Rates and determinants of peripartum and puerperal anemia in Enugu, Nigeria

Anemia in the peripartum or postpartum period could pose a significant risk for maternal morbidity and mortality during and after delivery.

To determine the rates of anemia at term and in the puerperium and describe the determinants of puerperal anemia among a cohort of women with both normal and cesarean deliveries, following uncomplicated term singleton pregnancies in Enugu, Nigeria.

A prospective longitudinal study involving women with uncomplicated singleton pregnancies who were recruited at term at two tertiary maternity centers and were followed up with the determination of hemoglobin and ferritin concentrations till 6 weeks after delivery. Data were analyzed with descriptive and inferential statistics at 95% level of confidence using the Statistical Package for Social Sciences computer software version 20.0 for Windows (IBM Corporation, Armonk, NY, USA).

A total of 202 women were studied. The mean hemoglobin levels at term, 48 h, and 6 weeks postpartum were 11.1 ± 0.9 g/dL, 10.5 ± 0.8 g/dL, and 11.2 ± 1.0 g/dL, respectively. The proportions of women with anemia at term, 48 h, and at 6 weeks postpartum were 46.0%, 72.8%, and 47.5%, respectively. Forty-eight hours postdelivery, 17.3% had anemia with low serum ferritin compared to 7.4% by 6 weeks postdelivery. Anemia at term (adjusted odds ratio [aOR] 2.02; 95% confidence interval [CI] 1.01, 4.05), anemia at 48 h postdelivery (aOR 6.17; 95% CI 3.30, 11.6), and low ferritin at 48 h postdelivery (aOR 3.11; 95% CI 1.51, 5.09) all increased the likelihood of anemia at 6-week postpartum.

A high proportion of low-risk pregnant women in the study centers could go through delivery with undetected anemia and this would predispose to high rates of postpartum anemia. Screening of low-risk women at term and in the immediate postdelivery periods may be necessary to improve detection of such cases.