PF503 MIGRATION FLOWS, IRON DEFICIENCY AND ANAEMIA AMONG PREGNANT REFUGEES IN NORTHERN GREECE
Authors: Adamidou D. , Sarmourli T. , Karafoulidou T. , Mainou M. , Mpartzoudis D. , Karakasidou O. , Vyzantiadis T. , Theodoridis T. , Theodoridou S. 
Published: June 2019

Background:

Iron deficiency anemia (IDA) is the most prevalent nutritional insufficiency worldwide. Greece has been an entry‐route to Europe due to its unique geographical position and accepts increasing number of refugees since 2015 because of the geopolitical changes in the nearby region

Aims:

The aim of the study was to determine the prevalence of iron deficiency with or without anemia in migrant pregnant women in the region of Macedonia in Northern Greece and the evaluation of the related epidemiological and biological factors.

Methods:

We performed a retrospective study for all the migrant pregnants referred at the Thalassaemia Prevention Unit of Hippokrateio Hospital of Thessaloniki within a four year period (2015–2018). Country of origin, gestation week at referral together with a full personal and family history were taken into consideration. The laboratory screening consisted of a full blood count, peripheral smear microscopy, ferritin levels, as well as high performance liquid chromatography (HPLC) and electrophoresis for the determination of haemoglobin variants Iron deficiency and IDA were defined according to WHO recommendations

Results:

538 migrant pregnants with a median age of 28 (13–44) years were included in the analysis. Median haemoglobin levels and serum ferritin values were 11,6(7,3–15,5)gr/dl and 33,28 (2–305)ng/ml accordingly. Almost half (268) of the study population were referred during the second trimester of pregnancy, while 136 were in the first and 136 in the third trimester. 39% of the pregnants were of Balkan origin (Albania, Bulgaria, Serbia, Fyrom), 27% came from the former Soviet Union– Eurasia. 67 women were from the Middle East (Syria, Afghanistan, Iraq, Palestine, Kuwait, Iran), 32 from Africa (Ghana, Nigeria, Ethiopia, Senegal, Sudan, Congo), 14 from Central European countries and 7 from Asia (India, Philippines, Thailand, China). 10% of the pregnants were Roma. Overall 43% of the women were diagnosed with iron‐deficiency and 82 (15%) with anemia. 49 (9%) were found to be carriers of hereditary hemoglobinopathies. Both median haemoglobin level and iron‐deficiency and/or anemia were strongly correlated with the country of origin (p 0,001 and p 0,031/0,002) as well as the gestation trimester (<0,000) and presence of hemoglobinopathy (p 0,005 and p 0,008/0,000). African women presented with the lowest median haemoglobin level while pregnants from Middle East, Asia, Balkans and Eurasia were following. Women from central Europe had the highest Hb values (10,9/11,1/11,4/11,7/11,8/12,2respectively). Median ferritin values were 20,7/24,7/32,5/38,5/45,9ng/dl for women from Middle East, Asia, Balkans, Eurasia and Central Europe accordingly. Of interest, pregnant Africans were found with the lowest Hb and the highest ferritin levels (47,2ng/dl) possibly due to the high incidence of hemoglobinopathies found in this ethnic population. 65% of pregnants from Middle East were diagnosed with iron‐deficiency whereas only 21% of those from Central Europe. Based on multivariate analysis the country of origin, the trimester of pregnancy and the hemoglobinopathy carrier status were independent risk factors related with iron deficiency and anemia.

Summary/Conclusion:

High incidence of iron‐deficiency/anemia in pregnancy was mainly found in pregnant refugees from Middle East reflecting probably the poor socio‐economic circumstances in the so called refugee hotspots, shedding light on the urgent need for medical as well as social interventions. The migration flows pose new challenges for the national health care systems worldwide