Evaluating the Effect of Maternal Iron Deficiency Anemia on FetalHemodynamics: A Doppler Ultrasound Study of it’s Impact onCPR.

Abstract

Purpose: The purpose of the study is to assess the impact and effects of maternal IDA on fetal hemodynamics by using the modality of Doppler ultrasound. In this research we are focusing on cerebral-placental ratio (CPR) and MCA-PSV to determine its association with fetal anemia, and overall outcomes that fetus has to face with mothers having maternal anemia. The reason of choosing this purpose was the contribution of maternal iron deficiency anemia IDA towards maternal and fetal morbidity and also it is important to study a major global health issue in rural area of Pakistan where its often neglected.

Methods: It is a comparative case control study. This study was conducted with the help of Dr. Hareem khan (Co-Supervisor) at the radiology and obstetrics department of Ali children and surgical hospital Manga Mandi Lahore, Pakistan. The population that was included in the study was 100 woman which were between 20 to 40 weeks of pregnancy, in this population 50 of them cases i.e: anemic and 50 of them non-anemic controls. Under the supervision of trained doctors ultrasound was used to evaluate the indices of umbilical artery and middle cerebral artery, PI, RI, MCA-PSV and CPR were calculated. After analyzing the data using SPSS version 26, we applied distribution statistical tests, chi-Square test and correlation analysis. The results were prepared and p˂ 0.05 was considered significant.

Results: After careful analysis of the collected data the results were as following: The population under study had 50% anemic cases and after ultrasound 40% of the fetuses showed signs of compromise. If we talk about anemia it was present in 19% of the cases and it was more frequently present in anemic mothers (p=0 .049). After careful calculations and statistical analysis it was concluded that the cerebral resistance was much reduced in anemic fetuses, the mean MCA-PI was much lower in cases (1.10± 0.33) as compared to controls (1.23±0.15), this ended up in reduce cerebral resistance and if we talk about correlation, a strong and negative correlation was observed between fetal anemia and MCA-PI (r = -0.900, p˂0.001). When it comes to outcomes and fetal condition on the current ultrasounds it was also noted that maternal anemia was associated with adverse fetal effects (x² = 21.80, p˂0.001). All these results confirmed that there is a negative effect of maternal iron deficiency anemia on fetal hemodynamics.

Conclusion: As the result shows, this study confirms the hypothesis that maternal iron deficiency anemia IDA does have a significant and negative impact on fetal Doppler indices MCA and UA, RI and PI. These results demonstrate alterations in fetal circulation resulting in increasing risk of fatal anemia and compromise in mothers with IDA and through this research we came to a conclusion that if we incorporate Doppler ultrasound particularly measurements like CPR and MCA-PSV into routine checkups of pregnant women suffering from maternal anemia, we could be able to detect any fetal compromise at early phase and it will also help us in timely management of pregnancies that are at high risk.

Keywords:

IDA Iron deficiency Anemia, Fetal Hemodynamics, Doppler indices, Cerebro-placental ratio CPR, Middle Cerebral Artery Peak Systolic Velocity MCA-PSV, Fetal anemia.