Anemia in pregnant women residing at different geographical altitudes in Arequipa, Peru
Keywords:
pregnant women, anemia, high altitude, hemoglobin.Abstract
Purpose: To identify the frequency of anemia in pregnant women at different geographical altitudes in the Arequipa region of Peru.
Materials and Methods: A quantitative, descriptive, and retrospective study was carried out. The study population consisted of 35,725 pregnant women living in the Arequipa Region at different altitudes. Data on age, gestational age, weight, height, province of residence, altitude, hemoglobin were collected.
Results: Using World Health Organization altitude adjusted hemoglobin values, anemia prevalence in pregnant women between 2018-2019 was 13.7 % in the Arequipa Region, while using unadjusted hemoglobin, the overall prevalence was 4.1 %. When analyzed by altitudes, the frequency of anemia was 9.77 % below 1 000 m 13.1 % between 1 000-1 999 m, 13.1 % between 2.000-2.999 m, 31.5 % between 3.000-3.999 and 47.1 % between 4.000-4.999. Nevertheless, when using unadjusted hemoglobin values rates were 6.67 % for the 1.000-1.999 range, 2.39 % for ranges between 2.000-2.999 m and 3.000-3.999 m, and 5.19 % for altitudes above 4.000 m.
Conclusions: There is a directly proportional correlation in the prevalence of anemia in pregnant women and higher altitude (p<0.01) as well as levels of anemia during the last trimester of pregnancy. Adjusting the hemoglobin values by altitude results in triple the prevalence of anemia. A throughout revision of the suitability of current guidelines to diagnose and prevent anemia at high altitude is recommended.
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References
1. World Health Organization. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. World Health Organization. 2011; [access 03/25/2021] (No. WHO/NMH/NHD/MNM/11.1) Available in: https://apps.who.int/iris/handle/10665/85839
2. Rahman MM, Abe SK, Rahman MS, Kanda M, Narita S, Bilano V, et al. Maternal anemia and risk of adverse birth and health outcomes in low-and middle-income countries: systematic review and meta-analysis. The Am J of Clin Nut. 2016;103(2):495-504. DOI: https://doi.org/10.3945/ajcn.115.107896
3. Mantadakis E, Chatzimichael E, Zikidou P. Iron deficiency anemia in children residing in high and low-income countries: risk factors, prevention, diagnosis and therapy. Mediterr J Hematol Infect Dis. 2020;12(1):e2020041. DOI: https://doi.org/10.4084/mjhid.2020.041
4. Gonzales GF. Hemoglobin and testosterone: importance on high altitude acclimatization and adaptation. Rev Peru Med Exp Salud Publica. 2011;28(1):92-100. DOI: https://doi.org/10.1590/s1726-46342011000100015
5. Huicho L, Passano-Del-Carpio A, Rivera-Ch M, van-Elteren HA, Martin DS, et al. Pregnancy at high altitude in the Andes leads to increased total vessel density in healthy newborns. J Appl Physiol. 2016;121(3):709-15. DOI: https://doi.org/10.1152/japplphysiol.00561.2016
6. Shaw S, Ghosh D, Kumar U, Panjwani U, Kumar B. Impact of high altitude on key determinants of female reproductive health: a review. Int J Biometeorol. 2018;62(11):2045-55. DOI: https://doi.org/10.1007/s00484-018-1609-0
7. Bailey BA, Donnelly M, Bol K, Moore LG, Julian CG. High altitude continues to reduce birth weights in Colorado. Matern Child Health J. 2019;23(11):1573-80. DOI: https://doi.org/10.1007/s10995-019-02788-3
8. Zhang P, Ke J, Li Y, Huang L, Chen Z, Huang X, et al. Long-term exposure to high altitude hypoxia during pregnancy increases fetal heart susceptibility to ischemia/reperfusion injury and cardiac dysfunction. Int J Cardiol. 2019;274:7-15. DOI: https://doi.org/10.1016/j.ijcard.2018.07.046
9. Tong W, Giussani DA. Preeclampsia link to gestational hypoxia. J Dev Orig Health Dis. 2019;10(3):322-33. DOI: https://doi.org/10.1017/s204017441900014x
10. Ministerio de Salud. Norma técnica - Manejo terapéutico y preventivo de la anemia en niños, adolescentes y mujeres gestantes y puérperas. 2017 [access 03/25/2021]. Available in: https://www.gob.pe/institucion/minsa/informes-publicaciones/280854-norma-tecnica-manejo-terapeutico-y-preventivo-de-la-anemia-en-ninos-adolescentes-mujeres-gestantes-y-puerperas
11. Silubonde TM, Baumgartner J, Ware LJ, Malan L, Smuts CM, Norris S. Adjusting haemoglobin values for altitude maximizes combined sensitivity and specificity to detect iron deficiency among women of reproductive age in Johannesburg, South Africa. Nutrients. 2020;12(3):633. DOI: https://doi.org/10.3390/nu12030633
12. Villamonte W, Lam N, Jerí M, De-La-Torre C, Villamonte AA. Maternal altitude-corrected hemoglobin and at term neonatal anthropometry at 3400 m of altitude. High Alt Med Biol. 2020;21(3):287-91. DOI: https://doi.org/10.1089/ham.2019.0127
13. Choque BM, Alarcón DE, Paredes W, Zaira A, Ochoa A, Gonzales GF. Is the prevalence of anemia in children living at high altitudes real? An observational study in Peru. Ann N Y Acad Sci. 2020;1473(1):35-47. DOI: https://doi.org/10.1111/nyas.14356
14. Accinelli RA, Leon-Abarca JA. Age and altitude of residence determine anemia prevalence in Peruvian 6 to 35 months old children. PLoS One. 2020;15(1):e0226846. DOI: https://doi.org/10.1371/journal.pone.0226846
15. Yi S-W, Han Y-J, Ohrr H. Anemia before pregnancy and risk of preterm birth, low birth weight and small-for-gestational-age birth in Korean women. Eur J Clin Nutr. 2013;67(4):337-42. DOI: https://doi.org/10.1038/ejcn.2013.12
16. Haniff J, Das A, Onn LT, Sun CW, Nordin NM, Rampal S, et al. Anemia in pregnancy in Malaysia: a cross-sectional survey. Asia Pac J Clin Nutr. 2007 [access 03/25/2021];16(3):527-36. Available in: https://pubmed.ncbi.nlm.nih.gov/17704035/
17. Ochsenbein-Kölble N, Roos M, Gasser T, Zimmermann R. Cross-sectional study of weight gain and increase in BMI throughout pregnancy. Eur J Obstet Gynecol Reprod Biol. 2007;130(2):180-6. DOI: https://doi.org/10.1016/j.ejogrb.2006.03.024
18. Krampl E, Kametas NA, Nowotny P, Roden M, Nicolaides KH. Glucose metabolism in pregnancy at high altitude. Diabetes Care. 2001;24(5):817-22. DOI: https://doi.org/10.2337/diacare.24.5.817
19. Xing Y, Yan H, Dang S, Zhuoma B, Zhou X, Wang D. Hemoglobin levels and anemia evaluation during pregnancy in the highlands of Tibet: a hospital-based study. BMC Public Health. 2009;9:e336. DOI: https://doi.org/10.1186/1471-2458-9-336
20. Zubieta-Calleja G Jr, Zubieta-Castillo G Sr. Tolerance to hypoxia: A high altitude paradox. Wilderness Environ Med. 2015;26(1):e1. DOI: https://doi.org/10.1016/j.wem.2014.11.008
21. Cohen JH, Haas JD. Hemoglobin correction factors for estimating the prevalence of iron deficiency anemia in pregnant women residing at high altitudes in Bolivia. Rev Panam Salud Publica. 1999;6(6):392-9. DOI: https://doi.org/10.1590/s1020-49891999001100004
22. Sperandio N, Sant’Ana LF da R, Franceschini S do CC, Priore SE. Differences in the hemoglobin cut-off point for the diagnosis of anemia as a function of race/color. Rev Médica Minas Gerais. 2015;25(1). DOI: http://doi.org/10.5935/2238-3182.20150017
23. Wu T-Y, Liu F-Y, Ouzhou-Loubu, Cui C-Y, Qi X-B, Su B. A genetic adaptive pattern-low hemoglobin concentration in the Himalayan highlanders. Zhongguo Ying Yong Sheng Li Xue Za Zhi. 2013 [access 03/25/2021];29(6):481-93. Available in: https://pubmed.ncbi.nlm.nih.gov/24654529/
24. Gonzales GF, Alarcón DE, Zevallos A. Human adaptation to life at high altitude. In: Advances in Biochemistry in Health and Disease, vol 16. Springer, Cham. Biochemistry of Oxidative Stress. Cham: Springer International Publishing; 2016. p. 109-26. DOI: https://doi.org/10.1007/978-3-319-45865-6_8
25. Gassmann M, Mairbäurl H, Livshits L, Seide S, Hackbusch M, Malczyk M, et al. The increase in hemoglobin concentration with altitude varies among human populations: Hemoglobin levels at high altitude. Ann N Y Acad Sci. 2019;1450(1):204-20. DOI: https://doi.org/10.1111/nyas.14136
26. Hinderaker SG, Olsen BE, Bergsjø P, Lie RT, Gasheka P, Kvåle G. Anemia in pregnancy in the highlands of Tanzania. Acta Obstet Gynecol Scand. 2001;80(1):18-26. DOI: https://doi.org/10.1034/j.1600-0412.2001.800104.x
27. Gonzales GF, Olavegoya P. Fisiopatología de la anemia durante el embarazo: ¿anemia o hemodilución? Rev peru ginecol obstet. 2019;65(4):489-502. DOI: http://dx.doi.org/10.31403/rpgo.v65i2210
28. Rahmati S, Delpishe A, Azami M, Hafezi Ahmadi MR, Sayehmiri K. Maternal anemia during pregnancy and infant low birth weight: a systematic review and meta-analysis. Int J Reprod Biomed (Yazd). 2017 [access 03/25/2021];15(3):125-34. Available in: https://pubmed.ncbi.nlm.nih.gov/28580444/
29. Nahum GG, Stanislaw H. Hemoglobin, altitude and birth weight: does maternal anemia during pregnancy influence fetal growth? J Reprod Med. 2004 [access 03/25/2021];49(4):297-305. Available in: https://pubmed.ncbi.nlm.nih.gov/15134157/
30. Muñoz Á, Cornejo I, Rojas S, Alvarez G, Bernabé JC, Gallegos A, et al. Childhood anemia in populations residing at different geographical altitudes of Arequipa, Peru: A descriptive and retrospective study. Medwave. 2020;20(7):e8004. DOI: https://doi.org/10.5867/medwave.2020.07.8004
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