DIET FACTOR Assessment of Dietary Practices Among Pregnant Anemic Females

Anemia is interpreted as low blood hemoglobin values. This medical condition can both developed and underdeveloped countries. The ability of blood to transfer oxygen to tissues is affected when the hemoglobin is low, which in turn develops symptoms such as fatigue, compromised physical work capacity, and shortness of breath. Objective : This study was conducted to find out the dietary practices among pregnant females. Methods : It was a comparative cross-sectional study. The substantial data was collected from the gynecology department, vaccination department of Tertiary Care Hospitals, Lahore. Nonprobability convenient sampling criteria were utilized in the study. 150 participants were selected for the study. This sample was finalized based on exclusion and inclusion criteria. Out of 150 pregnant females, 75 anemic pregnant females were placed in the experimental group and 75 non-anemic pregnant females were assigned to the control group. The exclusion criteria suggested that non-pregnant and non-cooperative patients will not be included in the study. Results : Maximum women belonged to the age group 26-30 years, and the employment status of the women was a housewife. 45% of women also had craving for pica because of the anemia. 68% of women were falling in the category of moderate anemia. The malpractices in diet were also inducing iron deficiency like 59% of women took tea after the meal. It was also interpreted that non-consumption of beef (41% of women), chicken (22% of women), fish (58% of women), and egg (34% of women) were recorded to be more anemic. Conclusion : The current study investigated the causative factors of anemia. It was inferred that low socio-economic status and less consumption of iron-rich foods make women prone to anemia. Pregnant women are also not cognizant wit iron-absorption inhibiting foods which leads to complications and abnormalities in pregnancy outcomes.

Anemia is interpreted as low blood hemoglobin values. This medical condition can both developed and underdeveloped countries. The ability of blood to transfer oxygen to tissues is affected when the hemoglobin is low, which in turn develops symptoms such as fatigue, compromised physical work capacity, and shortness of breath. Objective: This study was conducted to find out the dietary practices among pregnant females. Methods: It was a comparative cross-sectional study. The substantial data was collected from the gynecology department, vaccination department of Tertiary Care Hospitals, Lahore. Nonprobability convenient sampling criteria were utilized in the study. 150 participants were selected for the study. This sample was finalized based on exclusion and inclusion criteria. Out of 150 pregnant females, 75 anemic pregnant females were placed in the experimental group and 75 non-anemic pregnant females were assigned to the control group. The exclusion criteria suggested that non-pregnant and non-cooperative patients will not be included in the study. Results: Maximum women belonged to the age group 26-30 years, and the employment status of the women was a housewife. 45% of women also had craving for pica because of the anemia. 68% of women were falling in the category of moderate anemia. The malpractices in diet were also inducing iron deficiency like 59% of women took tea after the meal. It was also interpreted that non-consumption of beef (41% of women), chicken (22% of women), fish (58% of women), and egg (34% of women) were recorded to be more anemic. Conclusion: The current study investigated the causative factors of anemia. It was inferred that low socioeconomic status and less consumption of iron-rich foods make women prone to anemia. Pregnant women are also not cognizant wit iron-absorption inhibiting foods which leads to complications and abnormalities in pregnancy outcomes.

I N T R O D U C T I O N
Anemia is interpreted as low blood hemoglobin values [1]. This medical condition can both developed and underdeveloped countries [2]. The ability of blood to transfer oxygen to tissues is affected when the hemoglobin is low, which in turn develops symptoms such as fatigue, compromised physical work capacity, and shortness of breath [3,4]. Three mechanisms mainly lead to anemia: blood loss, when the body is unable to produce enough red blood cells (erythropoiesis), and when red blood cells die (hemolysis) [5].Genetic disorders and deficiency of certain nutrients are other contributors to anemia. The main contributing factor is deficiencies of vitamins A, B2 (riboflavin), B6 (pyridoxine), B12 (cobalamin) [6], C, D, and E, folate, and copper can also lead to anemia [7].
Infants, children under five years, adolescents, females of reproductive age (both pregnant and non-pregnant) and elderly people are more prone to anemia [8]. Women's susceptibly is because of menstruation and pregnancy [9]. Even low hemoglobin levels can result in maternal and perinatal mortality [10]. In newborn children, anemia has likewise been found to cause cognitive and behavioral dysfunction, low iron stores & iron deficiency anemia [11].
The iron-deficient person can develop Pica in which there are cravings for ingestion of non-food substances [12]. Pica consumption in pregnancy is very common and, if neglected, both mother and fetus may be at risk [13].
Rich dietary sources of iron include meat especially offal (organ meat), fish, eggs, poultry, and meat extracts [14]. Whereas bread and flour, breakfast cereals, dark green vegetables, pulses, nuts, dried fruits like prunes, figs, and apricots are good sources of iron. Absorption of iron is promoted by Vitamin C and is inhibited by the consumption of phytates, tea, coffee, calcium-rich foods [15]. Plant sources like tubers, vegetables, cereals, and pulses contain Non-Haem iron which is of low bio-availability and an essential source of dietary iron in developing countries [16].
56% of pregnant women in developing countries suffer from anemia. It is assessed that about 1.3 billion people all over the world suffer anemia, making it a standout amongst the most critical health problems globally [17]. 49% anemia was found prevalent among women in Pakistan according to The National Nutrition Survey (NNS) of 2011 [18]. The normal range of hemoglobin in women is 11-16 g/dl [19]. There are three categories of anemia mild anemia ranging from 10-10.9 g/dl, moderate anemia 7-10 g/dl, and severe anemia ranges <7 g/dl [19].

M E T H O D s
It was a comparative cross-sectional study. The substantial data was collected from the gynecology department, vaccination department of Tertiary Care Hospitals, Lahore. The complete study was conducted in 4 months. Nonprobability convenient sampling criteria were utilized in the study. 150 participants were selected for the study. This sample was finalized based on exclusion and inclusion criteria. Out of 150 pregnant females, 75 anemic pregnant females were placed in the experimental group and 75 non-anemic pregnant females were assigned to the control group. The exclusion criteria suggested that non-pregnant and noncooperative patients will not be included in the study.

R E S U L T S
In this study 10.7% women were suffering from first-trimester. Whereas 43.3% and 46% women were suffering from 2 nd and 3 rd trimester respectively as shown in the table 1.. Table 2 shows that 98.7% participant were from urban areas and remaining 2% were from rural areas.
Majority of participants was belonged to lower class (40.7%). About thirty-three percent (32.7%) women were from middle class and 26.7% were from upper class as shown in table 3.      The current study was aimed to assess dietary practices in pregnant women, by comparison among anemic and non-anemic females. Analysis revealed that anemia was more persistent in the third trimester of pregnancy and similar results were found in previous studies by Ergöçmen BA et al; Amany Mukhtar and colleague [20].
This research has found that anemic females have significantly higher (two and more than two times a day) daily consumption of tea and coffee and the majority of them took one of their tea serving with the breakfast meal. Likewise, results were reported in previous studies that tannins interfere with the absorption of non-haem iron in the body and become a major causative factor.
According to the current results, 34% of pregnant anemic women had pica cravings. 18% of women craved raw rice, 8% craved mud, 7.3% craved for ice and 0.7% craved for other non-food substances. Roy A et al; noted similar results in his research study from which he inferred that 37.6% of women were occupied with pica suggesting a strong association between anemia and pica [21].

C O N C L U S I O N
Based on the results of the current study, second and third trimester of pregnancy, multigravida, pica, lower socio-economic status, feeling fatigued, shortness of breath, nausea, spoon-shaped nails, bones pain, joints pain, less physical activity, loss of appetite, tea consumption right after meals, food insecurity, vitamins and minerals deficiency, poor and low protein diet are among the significant risk factors for anemia. Lack of education, lower literacy rate, and no knowledge of balanced diet, improper and infrequent supplementation also contributed to a higher prevalence of anemia in pregnancy. If anemia remained undiagnosed and untreated, it may lead to many complications including miscarriages, stillbirths, mental health impairment in child and low birth weight.