impact of multiparity on iron content in multiparous women

J Ayub Med Coll Abbottabad 2011;23(2) 

ORIGINAL ARTICLE 

IMPACT OF MULTIPARITY ON IRON CONTENT 

IN MULTIPAROUS WOMEN 

Ayesha Farooq, Shahid Rauf, Uzma Hassan*, Naushaba Sadiq** 

Department <strong>of</strong> Biochemistry, Foundation University Medical College, Islamabad, *Department <strong>of</strong> Community Medicine, Rawal Institute 

<strong>of</strong> Health Sciences, Islamabad, **Department <strong>of</strong> Medical Education, Foundation University Medical College, Islamabad, Pakistan 

Background: The effect <strong>of</strong> multiple pregnancies, a very common pattern in reproductive lifestyle <strong>of</strong> 

Pakistani women, needs to be addressed to see if it affects the iron content and hence cause iron 

deficiency. Recognising this deficiency prior to development <strong>of</strong> anaemia can prevent disastrous 

consequences that can complicate the life <strong>of</strong> the mother and foetus especially in developing countries. 

The objective <strong>of</strong> this study was to assess the effect that the stress <strong>of</strong> multiple pregnancies has on the iron 

status <strong>of</strong> the body. Methods: This comparative study was conducted in a focus group <strong>of</strong> female 

population. Two hundred subjects were selected by convenient sampling and grouped depending on 

their parity status. Data regarding diet, and socioeconomic history was collected on pre-designed 

questionnaire. Serum Ferritin was used to assess iron deficiency using the Electrochemiluminescence 

Immunoassay (ECLIA). Data was statistically analysed using SPSS-17. Results: Mean value <strong>of</strong> serum 

Ferritin in the nulliparous group was 76.52±4.92 ηg/mL with 16% <strong>of</strong> nulliparous subjects showing 

lower than normal values. Thirty-six percent <strong>of</strong> uniparous subjects showed low serum Ferritin values, 

mean value being 45.74±4.51 ηg/mL. Seventy-two percent <strong>of</strong> the multiparous subjects showed iron 

deficiency with Ferritin levels <strong>of</strong>


The reference ranges for Ferritin are 30– 

400 ηg/mL for males, and 13–150 ηg/mL for 

females. 13,14 Clinically, a threshold value <strong>of</strong> 20 ηg/mL 

has proved useful in the diagnosis <strong>of</strong> iron deficiency. 15 

Iron deficiency with anaemia is seen when a person has 

low values <strong>of</strong> both serum Ferritin and haemoglobin. 16 

This study was designed to see the Iron 

content <strong>of</strong> blood in multiparous women and compare it 

with the same in nulliparous and uniparous women. 17,18 

MATERIAL AND METHODS 

This comparative study was conducted at Fauji 

Foundation Hospital, Rawalpindi from April 2010 to 

April 2011. Selection <strong>of</strong> 200 female subjects who met 

the specified criteria, between the age group <strong>of</strong> 20–40 

years was done through convenient sampling. They 

were divided into groups on the basis <strong>of</strong> their parity. 

These women belonged to middle socioeconomic class 

(average monthly income <strong>of</strong> PKR 20,000–25,000). Age, 

socioeconomic status and dietary variables were kept in 

a constant range so as to least affect the results. Pregnant 

women, lactating mothers, women showing detectable 

causes <strong>of</strong> iron deficiency on history and clinical 

examination, and women taking iron supplements were 

excluded from the study. Consent <strong>of</strong> the patient to 

participate in this study was taken. 

Demographic and medical history was taken. 

Dietary history through Food Frequency questionnaire 19 

with stress on frequency <strong>of</strong> intake <strong>of</strong> iron rich foods was 

taken. Clinical examination was performed on all 

subjects and findings were entered in a Performa. Five 

to ten ml. venous blood was collected from the selected 

subjects and centrifuged for 1–2 minutes. Serum was 

transferred to another tube and used for assessment <strong>of</strong> 

Ferritin by Electro-chemi-luminescence Immunoassay 

(ECLIA) Serum Ferritin assay using COBAS E. 13 A 

two step ‘sandwich’ immunometric technique was 

performed. Results were determined by the calibration 

curve generated by the machine. 

Data was analysed using ANOVA on SPSS- 

17. Quantitative variables were described as Mean±SD 

and 95% confidence interval. Categorical variable were 

expressed as frequencies or percentages. Post Hoc 

Tukey’s Test was applied to see multiple comparison 

between individual groups and p


haemorrhage during delivery. In the absence <strong>of</strong> 

supplemented iron, however, the mother’s stores will be 

depleted and will not be able to meet the needs <strong>of</strong> the 

foetus. 24 In the multiparous group 64% had normal 

serum Ferritin, the average value being 45.74 ηg/mL. 

Eighteen (36%) subjects showed Ferritin concentrations 

in the range <strong>of</strong> iron deficiency. Hence the effects <strong>of</strong> iron 

deficiency are evident in this group as during 

pregnancy, women have an increased demand for iron 

in order to expand their erythrocyte mass and fulfil the 

iron needs <strong>of</strong> the growing foetus. 25,26 In the multiparous 

group only 28% had normal serum Ferritin levels, and 

mean serum Ferritin concentration in this group was 

25.21 ηg/mL. Seventy-two percent <strong>of</strong> the multiparous 

women showed Ferritin levels in the range <strong>of</strong>


24. Longo D, Fauci A, Kasper D, Hauser S, Jameson J, Loscalzo J. 

Harrison’s principles and practice <strong>of</strong> internal medicine. 18 th 

Edition. New York: McGraw-Hill Pr<strong>of</strong>essional; 2011. 

25. Hallberg L. Iron balance in pregnancy. Vitamins and Minerals in 

Pregnancy and Lactation. Nestles Nutr Workshop Series 

1988;16:115–27. 

26. Milman N, Bergholt T, Byg KE, Eriksen L, Graudal N. Iron status 

and iron balance during pregnancy. A critical reappraisal <strong>of</strong> iron 

supplementation. Acta Obstet Gynecol Scand 1999;78:749–57. 

27. Anonymous. Anemia during pregnancy a major public health 

problem. Safe Mother 1993;11:1–2. 

28. US Preventive Services Task Force. Routine iron 

supplementation during pregnancy. Policy statement. Review 

article. JAMA 1993;270:2846–54. 

29. Report <strong>of</strong> a Joint FAO/WHO Expert Consultation. Requirements 

<strong>of</strong> Vitamin A, iron, folate and Vitamin B 12. FAO Food Nutr Pap 

1988;23:33–50. 

Address for Correspondence: 

Dr. Ayesha Farooq, Assistant Pr<strong>of</strong>essor Biochemistry, Foundation University Medical College, Islamabad, Pakistan. 

Cell: +92-333-5174423 

Email: ayeshafarooque@gmail.com 

http://www.ayubmed.edu.pk/JAMC/23-2/Ayesha.pdf 35

impact of multiparity on iron content in multiparous women

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