Iron Deficiency Anemia in Pregnancy: Status and Contributing Factors Among Women in Northern Asir, Saudi Arabia

Summary

This study assessed the prevalence and risk factors of iron deficiency anemia among pregnant women in Bisha, Saudi Arabia. IDA was common during the second trimester and associated with rural residence, family history, and low intake of red meat, poultry, and citrus fruits. Affected women commonly experienced fatigue and dizziness.

Abstract

Iron deficiency anemia (IDA) is a common nutritional disorder during pregnancy and is linked to adverse maternal and fetal outcomes. Beyond hematological markers, understanding related sociodemographic, dietary, and clinical factors is important for prevention.

This study aimed to assess iron status and examine associations between sociodemographic characteristics, dietary habits, clinical factors, and IDA among pregnant women in Bisha, Saudi Arabia. A cross-sectional study was conducted from December 2022 to May 2023 at the Maternity and Children’s Hospital in Bisha. The study included 135 pregnant women and 65 non-pregnant controls. Data was collected using a validated questionnaire covering demographics, diet, and clinical history. Blood samples were analyzed to measure hemoglobin, serum iron, ferritin, total and unsaturated iron-binding capacity, and transferrin saturation. Multivariate logistic regression identified independent risk factors for IDA. IDA was highly prevalent among pregnant women, particularly in the second trimester. Compared with controls, affected women had lower hemoglobin, serum iron, ferritin, and transferrin saturation, and higher iron-binding capacity. Lower intake of red meat, poultry, and citrus fruits, rural residence, and family history of anemia were independently associated with IDA. Fatigue and dizziness were more common among affected women.

Introduction

Anemia is defined as a reduction in hemoglobin concentration, which in severe cases compromises oxygen delivery to vital organs¹. It affects individuals across all age groups, although infants and pregnant women are particularly vulnerable¹. Mild anemia may remain asymptomatic, whereas moderate to severe forms commonly present with fatigue, weakness, dizziness, and pallor. When left untreated, anemia is associated with reduced physical capacity, impaired cognitive development, increased susceptibility to infections during childhood, and unfavorable maternal and fetal outcomes during pregnancy²

Protocol

Ethical statement: The study was performed in accordance with the institutional guidelines and the ethical principles of the Declaration of Helsinki. Ethical approval was obtained from the Ethical Committee of Bisha University (UBCOM-RELOC), with approval number H-06-BH-087/(0802.23). Participation was voluntary, and written informed consent was obtained from all participants prior to enrollment. The materials, equipment, and analytical procedures used in the study are summarized in the Table of Materials.

Study design and setting
A retrospective cross-sectional study was conducted at....

Results

Study population and participant characteristics
A total of 200 women were enrolled in the study, including 135 pregnant women and 65 non-pregnant controls. Among the pregnant women, 91 (67.4%) were diagnosed with IDA, while 44 (32.6%) had no evidence of IDA.

Questionnaire-based findings
Sociodemographic characteristics
Among pregnant women with IDA, the majority were aged 20–40 years (57.1%), followed by those aged 18–20 years (22.......

Discussion

Iron deficiency anemia (IDA) remains a major global public health concern, particularly among pregnant women. Physiological changes during pregnancy, including plasma volume expansion and increasing fetal iron requirements, contribute to declining maternal iron status as gestation progresses. Maternal plasma volume typically increases by approximately 40–50%, resulting in physiological hemodilution and reduced hemoglobin concentration despite an increase in total red blood cell mass. This adaptive response decrease.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
5 mL Vacutainer Blood Collection Tubes	Becton, Dickinson and Company (BD), Franklin Lakes, NJ, USA	https://www.bd.com/en-us/products-and-solutions/products?query=5+mL+Vacutainer+Blood+Collection+Tubes	Used for venous blood sample collection.
Cobas 8000 Modular Analyzer	Roche Diagnostics, Basel, Switzerland	Cobas 8000	Used for serum ferritin, serum iron, TIBC, and UIBC analyses.
Ferritin ECLIA Reagent Kit	Roche Diagnostics, Basel, Switzerland	https://diagnostics.roche.com/global/en/products/lab/elecsys-ferritin-cps-000468.html	Electrochemiluminescence immunoassay for serum ferritin determination.
GraphPad Prism	GraphPad Software, San Diego, CA, USA	Version 9	Used for graphical presentation of results.
IBM SPSS Statistics	IBM Corporation, Armonk, NY, USA	Version 26.0	Used for statistical analyses.
Iron Colorimetric Reagent Kit	Roche Diagnostics, Basel, Switzerland	https://custombiotech.roche.com/global/en/products/cb/iron-bio-ht-3810349.html	Used for serum iron measurement.
Laboratory Centrifuge	Hospital Clinical Laboratory	N/A	Used to separate serum at 2000 × g for 15 min.
Microsoft Excel	Microsoft Corporation, Redmond, WA, USA	Microsoft 365 (or applicable version)	Used to generate the forest plot and organize study data.
OpenEpi Version 3.01	OpenEpi	Version 3.01	Used for sample size calculation.
Structured questionnaire (Supplementary File 1)	Developed by the authors	N/A	Questionnaire developed specifically for this study to collect sociodemographic, dietary, and clinical data.
Sysmex XN-1000 Hematology Analyzer	Sysmex Corporation, Kobe, Japan	XN-1000	Used for hemoglobin measurement.
TIBC/UIBC Colorimetric Reagent Kit	Roche Diagnostics, Basel, Switzerland	https://diagnostics.roche.com/global/en/products/lab/uibc-cps-000266.html	Used for determination of TIBC and UIBC.