Anaemia in pregnancy: possible causes and risk factors in Nepali women

Objective: The aim of this study was to investigate the importance of nutri tional deficiencies and infections in the development of anaemia in pregnan t Nepali women. Design: Case-control study. Setting: Patan Hospital, Kathmandu, Nepal. Subjects: A sub-sample (n = 479) of all pregnant women (n = 2856) coming fo r their first antenatal visit in a 12 month period, 1994-1995. Women who ha d already received any micronutrient supplementation (n = 82), and those wh ose serum samples showed macroscopic haemolysis (n = 7) were excluded. The remaining women (n = 390) were included in the statistical analysis. They w ere divided into three groups; a non-anaemic control group, haematocrit (Hc t)>33% (n = 82), and two case-groups: moderately anaemic, Hct 25-33% (n = 2 54), and severely anaemic, Hct<25% (n = 54). Results: We found high prevalences of nutritional deficiencies and intestin al infections, both among cases and controls. The prevalence of low s-ferri tin was high, especially among the severely anaemic women (55.6%). In a mul tiple logistic regression model, the presence of low s-vitamin A, elevated s-C-reactive protein or hookworm infection was associated with a significan tly increased risk of severe anaemia. The adjusted odds ratios (95% CI) wer e 8.38 (1.99, 35.30), 4.91 (1.22, 19.67) and 5.43 (1.20, 24.61), respective ly. Conclusions: In addition to the present routine iron and folate supplementa tion to pregnant Nepali women, vitamin A supplementation needs to be consid ered. Prevention and treatment of infections should, together with dietary advice, be emphasized more strongly in the antenatal care.