Archives of the Balkan Medical Union
37-40
Copyright © 2016 CELSIUS
ORIGINAL PAPER
RELATIONSHIP BETWEEN ANEMIA AND SPONTANEOUS
PRETERM BIRTH
R. ABOUSHAMAT1, D. NANU2
1
King Salman Hospital, Riyadh, Saudi Arabia
2
Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
S UMMARY
Aim: An analytical retrospective and prospective study to compare
the effect of lower hemoglobin (iron anemia, lower ferritin) in the
blood serum of pregnant women during pregnancy in the
incidence of preterm labor when patients treatment with iron and
comparison with pregnant women with normal ratios of iron and
ferritin.
Methods: Pregnant women with single fetus under surveillance
before and during research period form 3/5/2012 to 5/6/2014 and
cases included 586 cases in King Salman Hospital. Cases were
distributed as follows: pregnant women with iron deficiency
anemia and without treatment, pregnant women with iron
deficiency anemia and with iron treatment before week 30th,
pregnant women having normal blood.
Results: It was observed that the lower the hemoglobin in
pregnant women the greater percentage of preterm labor, where
the incidence of early labor 9% when the hemoglobin blood is
9-7 mg/dl. While early labor ratio rose to 15 % when the hemo-
globin blood is 7-4 mg /dl. This percentage dropped when pregnant
women taked iron.
Conclusions: Should be given preventive doses of iron for
pregnant women to avoid iron anemia, and prompt treatment for
any anemia to reduce complications to a minimum.
Key words: anemia, preterm labor, IDA
I NTRODUCTION
nemia affects millions of the people world-
A wide. The National center for health statistics
estimated that 3.4 millions are living with
Anemia. (1) Nevertheless the actual greater as anemic
individuals may be even greater as anemia is often under-
Correspondence address: Raghad Aboushamat MD
Bucharest, Romania
vol. 51, no. 1, pp.
March 2016
R ÉSUMÉ
Relation entre l'anémie et la prématurité spontanée
But: Une étude analytique rétrospective et prospective afin de com-
parer l'effet du niveau baissée d'hémoglobine (anémie ferriprive,
niveau réduit de ferritine) dans le sérum sanguin des femmes
enceintes pendant la grossesse sur l’incidence de l’accouchement
prématuré des patients traités avec du fer et la comparaison avec des
femmes enceintes aux taux normaux de fer et de ferritine.
Méthodes: Les femmes enceintes avec un seul fœtus sous surveil-
lance et pendant la période de la recherche de 3/5/2012 à 5/6/2014
et la casuistique incluant 586 de cas à l'Hôpital le Roi Salman. Les
cas étaient répartis comme suit: les femmes enceintes avec de
l'anémie ferriprive sans traitement, les femmes enceintes avec
anémie ferriprive et traitement avec du fer avant la 30 ème
semaine, les femmes enceintes aux valeurs du sang normales.
Résultats: On a observé que tant la valeur de l'hémoglobine chez
la femme enceinte etait plus réduite tant le pourcent du travail
prematuré était plus grand, donc l'incidence représentait 9%
lorsque l'hémoglobine dans le sang était de 9-7 mg / dl. Ouand le
taux du travail prématuré a augmente de 15%, l'hémoglobine dans
le sang était de 7-4 mg/dl. Le pourcentage s’est abaissé lorsque la
femme enceinte a pris du fer.
Conclusions: Des doses préventives de fer doivent être données
aux femmes enceintes pour éviter l'anémie ferriprive et un
traitement prompte pour toute forme d'anémie afin de réduire au
minimum les complications.
Mots clés: anémie, accouchement prématuré, IDA
diagnosed and undertreated. Anemia is one of the most
prevalent public health problems in most of the developing
countries and has serious consequences on national
development.
Incidence and prevalence
Iron deficiency is the common form of anemia seen in
e-mail: dr.raghadaboushamat@gmail.com
RELATIONSHIP BETWEEN ANEMIA AND SPONTANEOUS PRETERM BIRTH - ABOUSHAMAT et al
pediatric, general medical and clinical hematology prac-
tices in the US.
Prevalence:
• Adult men 5,000/100,000
• Adult women 14,000/100,000
Frequency:
• Prevalence in low income pregnant women in the
US is 9% to 14% and 37% in first second and third
trimesters respectively
Age:
• Most common in infant particularly those with diets
based on cow’s milk that is not fortified. This is less
common now, the introduction of iron fortified
• Common in toddlers with picky diets
• Common in women during reproductive years, due
to menses and pregnancy 7
• Slightly greater incidence in afro-american women
• No race prediction in children
Iron Deficiency Anemia is the most common nutri-
tional deficiency and is one of the leading risk factors of
disability and death worldwide affecting an estimated two
billion people. (2)
Anemia is usually a consequence of many diseases
including chronic inflammatory infections or neoplastic
disorders. It may also occur from the treatment of the disease
itself. Anemia may affect school children adolescents,
elderly and reproductive age women. Anemia has serious
negative consequences including:
• Increased mortality in women and children specially
in pregnant woman
• Reduced capacity to learn
• Decreased productivity in all individuals
Anemia in the elderly is linked to an increased morbidity
and mortality. (3) Pregnant women often show iron
deficiency anemia as a consequence of increased plasma
volume during pregnancy, and in many cases causes preterm
labor. Gynecological anemia is often caused by hyper-
menorrhea (increased menstrual bleeding). (4)
Treatment should be directed to the cause of the anemia
this will be discussed in detailed research. Regarding the iron
deficiency and its effects in causing preterm labor how a major
healthcare problem throughout the globe constitutes 7 to 8%
of the total births and contributes to 85% of deaths among
premature infants. (5)
Despite the current use of material, money effort in
perinatal medical technology. Neonatal mortality rates for
newborns born in the US (5 per 1 000 babies) may rank as
low as 32 industrialized nations superior only to Latvia
successful reduction of neonatal morbidity and mortality.
Associated with prematurity it may require implementa-
tion of effective identification and behavioral modification
programs for the prevention of the preterm labor.
M ETHODS
• Identify the various causes of low hemoglobin iron
deficiency in increase of preterm labor.
• Comparison of pregnant women with anemia of iron
vol. 51, no. 1, 38
deficiency and normal pregnant women in their
ability to respond to inhibitors of labor and in occur-
rence of early birth and the results on newborn.
• Comparison between pregnant women iron deficiency
anemia treatments with non-treatment pregnant
women in terms of response to stop the labor and the
results.
• Compare results with the results of similar studies.
Classification of cases
1. Groups of patients who suffer from anemia of iron
deficiency and who did not take their treatment
with iron, about 423 patients.
2. Groups of patients who suffer from anemia of iron
deficiency and who take treatment with iron before
week 30th, about 785 patients.
3. Groups of women who did not complain of anemia,
937 patients.
That excludes pregnant women who suffer from one of
the following conditions:
• Problems of uterus and cervix abnormalities.
• Embryonic reasons for preterm labor.
• Excessive stretching of the uterus.
Each patient of the three groups is evaluated; the detailed
story includes personal identity and story of pregnancy
(Where the three groups will be distributed under groups of
primiparous and parous women. In order to distinguish prece-
dents for early natural births or because of the possibility of
increased anemia in parous women.) story of the current
pregnancy (gestational age by date of last menstrual cycle,
studies data of ultrasound, complications associated with
pregnancy monthly schedule for analysis of hemoglobin and
ferritin.)
Early labor is being evaluated as follows:
• Do women with high risks patients for preterm labor.
• Are the patients improving the symptoms of early
labor.
• Patients in inevitable preterm labor.
• Are there other disorders when pregnant caused by
anemia and having had an impact factor increasing
the proportion of preterm labor:
 Pre-eclampsia and eclampsia; many studies suggest
that they are one of the complications of anemia;
 Early abruption of placenta;
 Aggravation of heart disease among pregnant
women;
 IUGR;
 Increased risk of infection of the amniotic fluid.
• Determine the degree of anemia.
• Determine the cause of anemia with iron deficiency
and ferritin:
 Insufficient iron diet accredited U.S;
 Insufficient iron stores in most of the women at
the reproductive age;
 Not enough natural absorption of iron intake;
 Iron loss excess from the body of the pregnant.
• Determine the adopted methods to compensate
the iron and the degree of response:
Archives of the Balkan Medical Union
Table 1
Category Hemoglobin level
Light 11-9
Average 9-7
Intense 7-4
Ferocious <4
 Type of iron;
 Dose;
 Way taken;
 Blood transfusion.
• Determine the methods adopted to discourage
preterm labor and degree of response compared to
patients with no anemia, preventive treatment for
high risk pregnant women.
R ESULTS
We found that from 423 pregnant (156 primaries, 267
fertile) who suffer from untreated iron deficiency anemia,
about 35 pregnant women had preterm labors, 8.27 % in
percentage. From previous 156 primary pregnant, about 15
had preterm labors, 9.61% in percentage. While in 267
fertile pregnancies about 25 pregnant had a preterm labor,
9.36% in percentage.
And we found out that from 785 pregnant (205 primary,
580 fertile) with treated iron deficiency anemia about 60
pregnancies had preterm labor which is about 7.64%. From
previous 205 primary pregnant, about 19 pregnant had
preterm labor which is 9.26 %. While in 580 fertile pregnant,
about 53 pregnant had preterm labor which is 9.1%.
From 937 pregnant (301primary, 636 fertile) who did not
have iron deficiency anemia about 71 pregnant had preterm
labor. This is equal to 7.57%. The previous 301 primary
pregnant about 27 pregnant had preterm labor. This is equal
to 8.97 %. While in 636 fertile pregnant about 56 pregnant
had preterm labor. This is equal to 8.8%.
D ISCUSSION
We noticed that the number of anemic pregnant women
who had been followed-up in our hospital is high. There are
several reasons why there is higher percentage of anemic
pregnant women, firstly because the hospital is big meaning
that huge numbers of pregnant women are mostly referred
patients from small hospitals, next is the kind of the diet of
our patients, then early marriage and lastly increased
number of pregnancies among women and other factors. We
found the percentage of preterm labor in untreated anemic
primary pregnant (9.61 %) is greater than the percentage of
preterm labor in treated anemic fertile pregnant (9.26 %),
the reason is that they were unable to tolerate the anemia
and presence of unknown other factors. Also we found the
percentage of preterm labor in untreated anemic pregnant
(8.27 %) is greater than the percentage of preterm labor in
treated anemic pregnant (7.64 %). This difference assures us
March 2016, 39
that the impact of anemia increases the percentage of
preterm labor.
On the other side, we found that the percentage of
preterm labor in untreated anemic primary pregnant (9.26%)
is greater than the percentage of preterm labor in treated
anemic fertile pregnant (9.1 %). And we noticed the per-
centage of preterm labor in treated anemic pregnant (7.64 %)
is almost equal to the percentage of preterm labor in preg-
nant without anemia (7.57 %) which shows the importance
of immediate treatment and preventive treatment for anemic
pregnant women.
C ONCLUSIONS
Anemia is one of the common and serious diseases
during pregnancy that causes wide range of side effects.
Therefore, early diagnosis and preventive treatment are
necessary for all cases even for the light ones. Since the rate
of anemia and preterm labor are high in primary pregnant
especially at very young age, pre-pregnancy laboratory is
necessary for early treatment. If the treatment with iron for
anemic pregnant is sufficient the side effects of anemia will
be reduced remarkably. Pregnant women who take iron
preventive therapy will make the rate of preterm labor
become less.
I conclude that the response of the treatment of
pre-term labor in anemic pregnancy is less than the
response of pre-term labor in patient who did not suffer
from anemia.
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