Frequency of Anemia and Its Type in Antenatal Women Presenting at Allied Hospital, Faisalabad

BackgroundAnemia in pregnancy remains a major public health problem in South Asia, and Pakistan carries one of the highest reported burdens among low-and middle-income countries, with facility-based estimates from Punjab showing little decline over three decades.Prevalence figures alone are an inadequate guide to management, because anemia in pregnancy is etiologically heterogeneous and morphological subtypes carry different therapeutic implications (e.g., iron versus folate/cobalamin replacement).Empirical iron supplementation without characterization risks both under-treatment of megaloblastic anemia and unnecessary iron exposure in women who are not iron deficient.This study was undertaken to determine the frequency of anemia and its morphological types among antenatal women presenting at Allied Hospital, Faisalabad. MethodologyA hospital-based descriptive cross-sectional study was conducted in the Department of Obstetrics and Gynecology, Allied Hospital, Faisalabad, from October 15, 2019, to April 14, 2020.Women aged 18 to 40 years with a singleton pregnancy attending for a first routine antenatal checkup were enrolled by nonprobability consecutive sampling.Women on iron supplementation, recently transfused, or with chronic liver or renal disease were excluded.Using Cochran's formula with 95% confidence, 6% margin of error, and an anticipated prevalence of 13.6%, the sample size was 126.Complete blood count, peripheral blood morphology, and serum ferritin were performed, and anemia was defined by trimester-specific hemoglobin cut-offs. ResultsAmong 126 antenatal women, the median age was 31.0 years (interquartile range (IQR): 28.0-34.0), the mean gestational age at booking was 31.58 ± 3.64 weeks, and the mean body mass index was 28.98 ± 3.41 kg/m².Most were categorized as multiparous (n=102, 81.0%) and urban residents (n=76, 60.3%).Anemia was present in 71 women (56.3%).Among these, 41 had microcytic hypochromic anemia (57.7%), 18 had macrocytic anemia (25.4%), and 12 had normocytic normochromic anemia (16.9%).Median hemoglobin was 10.4 g/dL (IQR: 8.0-12.2),median mean corpuscular volume was 87.8 fL, median mean corpuscular hemoglobin concentration was 33.5 g/dL, and median serum ferritin was 53.5 ng/mL.Anemia was significantly more frequent at 32 weeks or less, affecting 47 women (65.3%) versus 24 women (44.4%) beyond 32 weeks, and in women with a body mass index of 30 kg/m² or less, affecting 52 women (62.7%) versus 19 women (44.2%).Median ferritin differed markedly across morphological groups, from 8.7 ng/mL in the microcytic group to 119.3 ng/mL in the macrocytic group.Age, parity, residence, education, gestational diabetes, and pregnancy-induced hypertension showed no significant association. ConclusionMore than half of the antenatal women were anemic at first booking.Although microcytic hypochromic anemia predominated, macrocytic and normocytic normochromic forms together accounted for a substantial minority, and serum ferritin diverged sharply across these groups.Routine morphological and biochemical characterization at booking is therefore warranted so that replacement therapy is matched to the underlying deficiency rather than assumed to be iron.