Maternal myocardial performance in first and second trimesters of pregnancy with iron deficiency anemia

Abstract

Back Ground: Anemia during pregnancy in developing countries continues to be a public health problem of significant proportion. Most of the maternal deaths are from rural areas. Anemia affects various organs in body including the heart. Iron depletion and the amount of stored iron are reduced in iron deficiency anemia which limits red cell production. In anaemia, oxygen carrying capacity of blood decreases. However, the studies which show the effect of anemia on myocardial function during pregnancy are few in India. Objectives: To know the effect of degrees of iron deficiency anemia on cardiac function in first & second trimesters of pregnancy & to compare the relationship between left ventricular function & haematological, biochemical parameters in both anemic pregnant and normal pregnant women. Methods: Total 160 pregnant women were included , in which 80 pregnant women in each trimester were selected. Out of 80 pregnant women 3 groups - normal pregnant women (control) and pregnant women with moderate & severe iron deficiency anemia in each trimester depending on the severity of anemia were selected. In first trimester normal (Group-I n=30), Moderate (Group-II n=27) & severe (Group-III n=23) , in second trimester normal (Group-I n=30), Moderate (Group-II n=29) & severe (Group-III n=21) were selected. In second trimester pregnant women without anemic treatment were selected as study groups. Haematological parameters including CBP, Haemoglobin concentration were determined by an automated cell counter method. Biochemical parameters include estimation of serum ferritin, serum iron ,serum Total iron binding capacity & % Transferrin saturation were estimated. Serum electrolyte profile was estimated by ISE method. Echocardiograms were recorded using MEGAS CVX and MEGAS GPX equipped with ADV4 software from Italy. Two dimensional and Doppler echocardiographic examinations was performed using 3.5 MHz . Left ventricular parameters like EDD, ESD %EF, %FS were assessed. Electrocardiogram was recorded using Philips twelve channel ECG machine model TC20 in both control and study groups to evaluate myocardial performance. Analysis of Variance (One way ANOVA) was used for comparison between normal pregnant women and anemic pregnant women in first & second trimesters of pregnancy. Bonferroni method was used in posthoc for multiple comparison. The data was analysed by SPSS 17. Left ventricular findings like EDD, ESD, EF, FS &SV were correlated with Hb%, serum ferritin & serum iron using pearson’s co-relation co-efficient method. Results: The prevalence of anemia was more in rural, illeterates, house wives, agriculture labors with low income than employees. Also with non nutritional diet, with more number of children & less pregnancy gap in study groups of both trimesters. We found a significant increase in SBP by 6%,14% (p<0.001), 2% & 19% (p<0.001) , a significant decrease in DBP by 2% & 8%(p=0.001)(2nd trimester), MAP by 11% (p=0.03), 3%,9% (p=0.1), and decrease in TPR (p<0.001,P=0.005) was observed in study groups when compared to control group of first & second trimester pregnant women. Haemoglobin %, SF, SI also shown a statistically significant decrease (p<0.001) in study groups when compared to controls of both trimester pregnant women. A statistically significant increase was observed in HR by 16.13%,20.12% (p=0.001), 10.3%,18.36%(p=0.001) ,SV by 4.59%,8.61%(p=0.01) , COP by 1.6%, 2.3% (p=0.001),EDD & ESD in both trimesters. EF% was significantly in increased in group II by 2.89% (0.001), then decreased significantly in group III by 1.82%, 1.45% in both trimesters. A statistically significant decrease was observed in by 0.29%, 0.52% (p=0.001), 0.15 %,) 0.41 %(p=0.01). QRSD, QT intervals also shown significant decrease in 1st & 2nd trimesters. Conclusions: In this study echocardiography findings showed decrease in contractile (EF, FS) and pumping function of heart in pregnant woman with severe iron deficiency anemia. These findings suggest that as serum ferritin & serum iron levels are decreased there is a hyperkinetic state of heart depending on degrees of iron deficiency anemia. Detection of moderate anemia in first & second trimester of pregnancy will help the clinicians in proper treatment & prevention of further complications in 3rd trimester. Besides anti-anaemic drugs, cardio tonic facilities and drugs, should be included which improve the metabolism of myocardium & thus prevents further complications to mother in third trimester.