Adverse effect of Maternal Anemia on Fetal Doppler Indices and estimated fetal weight during the Last trimester of pregnancy in rural and suburban area

Background: Anemia is an important global health problem affecting nearly 529 million women of reproductive age, including 38% of all pregnant women. Anemia during pregnancy is a key contributor to maternal mortality and poor birth outcomes in both low‐ and high‐ income countries. Reducing maternal anemia is widely recognized as central to the health of women and children. Current WHO global targets call for a 50% reduction of anemia in women of reproductive age by 2025. Maternal anemia is a hypoxic condition that could be responsible for the redistribution of fetal blood flow, however, no evidence of placental insufficiency has been documented currently. In the presence of fetal hypoxemia, vasodilatation of the fetal middle cerebral artery occurs resulting in the so-called “brain sparing effect” to preserve cerebral oxygenation this plays a major role in fetal adaptations to oxygen deprivation (compensatory flow or adaptation changes). Objective: The aim of this study was to evaluate the effect of maternal anemia on fetal Doppler Indices namely umbilical artery and middle cerebral artery and subsequently fetal growth rate. Patients and Methods: This study was designed as a prospective comparative study was carried out in the Departments of Obstetrics & Gynecology, Faculty of Medicine, Fayoum University including 200 pregnant women. The pregnant women were divided into three groups: Group A: Patients with mild anemia (Hb concentration: 9.0-10.9g/dl). Group B: Patients with moderate anemia (Hb concentration: 7.08.9g/dl). Group C: Patients with severe anemia (Hb concentration: >7.0g/dl). A "Mild" is a misnomer: iron deficiency is already advanced by the time anemia is detected. The duration of the study ranged from 6 to 12 months. Patients aged 20-35 years with singleton living fetus of >_32 weeks gestation at time of first visit with no history of chronic illness or medical disorder other than iron deficiency anemia such as chronic hypertension, D.M. or chronic blood loss e.g.; peptic ulcer and no history of recurrent perinatal deaths, recent blood transfusion or other vitamin deficiency anemia Results:. Our results reported that there was no significant difference between the studied groups regarding age and BMI.As regard fetal Doppler cerebral artery Indices of the three studied groups, the current study shows that there is a significant difference between the three studied groups regarding middle cerebral artery resistance index, middle cerebral artery pulsatility index and middle cerebral artery systolic/diastolic ratio. In the study in our hands, there is a significant difference between the three studied groups regarding umbilical artery resistance index, umbilical artery pulsatility index, umbilical artery systolic/diastolic ratio and middle cerebral/ umbilical artery resistance index. The present study shows that there is a significant difference between the three studied groups regarding biparietal diameter, abdominal circumference and femur length. There is a significant difference between the three studied groups regarding amniotic fluid index at 10 days later and at delivery. our results reported that as for the AFI, no significant effect was noticed in the 3 groups. In the study in our hands, there is a significant difference between the three studied groups regarding middle cerebral artery resistance index at 10 days later and at delivery, umbilical artery resistance index at 10 days later, and middle cerebral/ umbilical artery resistance index at 10 days later and at delivery. There is a significant difference between the three studied groups regarding Apgar at 5 min and birth weight. Conclusion: There was a significant effect of maternal anemia on fetal Doppler indices in bot umbilical artery and middle cerebral artery in the last trimester of pregnancy and this effect is directly proportionate to the severity of anemia.