The study was approved by the Human Ethical Committee of Urmia Medical Science University. A total number of 1405 healthy women, aged between 17 - 45 years, after pregnancy confirmation and undergoing prenatal care during the three trimesters of pregnancy, were registered as subjects for the present study. At the end of pregnancy, they referred to hospitals for delivery. This study was conducted in health care centers which are located in Urmia. The present study was designed to observe the effect of hemoglobin levels during various trimesters of pregnancy for batter pregnancy outcome and fetal growth. Thus, it is important to understand the most vulnerable time for the fetus due to anemia in pregnancy. Based on literature review, the assessment of hemoglobin level in which trimester should be taken as standard is still not clear. in a meta-analysis showed that anemia during early pregnancy, but not during late pregnancy was associated with slightly increased risk of preterm delivery and low birth weight( 20), Whereas Ahankari et al., in systematic review study found that anemia in the first and third trimesters was associated with increased risk of low birth weight and they emphasized that hemoglobin needs to be routinely investigated during pregnancy, and women with low level of hemoglobin should be treated to minimize harmful impact on neonatal health ( 1). In another study, low birth weight and small for gestational age increased with severity of anemia in Korean women ( 18).Haggaz et al. An improvement in prenatal mean hemoglobin concentration linearly increased birth weight ( 14). Kozuki et al reported that moderate to severe, but not mild, maternal anemia appears to have an association intra uterian growth retardation ( 19).
Yi et al., revealed that anemia, but not hemoglobin concentration, before pregnancy was associated with an elevated risk of preterm delivery ( 18).
Low birth weight and preterm delivery have been persistently linked to anemia in pregnancy ( 14- 17). Anemia in pregnant women detrimental to fetal growth and pregnancy outcomes ( 12, 13). According to the classification of World Health Organization (WHO), pregnant women with hemoglobin levels less than 11.0 g/dl in the first and third trimesters and less than 10.5 g/dl in the second trimester are considered anemic ( Table I) ( 11). Research has shown that Hb and Hematocrit (Hct) concentrations typically decrease during the first trimester and reach the lowest levels at the end of second trimester and increase again during the third trimester of pregnancy ( 9). This physiological drop is attributed to increase of plasma volume and hence decrease of blood viscosity ( 6) lead to better circulation in placenta ( 7). It is a well established fact that there is a physiological drop in hemoglobin (Hb) in the mid trimester ( 5). Barooti in a systematic review illustrated that the frequency of anemia in Iran is 4.8-17.5 percent ( 3).ĭuring pregnancy, anemia increased more than fourfold from the first to third trimester ( 4). Anemia in pregnancy is associated with increased rates of maternal and perinatal mortality, premature delivery, low birth weight, and other adverse outcomes ( 2). Anemia is a major health problem that affects 25% to 50% of the population of the world and approximately 50% of pregnant women ( 1).
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