IRON AND ERYTHROCYTE INDICES VALUES IN PREGNANCY AND THE RISK OF ANEMIA

Abstract

Anemia during pregnancy remains a public health issue, as most women still experience anemia during pregnancy. Variations in hemoglobin concentration and erythrocyte indices during normal pregnancy have been thoroughly studied; however, in controlled studies, pregnant women who take iron supplements have significantly higher hemoglobin levels and erythrocyte indices compared to women who do not take supplements. This suggests that, in addition to hemodilution, iron deficiency erythropoiesis may be an important factor contributing to the development of anemia. According to WHO recommendations, the diagnosis of anemia in pregnant women can be considered when the Hb level is below 110 g/L.
Objectives: The aim of the study was to determine the values of iron, erythrocyte indices during pregnancy, and the risk of anemia.
Methods: We conducted a cross-sectional study at the obstetrics and gynecology department of the Health Center in Cazin, Bosnia and Herzegovina. The study included pregnant women who were monitored at the department between 2024 and 2025. We analyzed 204 pregnant women with recorded iron and erythrocyte index values. Iron values were documented and the data were categorized into two groups. The first group consisted of Fe ≤ 8 (μmol/L), while the second group consisted of Fe > 8 (μmol/L) during pregnancy. The measured erythrocyte indices included hemoglobin (Hb), hematocrit (Hct), red blood cell count (RBC), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), and red cell distribution width (RDW). Based on the iron values and erythrocyte indices, we analyzed the occurrence of anemia during pregnancy. The diagnosis of anemia was based on the WHO criteria for Hb concentration <110 (g/L), Fe<8 (μmol/L), with reference ranges for red blood cell count of RBC<2.81 (× 10^12/L), Hct <0.30 (L/L), MCV<85.8 (fL), MCH<30 pg/cell, MCHC<32.4 g/dL, and RDW>12.3 (%). Data were analyzed using descriptive statistics, including frequencies, means, and standard deviations. Statistical models used included one-way analysis of variance and risk assessment for the occurrence of anemia. IBM SPSS Statistics 27 software was used for data analysis.
Results and Discussion: Analyzing the data, we found that 17.6% of pregnant women had Fe values ≤8 μmol/L, while 82.4% had Fe values >8 μmol/L. Hemoglobin levels were <110 g/L in 9.8% of pregnant women, and in 92% of pregnant women, Hb levels were >110 g/L. Except for RBC and Hct, where no statistically significant differences were found, all other erythrocyte indices, including Hb, MCV, MCH, and MCHC, were statistically significantly lower in pregnant women with Fe ≤8 (μmol/L). RDW was statistically significantly higher in pregnant women with low iron levels.
Conclusions: The results obtained from this study show a prevalence of anemia of up to 10% among pregnant women in the Cazin municipality. Anemia is characterized by mild reductions in erythrocyte indices in pregnant women who had low iron levels in their blood. Elevated RDW levels and reduced MCV values in pregnant women with low iron levels are indicative of iron deficiency anemia.
Recommendations: In the future, it is essential to strengthen the implementation of nutritional interventions addressing the direct determinants of maternal malnutrition and fetal growth during prenatal care, particularly iron and folic acid supplements, nutrition education, food fortification, and dietary supplements.