Impact of hidden hunger on pregnant women from underserved communities and its role in anaemia.

BACKGROUND

Micronutrient deficiencies (MiNDs) during pregnancy contribute to anemia, preeclampsia, and poor fetal outcomes. We assessed the prevalence of MiNDs and their association with anemia among pregnant women in northern India.

METHODS

A prospective cross-sectional study was conducted on 322 first-trimester pregnant women from low- to middle socioeconomic backgrounds. Haematology indices were measured on an automated analyser; vitamins (A, B1, B9, B12, D3) by LC-MS/MS; and trace elements (Fe, Zn, Cu, Se, Mn) by ICP-MS.

RESULTS

Anaemia prevalence was 46.5 %. Anemic women had significantly lower levels of manganese (50.3 %), copper (32.8 %), zinc (41.9 %), and iron (51.1 %) (p < 0.0001) and vitamins A (14.8 %), B1 (59.3 %), B9 (46.4 %), and B12 (71.3 %) (p < 0.0001). Selenium (p = 0.752) and vitamin D3 (p = 0.340) were not associated with anemia. Among anaemic women, 14 % had multiple micronutrient deficiencies. Anemia increased the risk of low vitamin A (<900 pg/mL; OR 2.06, CI: 1.32-3.21, p = 0.001), B1 (<70 ng/mL; OR 4.30, CI: 2.68-6.89, p < 0.0001), B9 (<3 ng/mL; OR 5.91, CI: 3.64-9.59, p < 0.0001), and B12 (<200 pg/mL; OR 5.53, CI: 3.43-8.93, p < 0.0001) respectively. Similarly, the risk of low iron (<80 µg/dL; OR 8.01, 95 % CI: 4.85-13.23, p < 0.0001), zinc (<600 µg/L; OR 5.18, 95 % CI: 3.22-8.34, p < 0.0001), copper (<700 µg/L; OR 4.30, 95 % CI: 2.68-6.89, p < 0.0001), and manganese (<4.0 µg/L; OR 2.25, 95 % CI: 1.44-3.51, p = 0.004) was significantly associated with higher risk of anemia. Univariate analysis showed significant correlations between hemoglobin and vitamins A, B1, B12, manganese; copper; and iron (p < 0.05). In multivariate analysis, B1, B9, B12, Fe, Cu, and Zn were independent predictors of Hb levels.

CONCLUSIONS

Anemia during pregnancy is strongly linked to multiple micronutrient deficiencies. Findings support antenatal strategies that extend beyond iron-folate to address multiple micronutrient deficiencies.