Rate and predictors of low serum ferritin levels among healthy parturient women in Enugu, Nigeria

Fausta Chioma J Emegoakor,1 Chukwuemeka Anthony Iyoke,1 Hyginus Uzo Ezegwui,1 Frank Okechukwu Ezugwu,2 Odidika Ugochukwu Umeora,3 Izuchukwu Obumneme Ibeagha41Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Ituku-Ozalla, 2Department of Obstetrics and Gynaecology, Enugu State University Teaching Hospital, Park Lane, Enugu, 3Department of Obstetrics and Gynaecology, Federal Teaching Hospital, Abakaliki, 4Department of Haematology, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, NigeriaBackground: Low serum ferritin levels signify low iron stores and this could predispose to iron deficiency anemia.Objective: To determine the rate and predictors of low serum ferritin levels during the puerperium in Enugu, Southeast Nigeria.Study design: A hospital-based prospective longitudinal study involving parturient women who delivered singleton fetuses at term. Venous blood samples were collected to determine the serum ferritin concentration at 48 hours and 6 weeks postpartum. Data analysis involved descriptive and inferential statistics at 95% confidence interval (CI) using Statistical Package for Social Sciences (SPSS) computer software version 20.0.Results: Two-hundred and two women who carried singleton pregnancies to term were studied. The mean serum ferritin levels at 48 hours and 6 weeks were 27.82±18.41 µg/L and 36.12±21.53 µg/L, respectively. Forty-eight hours postdelivery, 29.2% had low ferritin levels and this decreased to 12.4% at 6 weeks postpartum. There was a significant positive correlation between the serum ferritin level at 48 hours postdelivery and the serum ferritin level at 6 weeks postpartum (r=0.89, P<0.001). Predictors of the low ferritin level at 6 weeks included age <20 years (odds ratio [OR] =0.70, 95% CI =0.53, 0.93), multiparity (OR =63.7, 95% CI =3.18, 127.5), anemia at 48 hours postpartum (OR =61.7, 95% CI =13.27, 116.6), a low ferritin level at 48 hours (OR =78.1, 95% CI =8.8, 108.3), and intake of antenatal hematinics for <3 months (OR =0.04, 95% CI =0.01, 0.20).Conclusion: There was a significant occurrence of low ferritin levels during the puerperium in the study centers, and this was associated mainly with pregnancy and delivery factors. Efforts to improve the iron stores in parturient women could benefit from early booking and compliance with antenatal hematinics and optimizing hemoglobin and iron levels before delivery.Keywords: iron deficiency, iron stores, puerperium, predictors, postpartu