Frequency of Beta Thalassemia in Anemic Pregnant Women

Objective: To determine the frequency of beta thalassemia trait among pregnant women presenting with anemia. Method: A cross sectional study was conducted in Gynecology & Obstetric department, district headquarters hospital Mardan from January 2019 to June 2020. This study includes all pregnant women who presented with anemia and having age 15 to 45 years. Patients with known hemoglobinopathies were excluded from the study. Collected data was analyzed using SPSS 20. Results: Mean age of the patient was 27.7 years and mean hemoglobin level was 8.7g/dl. Age distributions showed mother age 15 to 25 years were 40%, 26 to 36 years were 35% and 36 to 45 Original Research Article Khadija et al.; JPRI, 33(5): 1-5, 2021; Article no.JPRI.65345 2 years were 25%. Thalassemia trait was found in 40% anemic pregnant women. Thalassemia trait percentage was high in mother having age 15 to 25 years. Conclusion: Beta thalassemia trait is a common cause anemia in pregnancy. All pregnant women presenting with anemia should be investigated for it.


INTRODUCTION
Anemia has been defined as hemoglobin level of less than 11 g/dl by world health organization [1]. Anemia during pregnancy is reported to be 12 to 25% and adversely affect the outcome of pregnancy [2,3]. Thalassemia trait and Iron deficiency anemia are the most common reported causes of anemia during pregnancy [4]. Thalassemia is a genetic disorder which results in defective hemoglobin synthesis. Thalassemia is common in Mediterranean counties and high prevalence in Pakistan is due to consensual marriages [5]. Thalassemia has 2 major types, alpha and beta. Beta thalassemia is mainly due to defective synthesis of beta chain and results in imperfect hemoglobin production [6]. Numerous sign and symptoms are here to detect the condition of anemia during pregnancy including fatigue, weakness, fade coloring, irregular heartbeat, difficulty in breathing, hypoxia, dizziness, chest pain, hands and feet become cold and severe headache. Homozygous mutation presents with thalassemia major and heterozygous mutation in the gene lead to thalassemia trait. Thalassemia major patient presents with severe anemia and they require regular blood transfusion with chelating agents. Thalassemia major is health burden and this can be prevented by proper screening and knowing the carries stat [7]. People with thalassemia have an increased risk of infection. This is especially true if the spleen has been removed. The spleen aids in fighting infection and filters unwanted material, such as old or damaged blood cells. Thalassemia is often accompanied by the destruction of a large number of red blood cells and the task of removing these cells causes the spleen to enlarge. Splenomegaly can make anemia worse, and it can reduce the life of transfused red blood cells. Severe enlargement of the spleen may necessitate its removal. Patient with thalassemia trait presents with micro-cytic hypochromic anemia but not of clinical importance [8]. Hemo-dilution in pregnancy leads to physiologic anemia and thalassemia trait may worsen this situation.1-7% population in Pakistan are in the carrier state of thalassemia trait [9].Lack of screening facilities and high rate of consensual marriage in the society are the main reason behind high transmission rate of thalassemia in Pakistan [10]. Intrauterine growth retardation, preterm labor and low birth weight is being reported to be associated with anemia in pregnancy [11]. The outcome of pregnancy is largely associated with pregnant women is not being affected by thalassemia trait. In the current study, we analyzed data of all pregnant women who presented with anemia, in order to determine the frequency of beta thalassemia trait and outcome of pregnancy. There are different risk factors associated with anemic condition during pregnancy as females had greater menstrual flow before pregnancy; sometime concurrent pregnancies means after very short period of delivery females become pregnant. Morning sickness, continuous vomiting during gestational period are also risk factors. Female that has allergic reaction with nutritional items that contain Iron contents in huge quantity and the major risk factor is concern is giving birth to twins in single delivery.

MATERIALS AND METHODS
A Cross sectional study was conducted in the department of Obstetrics and Gynecology, district headquarters hospital Mardan from January 2019 to June 2020. This study includes 140 patients who presented with the complaint of anemia having a hemoglobin level below 10g/dl in 1 st trimester and age between 15 to 45 years. Patients who are diagnosed cases of other hemoglobinopathies were excluded from the study. Approval was taken from the hospital ethical approval committee prior to conduct a study. Data was collected using a predesigned proforma, which includes patient demographics, hemoglobin level, Hb electrophoresis. The collected data were revised, tabulated, coded and fed in PC having statistical analysis program SPSS-20. Statistical analysis was carried out using SPSS-20. Data was presented and suitable analysis was carried out according to the type of data. Mean and standard deviation was calculated for numerical data like age and Hb level while frequency and percentages were calculated for categorical data like thalassemia trait, age groups. Chi square test was used for categorical data like age groups and thalassemia traits.

RESULTS
Our study includes 140 patients with mean age of 27.74 Years+5.16.Mean hemoglobin level was 8.7 mg/dl + 0.83. Age of the patient was analyzed in categories, 56 patients (40%) were in range of 15 to 25 years, 49 patients (35%) were in range of 26 to 35 years and 35 patients (25%) were in range of 36 to 45 years.
Beta thalassemia trait was recorded in 60 patients (42.9%). Beta thalassemia trait was cross tabulated with age of the mother as shown in Table 1.
Females belong to numerous remote areas so they were unable to follow the protocols as described by the physician and their nutritional level was also inadequate to overcome the problem of anemic condition during pregnancies. Residential status of reported females is mentioned in Table 3.
Females, which were included in the study, had appeared in the hospital with different sign and symptoms and the frequency of such indication are mentioned in Table 4.

CONCLUSION
Our study concluded that beta thalassemia trait is among one of the common causes of anemia in pregnancy and recommend screening of all pregnant women presenting with hemoglobin level below 10 g/dl.

CONSENT
It is not applicable.

ETHICAL APPROVAL
Approval was taken from the hospital ethical approval committee prior to conduct a study. Data was collected using a predesigned proforma, which includes patient demographics, hemoglobin level, Hb electrophoresis. among pregnant women attending a highvolume tertiary care center for delivery.