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Association Between Serum Ferritin and Hemoglobin Levels in Pregnant Women: Implications for Early Iron Deficiency
Doaa Ahmed1,2, Rawaal Amin3, Vidya Raman4,5
1Obstetrics and Gynecology, Alexandria University, Alexandria, EGY.
Background:
Iron deficiency is the leading cause of anemia during pregnancy, and serum ferritin is the most widely used biochemical marker of body iron stores. However, population-specific evidence describing the relationship between serum ferritin concentrations and hemoglobin levels remains limited.
Purpose:
This study aimed to assess the relationship between serum ferritin and hemoglobin levels among pregnant women attending antenatal care.
Methods:
A cross-sectional, laboratory-based study was conducted among 522 pregnant women in their second and third trimesters. Serum ferritin concentrations were measured using the hospital's standardized laboratory procedures. Iron deficiency was defined as a serum ferritin concentration <30 µg/L, and anemia was defined as a hemoglobin concentration <11 g/dL. Statistical analyses included descriptive statistics, independent-samples Student's t-tests, chi-square tests, binary logistic regression, and receiver operating characteristic (ROC) curve analysis.
Findings:
Iron deficiency was identified in 209 participants (40.0%), and anemia was present in 235 participants (45.0%). Serum ferritin concentrations and mean corpuscular volume (MCV) were significantly lower in women with anemia than in those without anemia (p < 0.001). Serum ferritin was independently associated with anemia (OR = 0.95, p < 0.001). Notably, 35 women without anemia (12.2%) had low serum ferritin concentrations, indicating subclinical iron deficiency. ROC curve analysis demonstrated good discriminative performance, with serum ferritin showing greater diagnostic accuracy than MCV. The optimal serum ferritin cutoff was 17.0 µg/L, with a sensitivity of 81% and a specificity of 83%.
Conclusion:
Pregnant women with anemia had significantly lower serum ferritin concentrations than those without anemia, and a substantial proportion of women with normal hemoglobin levels had depleted iron stores. These findings support the potential value of serum ferritin as an adjunctive marker for assessing iron status during pregnancy. However, prospective studies are needed to further evaluate its clinical utility.
