We conducted a cross sectional study to investigate risk factors associated with severe
anemia [
hemoglobin (Hb) < 8.0 g dl(-1)] and poor
iron status among Nepali pregnant women. Socio-demographic, anthropometric, health and dietary data were collected from 3,531 women living in the southeastern plains of Nepal. Stool samples were analyzed for intestinal helminthes. Dark adaptation was assessed using the Night Vision Threshold Test (NVTT). Hb levels were measured in all subjects to detect
anemia and the soluble
transferrin receptor (sTfR) was measured among a subsample of 479 women. The
iron status categories were: 1) normal (Hb> or = 11.0 g/dl and sTfR < or = 8.5 mg/l); 2)
anemia without
iron deficiency (Hb<11.0 g/dl and sTfR < or = 8.5 mg/l); 3)
iron deficiency without
anemia (Hb > or = 11.0 g/dl and sTfR>8.5 mg/l); and 4)
iron deficiency anemia (IDA): (Hb<11.0 g/dl and sTfR>8.5 mg/l). Factors associated with severe
anemia and poor
iron status were determined using logistic regression.
Hookworm infection increased the risk for developing severe
anemia [adjusted odds ratio (AOR): 4.26; 95% CI 1.67-10.89; p<0.01] and IDA [relative risk ratio (RRR): 2.18; 95% CI 1.14-4.16; p<0.05]. Impaired dark adaptation was a common risk factor for
iron deficiency with and without
anemia. Intake of
iron supplements as
tablets and/or tonic was protective against severe
anemia,
anemia without
iron deficiency and IDA. Dietary
heme iron was significantly associated with
iron deficiency without
anemia (RRR: 0.1; 95% CI 0.02-0.47; p<0.01). These results indicate the risk factors varied by classification and multiple approaches are needed to reduce
anemia and associated nutrient deficiencies.