Risk factors for megaloblastic anemia related hematologic disorder among pregnant mothers attending ANC in Eastern Shoa Zone and the vicinity. A case control study.

  • Sisay Teklu Waji Addis Ababa University, College of Health Sciences, School of Medicine, Department of Obstetrics and Gynecology
  • Amaha Gebremedhin Addis Ababa University, College of Health Sciences, School of Medicine, Department of Internal Medicine
  • Dawit Worku Addis Ababa University, College of Health Sciences, School of Medicine, Department of Obstetrics and Gynecology
  • Alula Teklu St Paul’s Hospital Millennium Medical College
  • Fikru Abebe Adama Hospital Medical College, Department of Gynecology and Obstetrics
  • Godana Jarso Adama Hospital Medical College, Department of Internal Medicine
  • Kissi Mudie Ethiopian Public Health Institute
  • Tamrat Woldemichael Center for International Reproductive Health Training(CIRTH)

Abstract

 

Introduction: Dramatic increase in the number of mothers referred to Tikur Anbassa Specialized Hospital (TASH) from Eastern Shoa and Arsi zones of Oromia region of Ethiopia, with problems of severe anemia and thrombocytopenia, has been observed.. Further investigation in TASH revealed features of megaloblastic bone marrow changes. The aim of the study was to identify potential risk factors associated with the disease.

Methods: A case control study was conducted on 50 cases and 156 controls from mothers attending ANC in Adama and Assala Hospitals. .

Result: Cases were more exposed to fertilizers (AOR 7.3, 95% CI 3.6-15) and pesticides (AOR 6.2, 95% CI 2.8-13.5) than controls although specific chemicals were not identified in this study. Increased adverse maternal outcomes, including maternal deaths and perinatal mortality were observed among cases than controls.

Conclusion and recommendation:. Cases are more frequently exposed to pesticides and fertilizers and also have poor outcome compared to controls. This calls for further large scale study to explore potential environmental exposures, including those identified in this study and to further unravel the cause of this fatal and significant public health problem in this highly populated and industrial region of the country.

Key words: Hematological disorders during pregnancy, Risk factors, Megaloblastic anemia.

Author Biographies

Sisay Teklu Waji, Addis Ababa University, College of Health Sciences, School of Medicine, Department of Obstetrics and Gynecology
Associate Professor, Ob-Gyn department, Addis Ababa University
Amaha Gebremedhin, Addis Ababa University, College of Health Sciences, School of Medicine, Department of Internal Medicine
Associate Professor of hematology, Department of Internal Medicine, Addis Ababa University
Dawit Worku, Addis Ababa University, College of Health Sciences, School of Medicine, Department of Obstetrics and Gynecology
Assistant Professor, Ob-Gyn department, Addis Ababa University
Alula Teklu, St Paul’s Hospital Millennium Medical College
Assisatant professor of public health
Fikru Abebe, Adama Hospital Medical College, Department of Gynecology and Obstetrics
Assistant professor of OBstetrics and Gynecology,Adama University Medical college
Godana Jarso, Adama Hospital Medical College, Department of Internal Medicine
Assistant professor of Internal Medicine, Adama Hospital Medical College
Kissi Mudie, Ethiopian Public Health Institute
Head of Clinical chemistry laboratory
Tamrat Woldemichael, Center for International Reproductive Health Training(CIRTH)
Expert in environmental pollution at CIRHT

References

References

Worldwide prevalence of anaemia. 1993.

Milman N. Anemia—still a major health problem in many parts of the world! Ann Hematol. 2011;90(4):369–77.

Sifakis S PG. Anemia in pregnancy. Ann N Y Acad Sci. 2000;(900):125–36.

TRUMBO P, YATES AA, SCHLICKER S, POOS M. Dietary Reference Intakes. J Am Diet Assoc. 2001;101(3):294–301.

van den Broek N. Anaemia and micronutrient deficiencies. Br Med Bull. 2003;67:149–60.

Kraemer K, Zimmermann MB. Nutritional Anemia.

Allen LH. Pregnancy and iron deficiency: unresolved issues. Nutr Rev. 1997 Apr;55(4):91–101.

Karaoglu L, Pehlivan E, Egri M, Deprem C, Gunes G, Genc MF, et al. The prevalence of nutritional anemia in pregnancy in an east Anatolian province, Turkey. BMC Public Health. 2010 Dec 10;10(1):329.

Ethiopian Demographic and Health Statistics. 2011

Burrows RF, Kelton JG. Incidentally Detected Thrombocytopenia in Healthy Mothers and Their Infants. N Engl J Med. 1988 Jul 21;319(3):142–5.

Provan D, Stasi R, Newland AC, Blanchette VS, Bolton-Maggs P, Bussel JB, et al. International consensus report on the investigation and management of primary immune thrombocytopenia. Blood. 2010 Jan 14;115(2):168–86.

Institute of Medicine (US) Standing Committee on the Scientific Evaluation of Dietary Reference Intakes and its Panel on Folate OBV and C. Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline. National Academies Press (US); 1998

Chang JY-F, Wang Y-P, Wu Y-C, Cheng S-J, Chen H-M, Sun A. Hematinic deficiencies and anemia statuses in oral mucosal disease patients with folic acid deficiency. J Formos Med Assoc. 2015 Sep;114(9):806–12.

Castle WB. Megaloblastic anemia. Postgrad Med. 1978; 64(4):117–22.

Idris N, Arsyad A. Vitamin B12 deficiency presenting as pancytopenia in pregnancy: a case report. Malaysian Fam physician Off J Acad Fam Physicians Malaysia. 2012;7(2–3):46–50.

Trivette ET, Hoedebecke K, Berry-Cabán CS, Jacobs BR. Megaloblastic hematopoiesis in a 20 year old pregnant female. Am J Case Rep. 2013;14:10–2.

Teklu S, Gebremedhin A, Meressa A, Feki B. PANCYTOPENIA IN PREGNANT MOTHERS FROM EASTERN SHOA ZONE OF ETHIOPIA: A CASE SERIES. Ethiop Med J; 2016,54(3), 141-4

Reveiz L, Gyte GM, Cuervo LG. Treatments for iron-deficiency anaemia in pregnancy. In: Reveiz L, editor. Cochrane Database of Systematic Reviews [Internet]. Chichester, UK: John Wiley & Sons, Ltd; 2007

Campbell BA. Megaloblastic anemia in pregnancy. Clin Obstet Gynecol. 1995;38(3):455–62.

Hiss RG. Evaluation of the anemic patient. In: Laros RK, ed. Blood Disorders in Pregnancy. Philadelphia: Lea & Febiger, 1986, 3, 1–18.

Chanarin I. Folate and cobalamin. Clin Haematol. 1985; 14:729

Chanarin I (Israel). The megaloblastic anaemias, 3rd ed,Oxford ; Boston : Blackwell Scientific Publications

Ingeber S, Stoffersen E. Platelet Dysfunction in Patients with Vitamin B12 Deficiency. Acta Haematol. 1979 ;61(2):75–9.

Published
2019-06-28
Section
Original Article