| Abstract | Primarni cilj ovog istraživanja bio je utvrditi incidenciju anemije i deficita željeza u populaciji trudnica s područja grada Osijeka, uz utvrđivanje razine promjene u statusu željeza u krvi trudnica tijekom gestacijskog perioda. K tome, cilj je bio utvrditi kakvoću prehrane trudnica, s posebnim naglaskom na unos željeza hranom i promatranje njegove bioraspoloživosti u hrani. Sekundarni cilj bio je utvrditi eventualne učinke anemije i deficita željeza prema kriterijima Svjetske zdravstvene organizacije i kliničke prakse na ishod poroda i/ili trudnoće. Odabrano je randomizirano prospektivno longitudinalno obsevacijsko istraživanje, koje je obuhvatilo 222 uspješno okončane trudnoće. Kumulativna incidencija anemije (prema hemoglobinu) iznosi 26 % sa stopom incidencije od 0,301, te 31 % za deficit željeza sa stopom od 0,368. Prevalencija deficita željeza (prema hemoglobinu) u 1. tromjesečju iznosi 10,8 %, a u trećem 31,1 %, dok je prevalencija anemije 3,6 % u prvom, a 26,1 % u 3. tromjesečju. Deficit željeza je učestaliji od anemije. Prevalencija anemije i deficita željeza u 1. tromjesečju predstavlja blaži, a krajem gestacije poprima razmjere velikog javnozdravstvenog problema. Status željeza u krvi opada tijekom gestacijskog perioda (p < 0,001), čak i u slučaju uzimanja vitaminsko/mineralnih dodataka prehrani. Promjenu u statusu željeza kroz gestaciju ginekolog može procijeniti pomoću neke od razvijenih predikcionih jednadžbi. Unatoč opće prihvaćenim stanovištima, istraživanje je pokazalo kako trudnoća nije povezana s boljom kakvoćom prehrane, što se očtuje kroz nizak energetski unos i unos bjelančevina. Unos željeza hranom raste tijekom gestacije (p < 0,001), no taj je unos nizak i ne zadovoljava preporuke ni u jednoj fazi gestacije. Uzimajući u obzir doprinos vitaminsko/mineralnih dodataka prehrani, utvrđen je adekvatniji, ali još uvijek nezadovoljavajući unos željeza. Hrana biljnog podrijetla glavni je izvor željeza iz hrane uz doprinos ukupnom unosu željeza s više od 80 %, no niske je bioraspoloživosti. Potvrđen je trend porasta apsorpcije željeza kroz gestaciju (od 1,20 mg u prvom na 1,33 mg u 3. tromjesečju). Iako podaci o incidenciji anemije tijekom gestacijskog perioda ukazuju na veliki javnozdravstveni problem, nije utvrđena statistički značajna povezanosti anemije i deficita željeza s ishodom trudnoće i/ili poroda. Fiziološka prilagodba žene u trudnoći je u konačnici rezultirala povoljnim ishodom i po majku i po novorođenče. Istraživanjem su dobiveni reprezentativni podaci o prevalenciji anemije i deficitu željeza, te o kvaliteti prehrane trudnica što može imati i primjenu u obliku ciljanih intervencija u trudnica i izradi vodiča s ciljem prevencije deficita željeza i anemije ili nekih drugih poremećaja gestacije (prvenstveno gestoza). |
| Abstract (english) | The main goal was to determine the incidence of anaemia and iron deficiency in pregnant women from area of city Osijek, and to determine the level of change in iron blood status during gestation. Also, the aim was to determine nutrition quality of pregnant women, with an emphasis on iron intake from foods by observing its bioavailability. Secondary goal was to determine probable impacts that iron deficiency and anaemia, defined by either WHO or clinical criteria, have on pregnancy outcomes and delivery. Randomized prospective longitudinal observational study was chosen, encompassing overall 222 successfully ended pregnancies. Cumulative incidence of anaemia (based on haemoglobin) is 26% with the incidence rate of 0.301, and 31% for iron deficiency with the rate of 0.368. Prevalence of iron deficiency (based on haemoglobin) in the 1st trimester was 10.8%, and in the 3rd 31.1%, while the prevalence of anaemia in the 1st trimester was 3.6% and 26.1% in the 3rd. Iron deficiency is a more common disorder than anaemia. In terms of public health significance, prevalence of anaemia and iron deficiency in the 1st trimester presents a mild problem, but by the end of gestation reaches proportions of a severe public health problem. Iron blood status drops throughout gestation (p < 0,001), even when supplements are taken. By one of four developed prediction formulas, gynaecologist can estimate the iron blood status of a pregnant woman. Despite general thinking, research has shown that pregnancy is not related to better quality of nutrition, what’s visible through low energy and protein intake. Nutritional intake of iron rises through gestation (p < 0,001), but is low and does not satisfy recommendations in any stage of gestation. If supplementation is considered, iron intake is more adequate, but still doesn’t satisfy recommendations. Plant foods present the main source of iron contributing by more than 80% in overall nutritional iron intake, which has low bioavailability. The rising trend of iron absorption through gestation is confirmed (from 1.20 mg in the 1st to 1.33 mg in the 3rd trimester). Although results for anaemia incidence during gestation point out on a high public health problem, no statistical correlation was found between anaemia and iron deficiency and pregnancy/delivery outcomes. Physiologic adaptation during pregnancy eventually resulted in positive outcomes for both, mother and child. The research gives representative data regarding prevalence of anaemia and iron deficiency, and nutrition quality in pregnant women. This can be used in interventions targeting pregnant women and as a platform for the development of the guidelines for pregnant women aiming at the prevention of these disorders as well as other gestational disorders (i.e. gestosis). |
