Association of Quality of Life and Dietary Pattern With Iron Deficiency Anemia in Pregnant Women in Rural Haripur

Background: Maternal iron deficiency anaemia (IDA) represents an intractable global public health challenge, precipitated by heightened gestational metabolic demands and compounded by micronutrient-deficient subsistence diets. In rural landscapes, IDA severely impairs physical performance, cognitive vitality, and overall health-related quality of life (HRQoL). This investigation sought to delineate the prevalence and independent determinants of IDA, characterize habitual dietary patterns via dimensionality reduction, and evaluate their systemic association with maternal HRQoL among pregnant women in rural District Haripur, Pakistan. Methods: A facility-based cross-sectional study was executed between June and September 2023 across public primary and secondary healthcare facilities in rural Haripur. A final cohort of 372 pregnant women was enrolled via non-probability consecutive sampling. Biochemical iron exhaustion and anemia severity were measured using serum ferritin, total iron-binding capacity (TIBC), and point-of-care photometric hemoglobin estimation (HemoCue Hb 301). Habitual nutritional intake was quantified utilizing an interviewer-administered, validated semi-quantitative Food Frequency Questionnaire (FFQ), with Principal Component Analysis (PCA) applied to identify latent dietary constructs. Maternal HRQoL was appraised across physical, psychological, environmental, and social domains using the validated WHOQOL-BREF and SF-8 health surveys. Independent predictors of IDA were isolated through multivariable binary logistic regression, reporting adjusted odds ratios (AOR) alongside corresponding 95% confidence intervals (CI). Results: The cumulative prevalence of gestational anemia () was 83.1% (), with confirmed IDA identified in 67.6% (). Biomarker analysis revealed marked iron depletion: 57.0% displayed deficient serum ferritin levels and 55.4% exhibited elevated TIBC. Mid-upper arm circumference (MUAC) identified moderate-to-severe acute undernutrition in 28.2% of participants. PCA identified three robust dietary architectures: the Protein Pattern, the Vegetable and Fruit Pattern, and the Carbohydrate Pattern. Adherence to the Protein and Vegetable/Fruit patterns demonstrated significant protective effects against IDA, whereas reliance on the phytate-laden Carbohydrate pattern was positively associated with anemia risk. Multivariable modeling confirmed that low monthly household income (; , , ), sedentary ambulatory status (; , , ), and severe nocturnal sleep deprivation (; , , ) were independent risk factors for IDA. Conversely, maternal chronological age, parity, gravidity, gestational trimester, educational attainment, and phenotypic body mass index exhibited no statistically significant associations. Women presenting with IDA demonstrated significantly attenuated HRQoL scores, predominantly across the physical health, vitality, and functional role domains. Conclusion: Pregnant women in rural Haripur experience a profound burden of IDA and nutritional vulnerability, driven by structural poverty, reliance on non-bioavailable carbohydrate-dense staples, and adverse lifestyle behaviors rather than biological or somatic characteristics. Eradicating gestational IDA requires a fundamental paradigm shift away from unmonitored iron distribution toward comprehensive public health initiatives integrating mandatory food vehicle fortification, community-level dietary diversification, and routine multidimensional quality-of-life surveillance within antenatal care.