Anaemia status is associated with insufficient iodine levels in pregnant women in rural settings; a two-centre observational study

Background: Adequate maternal hemoglobin and iodine are essential for optimal fetal-placental oxygenation, and, fetal brain development respectively. Intra-pregnancy anemia and iodine insufficiency are associated with adverse fetal-maternal outcomes. This study explored the potential association between intra-pregnancy anemia and iodine insufficiency and identified factors associated with third-trimester anemia. Methods: This study recruited pregnant women attending antenatal care in two rural health centres in the Ellembelle District, Ghana. Participants were followed from first-trimester visit until delivery. Demographic information, iodized salt usage, birth outcomes, urinary iodine concentration, and hemoglobin levels were collected per trimester; statistical significance was set at p<0.05. Results: Despite 97.0% of participants reporting iodized salt use, 48.0%, 54.0%, and 51.0% had iodine insufficiency in trimesters 1, 2, and 3, respectively. Anemia rates were 44.0%, 32.0%, and 41.0% in trimesters 1, 2, and 3, respectively, with higher prevalence among pregnant teenagers. In all trimesters, anemic individuals had iodine insufficiency [T1: 141.4 vs 158.7 μg/L (p=0.1173); T2: 135.1 vs 155.3 μg/L (p=0.0327; T3: 139.2 vs 156.8 μg/L (p=0.0325)], or reduced gestational weight [T1: 55.35 vs 58.20 kg (p=0.4272); T2: 55.50 vs 63.25 kg (p=0.0094); T3: 60.0 vs 68.2 μg/L (p=0.0388)] than non-anemic individuals. Logistic regression analyses found that third-trimester anemia was prevalent in married women (aOR: 2.15, p=0.011), with non-formal (aOR: 11.477; p=0.076), basic (aOR: 3.559; p=0.286), or secondary (aOR: 9.562; p=0.044) education, and is associated with higher risk of cesarean section delivery (aOR:.41.070; p=0.011). Conclusion: Further research is needed to determine any potential causal relationship between insufficient iodine levels and anemia status during pregnancy.