Iron Store of Pregnant Women with Hemoglobin SS and SC in Benin City

Abstract

Background: Anemia in pregnancy is common and morbidity is increased in the presence of sickle cell disease. There has been conflicting argument concerning routine iron replacement. However few, studies in Nigeria have comprehensively evaluated the iron status of these women. Objective: The study was carried out to determine the iron stores status of pregnant women with hemoglobin (Hb) Sickle cell S or Sickle cell C using the serum assay. C-reactive protein (CRP) was also assayed to rule out the effect of inflammation / infection on the serum level of ferritin.

Materials and Methods: This was a prospective longitudinal study conducted at the University of Benin Teaching Hospital (UBTH), Benin City, over a period of eight months (from April 2011 to December 2011). The patients for the study were identified using the booking investigation results in the antenatal clinic records. Only those clinically stable pregnant women, in a healthy state, participated in this study.The hematological indices, serum ferritin assay, and the CRP were determined in both test (Hb SS / SC) and control (Hb AA) pregnant women. The data obtained were fed into a personal computer (PC) and analyzed using the Statistical Package for Social Sciences (SPSS) software version 16 for Windows. Categorical data were expressed as percentages and compared using the Chi-squared test, whereas, numerical data were expressed as mean (SD) and compared using the Student’s t-test. The level of significance was set at P≤0.05.

Results: A total of 23 Hb SS / SC pregnant women formed the test group. They were recruited for the study from the Sickle-Cell Center (attached to the Central Hospital, Benin City, the UBTH). The mean age, educational status, and the social class of both the test group and the control group were comparable. There was a significant difference in the mean hemoglobin concentration between the test group and control group, both at 16–20 weeks and 28 – 32 weeks of gestation (P<0.001), and the mean corpuscular volume (MCV) values at both gestational ages (GAs) (P=0.097 and 0.231, respectively). The values of the serum ferritin in the test group were also statistically and significantly higher than those of the control group (P<0.001 and P=0.009, respectively), at both GAs.

Conclusion: This study demonstrated higher serum iron levels in Hb SS / SC pregnant women than in the controls (even after excluding those levels raised by the increased levels of CRP). In situations that may require iron supplementation, it may be reasonable to determine the iron status to ascertain the quantity that should be given.

Keywords: Benin City, iron status, pregnancy, sickle-cell hemoglobin