Improved income status increased obesity and decreased anemia risk compared to high parity and low-income in pregnant south Ghanaian women: Analysis of hospital-acquired data

Abstract Background Women of reproductive age (WIFA, 15-49 years) in Ghana are experiencing an upsurge in excess body mass index (BMI) and anemia (low hemoglobin concentration (Hb of ≤ 10.9 g/dl)). Regions of Southern Ghana (Central, Eastern, and Volta) are recognized to have high rates of adolescent pregnancies, and is known to be associated with high risk of anemia. However, little is known for pregnant South Ghanaian women. This study aimed to examine anthropometry – maternal stature and early pregnancy BMI – and socio-demographic measures as independent risk factors for anemia in antenatal women in Southern Ghana. Methodology Baseline data on anemia from healthy pregnant women (15-49 years; n = 1278) collected through antenatal attendance in an observational cohort study was included in the descriptive and logistic regression analysis using STATA (Stata Corp LLC [US]). Anemia (dependent) and the independent variables: high parity (≥5 children/woman); short stature (145≤155cm); underweight (BMI <18.5kg/m 2 ), normal (BMI 18.5-24.9kg/m 2 ), overweight (BMI 25-29.9kg/m 2 ), and obesity (BMI >30 kg/m 2 ) assessed with weight (kg) before the 20 th week of gestation divided by height (m 2 ) were defined following standards. Wealth status was constructed using Principal Component Analysis of durable assets, housing characteristics, water/sanitation, and toilets facilities. All estimates were evaluated at the 5% significance level (p < 0.05). Results Of the sample, 45.85% had moderate/severe anemia with 9.67(±0.04) average hemoglobin (g/dl) concentration. Overweight/obesity was approximately (47%; overweight 29% vs obesity 18%), short stature (4.77%), and underweight (4.61%) in the 1278 women interviewed. Obesity was highest in the highest income women (26.24% (69/263)) in whom anemia decreased (34.78%, 80/230)) compared to highest prevalence of anemia in short stature (59.01%, 36/61), underweight (57.62%, 34/59), and overweight (44.68%, 164/367) women. The risk of anemia increased with high parity (adjusted odds ratio; aOR 3.91; 95%CI: 1.79-8.52; p = 0.001); lowest income quintile (aOR:2.10; 95%CI: 1.35-3.26; p = 0.001); second income quintile (aOR:1.52; 95%CI: 1.01-2.30 p = 0.045); being Ewe ethnicity (aOR:2.09; 95%CI: 1.35-3.24; p = 0.001); and Akan (aOR:1.79; 95%CI: 1.16-2.74; p = 0.008); while obesity reduced the risk (aOR:0.70; 95%CI: 0.50-0.99; p = 0.045). Conclusion Anemia in pregnancy and overweight, and obesity as double burden of malnutrition remain significantly high in pregnant South Ghanaian women. The AIP exceeded the WHO defined threshold and was particularly highest in women having high parity, short stature, and underweight. While high parity and income status increased overweight/obesity, obese women were more likely to have a reduced risk of anemia. However, across the ethnicity, high parity and low-income status posed significant risk of anemia in women. Further research examining the nexus between underweight or short stature versus high rates of anemia or overweight/obesity and income and anemia to better explain, and prevent the increasing trend of anemia in pregnant Ghanaian women is recommended.