic pregnant women were 8.4 ± 1 g / dl and in pregnant women, without anemia, it was 11.6 ± 0.6 g / dl (p = 0.000). Average hemoglobin level data lower than that observed in our study, this suggests that the pregnant women included in our study probably have better control of their serum hemoglobin levels than other populations, since the pregnant women who attend HNGAI generally They come from economically stable families, so it can be thought that they receive adequate diets and supplements, causing hemoglobin during pregnancy, rarely to reach a considerable magnitude to generate symptoms.(13)
There were no significant differences regarding the route of delivery, history of abortion, nulliparity, marital status, and adequate prenatal controls. Regarding this last point, in the study by Soto(14), it was observed that pregnant women with inadequate prenatal controls prevailed in the group of anemic pregnant women (64.9% vs. 2.6%), while in the group of pregnant women With adequate prenatal controls, the group of non-anemic pregnant women prevails (18.4% vs. 14%), this difference being statistically significant (p = 0.000), these findings differ from what was found in our study, although it is true, the pregnant women with adequate prenatal controls predominated in the group of non-anemic pregnant women, in contrast to the anemic group; however, this difference was not statistically significant (p = 0.084).
InTable 2, it was found that anemic pregnant women are associated with 6,476 times greater risk of their products having low birth weight (95% CI: 2,410 to 17,403), compared to the control group (p = 0.000). An investigation carried out in Cuba found that mothers who present anemia during their pregnancy have a 3.6 times higher risk of having children with low birth weight than women who did not present it, and they also affirm that maternal anemia favors the simultaneous presence of anemia in the newborn, values that do not exceed the result found in our study.(13)
Urdaneta et al(11), determined that the weight of the newborn in anemic mothers was decreased by 12.39% (420 grams approx.) When compared with the weights of the neonates of mothers without anemia, also demonstrated a Directly proportional and significant relationship between birth weight and hemoglobin values, however, anemic pregnant women presented higher birth weight, however, this difference was not significant. The same happens with the study by Tapia(15), which concludes that maternal anemia during pregnancy was not a condition for the presence of low birth weight in the patients studied, apparently, results that differ from our study. Due to the findings in our study, it should be taken into account that third-trimester hemoglobin is an important factor in determining birth weight because this trimester produces rapid fetal growth and storage rates of iron and other micronutrients they are the highest.(16)
In Table 3, no association was found between anemic adolescent pregnant women with the risk of presenting low birth weight compared to the control group (p = 0.056).
Results that are similar to those found by Zamudio(17), where he states that there is no relationship between anemia in pregnant adolescents and newborn weight (p> 0.05). In contrast, according to the study by Cisneros(18), it concludes that there is a statistically significant relationship between anemia in pregnant adolescents and the weight of the newborn (p <0.05). Also, according to the study by Cárdenas(19), it concludes that anemia in pregnant women under 20 years of age is associated with low birth weight, however, this may not be the main risk factor in this age group. The results found in our study are to be expected, since there is less admission of adolescent pregnant women to our service than other centers, so the data presented could not be definitive.
In Table 4, it was found that anemic elderly pregnant women are associated with a 6,324 times greater risk that their products have low birth weight (95% CI: 2,219 to 18,026), compared to the control group (p = 0.000). An exhaustive review has been carried out to search for related jobs, only one indirectly related job was found, such as the study by Munares et al, elderly(20) where pregnant women treated in the facilities of the Ministry of Health of Peru, during the period from 2009 to 2012, finding that the frequency of anemia in 35-year-old pregnant women was 26.6% and higher in the third trimester (30.2%), concluding that maternal age and gestational age they are inversely related to the hemoglobin level. This can then be translated into the higher the maternal age, the lower the hemoglobin levels and, due to the studies described above, the lower the maternal hemoglobin level, the higher the risk of low birth weight, a result that we concluded in our study.
CONCLUSIONS
In anemic pregnant women, nulliparity and vaginal delivery were found more frequently, and a history of abortion and adequate prenatal control was found less frequently. Cohabiting marital status predominated in both groups.
Adolescent pregnant women with anemia were not associated with a higher risk of low birth weight, at the Hospital National Guillermo Almenara Irigoyen in Lima (p = 0.056).
Elderly pregnant women with anemia were associated with 6 times higher risk of low birth weight, at the Guillermo Almenara Irigoyen National Hospital in Lima (95% CI: 2.219 to 18.026; p = 0.000).
Recommendations: Implement at the Guillermo Almenara Irigoyen National Hospital differentiated care to pregnant women with maternal age at risk, especially in the group of elderly pregnant women, to implement strategies for the early detection of anemia and timely treatment of it, give counseling in a varied diet rich in iron; in turn, we recommend carrying out new related projects in other centers, to establish the association found in this study.
The World Health Organization (WHO) has defined anemia in pregnancy as serum hemoglobin <11 g / dl, with its respective variations according to altitude and geographic space.(1)
The most common cause of anemia in pregnancy is iron deficiency. Anemia is a disorder in which the number of erythrocytes is decreased and, consequently, the oxygen transport capacity in the blood is insufficient to meet the body's needs. Physiological changes in pregnancy associated with the inadequate intake of foods rich in iron can worsen the final outcome of maternal hemoglobin, leading to alterations in fetal growth, such as low birth weight and pre-term delivery.(2-6)
Low birth weight, has been defined by the WHO as a weight below 2500 grams, whose weight is of importance because it is associated with greater perinatal morbidity, cognitive development deficits, and chronic diseases in the future (7).
Regarding the maternal age at risk, made up of elderly pregnant women, according to FIGO ≥ 35 years of age,(2) and pregnant adolescent. The age of pregnant adolescents is important because they are associated with perinatal pathologies such as growth restriction intrauterine, prematurity and low birth weight(8,9).
To allow the economic and social progress of our country, the Peruvian Government has the objective of improving the state of health and development, prioritizing vulnerable populations such as pregnant women and infants under 3 years of age.(10)
Therefore, this work aims to determine the association between anemia in pregnant women with maternal age at risk and low birth weight at the Guillermo Almenara Irigoyen National Hospital, for this analysis, it has been considered to take the main maternal variable as anemia status and low birth weight as a neonatal variable, even more so this variable because it is an important cause of perinatal morbidity and mortality.
METHODS
Design and study area: A non-experimental, retrospective, cross-sectional, analytical, case-control study was carried out at the Guillermo Almenara Irigoyen National Hospital. The information was collected based on the laboratory history of the Hospital Management System and the birth record book of the High-Risk Obstetrics Service in the period from October to December 2019. The data collected were: Maternal age at risk (maternal age <19 years and> 35 years), gestational age by weeks, maternal hemoglobin level, history of abortion, adequate prenatal control, nulliparity, marital status, method of delivery, and birth weight of the product.
A total of 312 pregnant women with maternal age at risk (adolescents and old women) were registered, of which, reviewing the laboratory history, a total of 72 anemic pregnant women were obtained.
Based on the above, no sample size calculation was performed as our population was small for the time proposed by this study. Thus, the number of anemic cases or pregnant women is 72, and to improve the statistical power, a case-control ratio of 1: 2 was used, requiring 144 controls, but the use of 142 controls was spared. not anemic.
The following inclusion and exclusion criteria are taken according to groups of cases and controls.
Group of cases:
Inclusion criteria: Anemic pregnant women with maternal age at risk who have completed their pregnancy in the period from October to December 2019 at the Hospital National Guillermo Almenara Irigoyen in Lima.
Exclusion criteria:
- Patients with multiple gestations and/or use of assisted reproductive techniques.
- Patients with a history of chronic diseases: pre-gestational diabetes mellitus, chronic arterial hypertension, morbid obesity (BMI> 40), chronic kidney disease, infection by the acquired immunodeficiency virus, heart disease, or lung disease.
- Patients with an incomplete history.
Inclusion criteria: Non-anemic pregnant women with maternal age at risk who have completed their pregnancy in the period from October to December 2019 at the Guillermo Almenara Irigoyen National Hospital in Lima.
Exclusion criteria:
- Patients with multiple gestations and/or use of assisted reproductive techniques.
- Patients with a history of chronic diseases: pre-gestational diabetes mellitus, chronic arterial hypertension, morbid obesity (BMI> 40), chronic kidney disease, infection by the acquired immunodeficiency virus, heart disease, or lung disease
- Patients with an incomplete history.
The information obtained was recorded in Excel tables and transferred to a database of the SPSS version 25.0 program; where the different variables were tabulated, summarized, and represented in frequency distribution tables, proceeding to the statistical analysis, comparing the results of the "anemic pregnant women" and the "non-anemic pregnant women", determining the Odds Ratio (OR) for the variables raised in our study, as well as the limits of the 95% confidence interval (CI) and its statistical significance (p-value). For this analysis, it was considered to take the main maternal variable as the state of anemia and as a neonatal variable low birth weight, even more so this variable because it is an important cause of perinatal morbidity and mortality. The respective institutional permissions were obtained to obtain the file information and the identity of the people was respected at all times.
RESULTS
At the Guillermo Almenara Irigoyen National Hospital in Lima, during the period from October to December 2019, approximately 312 childbirth care was performed by pregnant women with maternal age at risk, of which 72 care corresponded to anemic pregnant women. For the study, all anemic pregnant women were taken as a group of cases, after which the selection criteria were applied, obtaining a final sample of 72 cases and 142 controls.
Table 1. General characteristics of the sample by groups of anemic and non-anemic pregnant women.
| Sample distribution (N = 214) | |||||
| General characteristics |
Anemic pregnant woman (N1=72)
|
Non-anemic pregnant woman (N2=142)
|
p-value
|
||
|
Gestational age (mean in
weeks)
|
38.46 ± 1.1 | 12.5 ± 0.9 |
0.025*
|
||
| Hemoglobin level (mean serum hemoglobin in g / dl) |
10.4 ± 0.7
|
12.5 ± 0.9 | 0.000* | ||
| History of abortion | 26 | 36.1% |
112
|
40.8% | 0.456 |
| Adequate NPC ( ≥6) | 40 | 55.6% | 96 | 67.6% | 0.084 |
|
Nulliparity
|
28 | 38.9% | 25 | 26.1% | 0.054 |
In Table 1, the general characteristics of the group distribution are observed (categorized as anemic and nonanemic pregnant). The group of cases with 72 pregnant women corresponds to 33.64% of the total sample, while the group of controls has 142 pregnant women (66.36%). Concerning gestational age, the mean gestational age of anemic pregnant women (38.46 ± 1.1 weeks) is higher than the mean age of non-anemic pregnant women (37.75 ± 2.5 weeks), being the difference between both groups statistically significant (p = 0.025). Regarding the serum hemoglobin level, the mean in the group of anemic pregnant women was 10.4 ± 0.7 g / dl, while in the group of non-anemic pregnant women it was 12.5 ± 0.9 g / dl, being this statistically significant difference (p = 0.000). There was no significant difference in terms of the history of abortion, adequate prenatal check-ups, and nulliparity.
Table 2. General characteristics of the sample by groups of anemic and non-anemic pregnant women
|
Anemia
|
|||||
|
Anemic
|
Non-anemic |
Total
|
|||
| Marital status |
Single
|
Count | 23 | 33 | 56 |
| % | 31.9% | 23.2% | 26.2% | ||
| Cohabitant | Count | 32 | 55 | 87 | |
| % | 44.4% | 38.7% | 40.7% | ||
| Married | Count | 17 | 52 | 69 | |
| % | 23.6% | 36.6% | 32.2% | ||
| Separate | Count | 0 | 1 | 1 | |
| % | 0.0% | 0.7% | 0.5% | ||
| Widow | Count | 0 | 1 | 1 | |
|
Total
|
% | 0.0% | 0.7% | 0.5% | |
| Count | 72 | 142 | 214 | ||
| % | 100,0% | 100.0% | 100.0% | ||
| p-valor | 0.259 | ||||
In Table 2, it is observed that, in the group of anemic and non-anemic pregnant women, the marital status of cohabitation predominated (44.4% and 38.7%, respectively); in the marital status of single and cohabiting, anemic pregnant women predominated (31.9% and 4.4%, respectively), while in the marital status of married women predominated in non-anemic pregnant women. (36.6%). However, there was no statistically significant difference between the two groups (p = 0.259).
Table 3 General characteristics of the sample by groups of anemic and non-anemic pregnant women.
|
Anemia
|
|||||
|
Anemic
|
Non-anemic |
Total
|
|||
|
Route of delivery
|
Cesarean delivery
|
Count | 49 | 99 | 148 |
| % | 68.1% | 69.7% | 69.2% | ||
| Vaginal delivery | Count | 23 | 55 | 87 | |
| % | 31.9% | 30.3% | 30.8% | ||
| Count | 72 | 142 | 214 | ||
| % | 100.0% | 100.0% | 100.0% | ||
| p-value | 0,803 | ||||
In Table 3, it is observed that in the group of non-anemic pregnant women a slight predominance of cesarean delivery compared to anemic pregnant women (69.7% vs. 68.1%), while anemic pregnant women were observed slightly predominance of vaginal delivery in contrast to non-anemic pregnant women (31.9% vs. 30.3%). However, there was no statistically significant difference between both groups (p = 0.803).
Table 4. Relationship between anemia and low birth weight in pregnant women with maternal age at risk.
|
Low birth weight
|
OR
|
CI(95%)
|
p-value
|
|||||
|
Present
|
Absent | |||||||
|
Anemia
|
Anemic Pregnant women
|
Count | 16 | 56 | 6.5 | 2.41 | 17.40 | 0.000 |
| % | 72.2% | 29.2% | ||||||
| Mild anemia | 16 | 43 |
9.2
|
3.41 | 25.06 | 0.000 | ||
| 27.6% | 22.4% | |||||||
| Moderate anemia | 0 | 13 | - | - | - | 0.208 | ||
| 0.0% | 6.8% | |||||||
| Severe anemia | 0 | 0 | - | - | - | |||
| 0.0% | 0.0% | |||||||
| Non-anemic pregnant women | Count | 6 | 136 | |||||
| % | 27.3% | 70.8% | ||||||
| Total | Count | 22 | 192 | |||||
| % | 100.0% | 100.0% | ||||||
In Table 4, the distribution of anemic and nonanemic pregnant with maternal age at risk is shown by a diagnosis of low birth weight to the, which was present in 72.5% of cases of anemia. Through statistical analysis using the chi-square test, it was found that anemic pregnant women are associated with a 6,476 times greater risk of their products having low birth weight (95% CI: 2,410 to 17,403), compared to the control group (p = 0.000). In the analysis according to the degree of anemia, it was observed that pregnant women with mild anemia are associated with a 9.240 times greater risk that their products have low birth weight (95% CI: 3.407 to 25.061), compared to the control group (p = 0.000). On the other hand, the moderate and severe degree of anemia did not show an association with low birth weight.
Table 5 Relationship between anemia and low birth weight in adolescent pregnant women.
|
Low birth weight
|
OR
|
CI(95%)
|
p-value
|
|||||
|
Present
|
Absent | |||||||
|
Anemia
|
Pregnant anemic
|
Count | 4 | 19 | - | - | - | 0.056 |
| % | 100.0% | 50.0% | ||||||
|
Non-pregnant women
anemic
|
Count | 0 | 19 | |||||
| % | 0,0% | 50,0% | ||||||
| Total | Count | 4 | 38 | |||||
| % | 100.0% | 100.0% | ||||||
In Table 5, the distribution of anemic and nonanemic pregnant adolescents shown by a diagnosis of low birth weight to the, which was in 100% of cases of anemia. Through statistical analysis using the chi-square test, no association was found that anemic pregnant adolescents have the risk of presenting low-birth-weight products compared to the control group (p = 0.056).
Table 6. Relationship between anemia and low birth weight in elderly pregnant women.
|
Low birth weight
|
OR
|
CI(95%)
|
p-value
|
|||||
|
Present
|
Absent | |||||||
|
Anemia
|
Gestantes anemic
|
Count | 12 | 37 | 6.3 | 2.21 | 18.03 | 0.000 |
| % | 66.7% | 24.0% | ||||||
|
Non-pregnant women
anemic
|
Count | 6 | 117 | |||||
| % | 33.3% | 76.0% | ||||||
| Total | Count | 18 | 154 | |||||
| % | 100.0% | 100.0% | ||||||
In Table 4, the distribution of anemic and nonanemic pregnant añosas shown by a diagnosis of low birth weight to the, which was present in 66.7% of cases of anemia. Through statistical analysis using the chi-square test, it was found that anemic elderly pregnant women are associated with 6,324 times greater risk of their products having low birth weight (95% CI: 2,219 to 18,026), compared to the group control (p = 0.000).
DISCUSSION
The present study was carried out at the Guillermo Almenara Irigoyen National Hospital in Lima, as it is a high-complexity hospital that is a national reference, with an exclusive service for high-risk pregnant women, which can shed some light on our problems. country, since pregnant women come from various regions of Peru.
Table 1 – A, B, C the general characteristics of the distribution of groups (categorized as anemic and non-anemic pregnant women) were observed. Regarding the gestational age at the end of pregnancy, it was observed that the mean gestational age of anemic pregnant women (38.46 ± 1.1 weeks) is higher than the mean of non-anemic pregnant women (37.75 ± 2 , 5 weeks), the difference between both groups being statistically significant (p = 0.025).
Results that differ from the study by Urdaneta et al(11), where the mean of anemic and non-anemic pregnant women was similar (38.4 weeks), so no statistically significant difference was found (p = 1,000). Our results show that anemic pregnant women have a higher gestational age at the end of pregnancy than non-anemic pregnant women, a fact that does not contrast with that found by Villegas(12), where there is an association between anemia in third-trimester pregnant women and pre-term delivery with a probability ratio (OR) of 2.03 (95% CI: 1.30 to 3.17; p = 0.002). Our results are probably influenced by the lower frequency of preterm deliveries in our study.
Regarding the serum hemoglobin level, the mean in the group of anemic pregnant women was 10.4 ± 0.7 g / dl while in the group of non-anemic pregnant women it was 12.5 ± 0.9 g / dl, this being a statistically significant difference (p = 0.000). According to Urdaneta et al(11), hemoglobin values in anemic pregnant women were 8.4 ± 1 g / dl and in pregnant women, without anemia, it was 11.6 ± 0.6 g / dl (p = 0.000). Average hemoglobin level data lower than that observed in our study, this suggests that the pregnant women included in our study probably have better control of their serum hemoglobin levels than other populations, since the pregnant women who attend HNGAI generally They come from economically stable families, so it can be thought that they receive adequate diets and supplements, causing hemoglobin during pregnancy, rarely to reach a considerable magnitude to generate symptoms.(13)
There were no significant differences regarding the route of delivery, history of abortion, nulliparity, marital status, and adequate prenatal controls. Regarding this last point, in the study by Soto(14), it was observed that pregnant women with inadequate prenatal controls prevailed in the group of anemic pregnant women (64.9% vs. 2.6%), while in the group of pregnant women With adequate prenatal controls, the group of non-anemic pregnant women prevails (18.4% vs. 14%), this difference being statistically significant (p = 0.000), these findings differ from what was found in our study, although it is true, the pregnant women with adequate prenatal controls predominated in the group of non-anemic pregnant women, in contrast to the anemic group; however, this difference was not statistically significant (p = 0.084).
InTable 2, it was found that anemic pregnant women are associated with 6,476 times greater risk of their products having low birth weight (95% CI: 2,410 to 17,403), compared to the control group (p = 0.000). An investigation carried out in Cuba found that mothers who present anemia during their pregnancy have a 3.6 times higher risk of having children with low birth weight than women who did not present it, and they also affirm that maternal anemia favors the simultaneous presence of anemia in the newborn, values that do not exceed the result found in our study.(13)
Urdaneta et al(11), determined that the weight of the newborn in anemic mothers was decreased by 12.39% (420 grams approx.) When compared with the weights of the neonates of mothers without anemia, also demonstrated a Directly proportional and significant relationship between birth weight and hemoglobin values, however, anemic pregnant women presented higher birth weight, however, this difference was not significant. The same happens with the study by Tapia(15), which concludes that maternal anemia during pregnancy was not a condition for the presence of low birth weight in the patients studied, apparently, results that differ from our study. Due to the findings in our study, it should be taken into account that third-trimester hemoglobin is an important factor in determining birth weight because this trimester produces rapid fetal growth and storage rates of iron and other micronutrients they are the highest.(16)
In Table 3, no association was found between anemic adolescent pregnant women with the risk of presenting low birth weight compared to the control group (p = 0.056).
Results that are similar to those found by Zamudio(17), where he states that there is no relationship between anemia in pregnant adolescents and newborn weight (p> 0.05). In contrast, according to the study by Cisneros(18), it concludes that there is a statistically significant relationship between anemia in pregnant adolescents and the weight of the newborn (p <0.05). Also, according to the study by Cárdenas(19), it concludes that anemia in pregnant women under 20 years of age is associated with low birth weight, however, this may not be the main risk factor in this age group. The results found in our study are to be expected, since there is less admission of adolescent pregnant women to our service than other centers, so the data presented could not be definitive.
In Table 4, it was found that anemic elderly pregnant women are associated with a 6,324 times greater risk that their products have low birth weight (95% CI: 2,219 to 18,026), compared to the control group (p = 0.000). An exhaustive review has been carried out to search for related jobs, only one indirectly related job was found, such as the study by Munares et al, elderly(20) where pregnant women treated in the facilities of the Ministry of Health of Peru, during the period from 2009 to 2012, finding that the frequency of anemia in 35-year-old pregnant women was 26.6% and higher in the third trimester (30.2%), concluding that maternal age and gestational age they are inversely related to the hemoglobin level. This can then be translated into the higher the maternal age, the lower the hemoglobin levels and, due to the studies described above, the lower the maternal hemoglobin level, the higher the risk of low birth weight, a result that we concluded in our study.
CONCLUSIONS
In anemic pregnant women, nulliparity and vaginal delivery were found more frequently, and a history of abortion and adequate prenatal control was found less frequently. Cohabiting marital status predominated in both groups.
Adolescent pregnant women with anemia were not associated with a higher risk of low birth weight, at the Hospital National Guillermo Almenara Irigoyen in Lima (p = 0.056).
Elderly pregnant women with anemia were associated with 6 times higher risk of low birth weight, at the Guillermo Almenara Irigoyen National Hospital in Lima (95% CI: 2.219 to 18.026; p = 0.000).
Recommendations: Implement at the Guillermo Almenara Irigoyen National Hospital differentiated care to pregnant women with maternal age at risk, especially in the group of elderly pregnant women, to implement strategies for the early detection of anemia and timely treatment of it, give counseling in a varied diet rich in iron; in turn, we recommend carrying out new related projects in other centers, to establish the association found in this study.
Author’s contributions: The authors participated in the genesis of the idea, project design, development, collection and interpretation of data, analysis of results, and preparation of the manuscript.
Financing: Self-financed
Conflict of interest: The authors declare no conflicts of interest in the publication of this article.
Received: April 26, 2020
Approved: August 6, 2020
Correspondence: Jose L. Villalva Luna
Address: Urbanización Bacigalupo. Street Ticaco L5. Tacna.
Telephone: 953277753
E-mail: Joselo.villa.luna@gmail.com
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