Posted: September 18th, 2022
Description of the Problem
Anemia is a condition that happens when the hemoglobin level within the body is lower than the level supposed to be. This, in turn, leads to a decreased level of oxygen being carried to the parts of the body and also a lower case of red blood cells to other tissues. Anemia is prevalent in affecting a wide group range of people; however, pregnant women and children are the most prevalent ones. In a study carried out by (Stevens et al.), they reported that the prevalence of anemia in non-pregnant women, pregnant women, and children is 29, 38, and 43%, respectively. Furthermore, in a study carried out by the WHO, in pregnant women, anemia has been labeled with a level <110g/L. However, other sources have also showcased that anemia is more prevalent in developing countries which have recorded 43% cases, as to developed countries which have recorded 9% cases. However, anemia has been linked to affecting people with different lifestyles and social-economic factors which differ from the different cultures as shown at
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. One of the most common complications during pregnancy is anemia. It is frequently regarded as a risk factor for unfavorable pregnancy outcomes and may lead to issues like premature birth that endanger both the mother and the fetus’s lives.
According to global statistics, up to 56% of pregnant women who have recorded cases of anemia are from countries that are still developing. However, its prevalence is higher in pregnant women. The pregnancy chances of preterm birth have been linked more with pregnant women who have reported to have anemia as to pregnant women who do not have anemia. The impaired immune which the mother is subjected to as a result of anemia, and increased cardiac diseases can increase the chances of preterm birth and also other complications that lead to stillbirths. Furthermore, preterm births have also been recorded to be among the leading cause of neonatal deaths. With such increased death rates, it raises the need to be a public health issue within the health sector. The increased costs that hospitals have to incur while taking care of the preterm babies, has made treatment to be more expensive as the hospitals need extra costs. Considering that it is the goal of many hospitals to reduce the cost of treatment being used, there is also the need to reduce the cause of preterm births, which have been linked to being from Anemia in Pregnant women.
Causes of the problem
The amount of blood rises during pregnancy. Therefore, in order to produce more red blood cells, more iron and vitamins are required. Anemia can be brought on by a lack of iron. Although the red blood cell count drops very low, it’s not regarded as odd. The baby utilizes the mother’s red blood cells during pregnancy for development and growth, especially in the final three months. The body can utilize any excess red blood cells that are present in the bone marrow before becoming pregnant. Iron-deficiency anemia can develop in women who don’t have enough iron reserves. Pregnancy-related anemia of this kind is the most prevalent. Prior to becoming pregnant, it’s crucial to eat healthfully to assist build up these reserves. Protein and red blood cells are produced with the help of vitamin B-12. Vitamin B-12 deficiency can be avoided by eating foods derived from animals, such as milk, eggs, meats, and poultry. Vegan women are most prone to suffer from a vitamin B-12 shortage than other groups of women. During pregnancy, strict vegans may require doses of vitamin B-12. B vitamin folic acid, often known as foliate, helps in cell growth when combined with iron. Iron deficiency may result from a lack of folate when pregnant. In the first trimester it is important for the mother to consume the folic acid as it will help in the development of the baby and also help the baby evade abnormalities within the spine and the brain. An alternate explanation is that iron deficiency makes erythrocytes and the fetoplacental unit more susceptible to oxidative damage. A key risk factor for preterm birth is maternal infections, which can boost the formation of CRH. Iron deficiency may also raise the risk of these infections. A vitamin B12 deficiency may increase the chance of birth malformations such as malformed neural tubes and premature labor in pregnant women who don’t consume meat, poultry, dairy products, or eggs.
Impact of the problem
Anemia has several impacts on the health of the baby and also the health of the mother. Anemia in pregnancy is associated with difficulties in breathing, fainting, and feeling tired easily. Mothers with Anemia have also been associated with having high risks of developing perinatal infections, preeclampsia, and also bleeding. In a study carried out by (Moreno-Fernandez & Diaz-Castro, 2019), he also reports that some of the mothers who had anemia showed postpartum cognitive impairments and behavioral difficulties. Anemia during pregnancy prevents the body from receiving enough oxygen-rich blood. They may feel exhausted or weak due to the lack of oxygen. Additionally, they could experience headaches, dizziness, shortness of breath, and an irregular heartbeat (Kang & Sunwoo, 2020).
On the child, anemia can persist and cause Developmental delays and behavioral issues like reduced motor activity, social interaction, and task-focused attention. Numerous studies reveal that iron shortage increases the risk of mild or moderate mental retardation, even if it has not yet developed to the point of Anemia (Safiri & Grieger, 2021). Through pregnancy, there are higher chances of affecting the maternal and fetal wellbeing, which can then proceed to the death of the baby. Having anemia during pregnancy has also been linked with low birth weights, which can also affect the survival chances of the baby too. Iron has been named to be a key factor in the development of the fetus. Iron is important in facilitating the production of new red blood cells, brain cells, and also muscle development. If the baby does not get enough iron which is supposed to come from the mother, there are higher risks that the baby might fail to have enough red blood cells, which can lead to conditions such as anemia.
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Anemia in pregnant women that leads to preterm birth has health effects and also economic effects that have become a global concern. This health condition has been linked with affecting the global economy both directly and indirectly. Preterm births have been associated with a cost of $26 billion venery year. This is due to the fact that babies that have been born even a week earlier have higher rates of being hospitalized. These babies will currently develop breathing problems that need to be responded to quickly. However, there is also another study carried out by (Walani, 2020), who concludes that up to 15 million babies are born prematurely based on yearly statistics. Of the 1 million numbers that die, up to 75% could have been saved if the current cost-effective intervention were available to all. This shows that even the amounts that are being produced by the WHO for the premature babies to be taken care of are not enough, which leaves others to suffer more. This has put pressure on the World Bank to further look into and provide more money to take care of premature babies. With such, it then conforms that the World Bank is suffering financially while struggling to ensure that they are meeting the finical demands raised. In statistics, children who are not born prematurely may need one or two days in the hospital; however, the children who have been born prematurely tend to stay longer in hospitals (Maier & Zeitlin, 2018). This shows that the medications and also oxygen for some who are not able to breathe on their own will have to be catered for by the hospitals. Instead, if they could have been born mature, then their medications could have been used for other purposes.
Intervention description and how it works
Offering education to women who are trying to conceive and also those who are pregnant on the importance of ensuring that they take foods that will help them have high folic acids and also have a high level of Vitamin C will help reduce the cases of anemia in pregnancy. However, this strategy requires high financial support from the global perception.
To offer education, there will be the need for more health practitioners who will take the roles of offering education. This will also mean that there will be more enrollments in the colleges to meet the demand. According to studies done by (Saepul & Platini, 2019), many women claim that they do not take foods rich in iron as they do not know which foods they are supposed to take to help them. In developing countries, many families have not invested in taking balanced diets. This has been associated with the fact that even though some might know the constitutes of a specific food, they could not even be in a position to afford them. However, offering education and also aligning along with more finances that are to support such poor families in helping them have a balanced diet could help reduce the cases. Considering that after the education, many of the people will know how serious the issue of anemia is in pregnancy shows that it will have achieved success as people will focus more on taking the foods, which they will have been educated on that can help them. This, in turn, will lead to reduced rates of anemia cases as high nutrition and even healthier babies will be born, reducing the extra costs that the World Bank submits to taking care of preterm babies.
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The rationale for conducting this systematic Review
The urgency of having the current systematic review on the increase in chances of having preterm birth as a result of anemia in pregnancy has raised the need to be familiar with anemia during pregnancy. This has also been associated with the fact that there is currently not enough evidence. Furthermore, there is also not enough evidence that the mothers will react well to the education to be offered to them about taking foods with a high level of iron that is to help them reduce the chances of anemia while pregnant; this review has been chosen to ensure that the gap that exists in the literature has been filled. In previous studies, offering clinical books to mothers’ that contain educational information about the dangerous effects of anemia in pregnancies has been tackled. However, the literature has not considered the best educational ways that they can employ. According to (Aston & Paynter, 2021), it has been reported that many mothers look for the book when they are going to appointments, and when they come back, they don’t bother reading them. (Graham, 2018) This further supports them as a large portion of the population believes that the books are for the medical practitioners to fill in data. However, some research (Indonesia, 2020) proves that the expectant mothers who take the notes from the book seriously end up recording healthy pregnancies. Many studies have, however, claimed that many of the women who are affected by anemia in pregnancies come from poor countries, and they cannot afford a balanced diet. However (Herforth & Masters, 2020) other literature has proved that for someone to record a balanced diet, they do not necessarily have to go through high costs of expenditures; instead, the major problem is that the women do not know what to eat and what benefits the basic food that they can afford have to their bodies. With such gaps existing in literature, this research is aiming at filling the gaps.
Aims and Objectives
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The researcher underrating this review has had five years of working in the maternal departments, where many cases of preterm birth have been reported with the association of the mother having anemia. Considering the reviewer’s previous background, many of the mothers do not know how to help boost their immunities by taking. However, the organization of communal education to the mothers on the basic foods that can help them improve their iron deficiency without them having to go an extra coin will help solve eth challenge. Hence with this at hand, the research is aiming at reviewing the effectiveness of offering communal education to mothers on how they can balance their diet to ensure they fight iron deficiency during pregnancies.
The main objectives are:
Up to half of women experience anemia during pregnancy, the most noticeable hematological manifestation of pregnancy that mostly affects those of low class position globally. In affluent nations like Australia, the United States, the United Kingdom, and Germany, the number of anemia in women reported ranges from 9% to 51% (Baldi & Pasricha, 2020), (Malinowski & Daru, 2019).
These statistics stand in contrast to those of developing nations like Ghana, Sudan, Nepal, Bangladesh, Pakistan, and India, as the prevalence of anemia ranges from 44% to 81 % (Baig-Ansari & Goldenberg, 2008).). Between 40 and 72 percent of the load is shared across the states in India (Sohail & Raziuddin, 2015). Jharkhand has one of the highest recorded rates of anemia during pregnancy, just over 71 percent of any Indian state (Iips, 2017). Previously published data shows substantially higher prevalence in the state, with pregnant and postpartum women experiencing 86 percent and 72 percent, respectively.
A worldwide issue for mothers and babies, anemia during pregnancy and in labor results in roughly 115,000 deaths and 590,000 perinatal infant deaths each year (Feleke & Feleke, 2018). Due to compromised immunity and differences in hormonal orchestration, anemia during pregnancy and delivery increases the risk of bleeding, labor difficulties, and abnormal delivery, as well as infection to both the mother and growing embryo (Robinson & Klein, 2012). In the majority of developing nations, especially in south-east Asia, the significant effects of anemia during pregnancy include gestational problems, maternal deaths, low birth weight, and bad birth outcomes (Rahman & Shibuya, 2016).
Anemia remains a mystery for pregnant and giving challenges to mothers from countries that are developing as India (Branca & Mustafa, 2014), despite advancements in obstetric technology, successes in MCH-related difficulties, and nutritional awareness in MCH campaigns for the last ten years. However there have been many interventions developed with the aim of boosting the heath of pregnant mothers, but still 15 million babies are born preterm each year, and their commonness is a worldwide epidemic, especially in countries that are developing (Iams & Goldenberg, 2008).
The risk of unfavorable outcomes for both mothers and newborns is increased by anemia, which has long been recognized as a sign of both inadequate nutrition and deteriorating health in general among women. Maternal anemia poses a risk for preterm birth, and also a number of further prenatal problems, including the possibility of miscarriages, stillbirths, intrauterine growth restriction, and postpartum hemorrhage. These difficulties are brought on by a disturbed physiological balance as well as a buildup of gynecological and obstetric variables.
Preterm deliveries, low birth weight, reduced hemoglobin concentration, and maternal mortality has all been associated with maternal anemia throughout pregnancy and delivery. There have been conflicting reports about how maternal anemia contributes to poor birth outcomes and low birth weight. Anemia during pregnancy and in postpartum women has been linked to preterm delivery, low birth weight, and maternal death, according to certain authors (Steer, 2020), whereas other authors have reported an increased risk of premature and low birth weight.
Unfortunately, despite improvements in obstetric equipment, a variety of current public health and health check measures, with the years of preterm study, India is among the countries with major challenges in preterm births. Preterm births and low birth weight remain to have a major negative impact on the cost of maternity and child health (MCH) care in this nation (Interventions, 2012). If India intends to get better its record for mother and child wellbeing, it must address the issue of unfavorable birth outcomes, particularly PTB, in light of its scope, associated illness, and associated death.
Rarely has the relationship between maternal early and late pregnancy hemoglobin levels and unfavorable birth outcomes been studied. In light of the startling anemia status of 69 percent and 71 percent in male and female, which is a high number when compared to any other states in India. (Iips, 2017), investigated if women with anemia and/or without anemia have a high risk of experiencing preterm birth. Because it enables the start of threat treatment for women at risk, the identification of risk variables is useful for predicting preterm birth. Finding these risk variables could help us better understand the processes that lead to preterm birth.
This study considered the prevalence of early labour that are caused by susceptibility of infections, poor level of nutrition’s and low level of blood in pregnant women. Through this research the author considered carrying out investigations and even data collection on a regional level.
To the best of our knowledge, the inquiry into maternal health care, data collection on preterm birth and low birth weight, and the first systematic report from its sort from the high priority and risk region, i.e., Jharkhand, is a place that is not just mostly ignored but also understudied and neglected. The fact that the initiative and research were taken in the first place indicates the importance of this work in supporting the idea that healthy mothers give birth to healthy children, which is a key component of programs for sexual and family health care. Additionally, our initial attempts to construct and re-orient much-needed region-specific techniques for evaluation, diagnosis, intervention, prevention, and treatment while providing a platform for governmental decision-makers based on evidence.
The current results promise to offer a broad range and multidisciplinary facts that can help analyze and intervene in women issues especially in low and middle income societies. These societies are usually affected by low healthcare services, low funding, shortage of food that mainly contribute to effects on the health of the mother and the child.
Maternal infection, hypoxia, and oxidative stress are three of the key molecular mechanisms that have been suggested to cause preterm birth. 16 A low-grade chronic hypoxia caused by low hemoglobin levels may increase the risk of maternal infections and stress in both the mother and the fetus. The hypothalamic-pituitary-adrenal axis can be triggered in either the mother or the fetus by an immune system that is overactive in the presence of infections and inflammation and corticotrophin-releasing hormone or cortisol that is generated after a stress reaction. In turn, this may start labor and ultimately lead to preterm delivery.
Hong & Park, 2020 investigated if risk variables varied between subgroups of premature labor in research regarding risk factors for preterm birth in a healthy cohort. They discovered no correlation between anemia and premature delivery. They came to the conclusion that the absence of a link is consistent with other researchers’ findings, which showed that the majority of the cause of preterm birth are still unknown.
In a control-cases analysis, Xiong & Hao, 2021, found that anemia at any point in the second trimester was positively linked with premature delivery. However, this association did not account for the significant ethnic variation in preterm birth rates. These same authors discovered a slight correlation between maternal anemia in the early third trimester and preterm in another investigation (Youssry & Patel, 2018).
According to Ballestín & Bartolomé, 2021, a high hematocrit (Ht) was linked to fetal retardation and preterm delivery, especially when the level of Ht was equal to or higher than 43% around 31 and 34 weeks gestation.
Any initiative aimed at promoting nutrition must start with nutrition education (Aramesh & Hassanzadeh, 2020). For the health of mother and fetus, understanding good nutrition and a balanced diet throughout pregnancy is crucial. Nutritional issues during pregnancy can affect both the mother and the fetus, necessitating specific attention. Anemia and other nutritional deficits can result from an inadequate diet during pregnancy. Therefore, it is essential to get enough nutrients while pregnant and should not be ignored.
A woman and her family can improve their nutrition by making decisions and taking action with the aid of maternal nutrition counseling. This comprises choices and behaviors on the kinds, variety, and quantities of food a woman should eat to achieve her dietary needs, the quantity of exercise she needs, and the use of dietary supplements. Even while dietary counseling is a strongly advised part of healthcare, many women don’t really obtain high-quality services. With the help of this program brief, UNICEF country offices and its partners may learn how to increase the accessibility, efficacy, and justice of maternal nutrition counseling in low- and middle-income nations. Preconception (for individuals intending a pregnancy), pregnancy, and postpartum care are covered for adolescent girls and women between the ages of 20 and 49 (Govender & Taylor, 2020).
The nutritional status of women is crucial to their health and wellbeing, particularly before, during, and after childbirth. If women are free from any form of malnutrition when they become pregnant, if they have nourishing diets, if they have access to necessary nutrition services, and if they adopt ideal dietary practices during pregnancy, they are more likely to have a healthy pregnancy that are less likely to experience life-threatening complications. Additionally, newborns of adequately fed mothers are more likely to have a healthy birth and grow and develop normally in infancy. Following birth, women must have adequate nutritional care in order to meet their nutrient needs, which are high among breastfeeding mothers, and to replenish their bodily stores of nutrients.
The World Health Organization set goals to reduce the incidence of anemia in women of reproductive age by 50% and the prevalence of low birth weight by 30% by 2025 in recognition of the critical role that maternal nutrition plays in health (World Health Organization, 2020). Progress towards these goals can support worldwide efforts to fulfill the Sustainable Development Goal goals of reducing child stunting, wasting, and overweight because maternal nutrition directly affects the nutritional condition of children.
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The rate of development is currently too sluggish to achieve the goals set by the World Health Assembly for maternal anemia and low birth weight. An estimated 571 million women of reproductive age experienced anemia in 2019 (30%), whereas the frequency of low birth weight stayed at 15% between 2012 and 2019 (Kinyoki & Hay, 2021). Throughout 2012 and 2015, the prevalence of preterm labor stayed at 15%. There is still a public health issue with maternal underweight (thinness), which affected 170 million women (9%) in 2016 (Kinyoki & Hay, 2021). Poor diets, poor access to necessary nutrient-rich services and subpar procedures continue to impede growth.
Premature birth, mother and infant mortality, and infectious illnesses have all been linked to low hemoglobin levels suggestive of mild to severe anemia during pregnancy. In utero and throughout time, developments may also be impacted. In contrast, adverse pregnancy outcomes like preterm labor and low birth weight may also be linked to hemoglobin levels higher than 130 g/l at sea level. Iron supplementation, iron-fortified staple foods, nutrition and health education, parasite management, and hygienic improvements are only a few of the interventions used to avoid iron deficiency and IDA in pregnant women. Women must take in more iron throughout pregnancy to make sure they have enough on hand to avoid an iron deficiency, as a result, in the majority of low- and middle-income nations.
Iron supplements are therefore widely utilized by pregnant women in the majority of low- and middle-income nations to prevent and treat iron deficiency and anemia during pregnancy. This recommendation was made after updating an earlier Cochrane systematic analysis that evaluated the advantages and disadvantages of iron supplementation in healthy pregnant women (McCauley & van den Broek, 2022). Overall, women who took daily iron supplements had LBW babies less frequently than controls, and the average birth weight was higher for newborns whose mothers took iron during pregnancy, at 30.81 g. Neonatal mortality and preterm birth had no discernible impact. Daily iron supplementation decreased the likelihood of iron deficiency and maternal anemia at term by 57 percent and 70 percent, respectively, but had no discernible impact on infection risk.
A fifth of the population of the globe carries an inherited hemoglobin problem. Because of advancements in hematological therapy, impacted women with hemoglobinopathies frequently seek conception when they reach childbearing age.
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Nutrition education and counseling are common methods to enhance the nutritional status of pregnant women (NEC). NEC strategies typically center on improving maternal diet performance by enhancing the variety and quantity of foods consumed, achieving adequate weight gain through consuming an adequate and balanced amount of protein and energy, and utilizing supplements, and fortified foods consistently and continuously. Nielsen et al.’s review found that pregnancy NEC initiatives had a beneficial effect on pregnant adolescents’ understanding of nutrition and diet quality.
Interventions also slightly enhanced birth weight and gestational weight increase. Another analysis of data, mostly from developed nations (HIC), found that prenatal nutrition teaching decreased uncontrollable gestational weight gain. 14 Last but not least, a Cochrane systematic review from 2010 discovered that explicit recommendations to boost protein and energy intake while pregnant. Only two of the five trials included in this Cochrane review had results for maternal weight increase, birth weight, and premature delivery. 15, 16, and meta-analyses did not have any bearing.
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