Review Article Volume 7 Issue 4
^{1}Department of mathematics and computer science, Beirut Arab University, Lebanon
^{2}Faculty of Health Sciences, Beirut Arab University, Lebanon
Correspondence: Seifedine Kadry, Department of mathematics and computer science, Beirut Arab University, Beirut, Lebanon, Tel 961 370 0512
Received: May 19, 2018  Published: August 6, 2018
Citation: Kadry S, Sleem C, Samad RA. Hemoglobin levels in pregnant women and its outcomes. Biom Biostat Int J. 2018;7(4):326336. DOI: 10.15406/bbij.2018.07.00226
The pregnancy is a sensitive period in women life; pregnant women should avoid any risk factor that can affect their health as well as the growth and development of their baby. One of the critical problems that pregnant women may face is iron deficiency and its anemia which represents a risk factor for preterm delivery, prematurity and small for gestational age, birth, and weight. The world health organization (WHO) estimates that an average of 56% of pregnant women in developing countries is anemic. This percentage ranges from 3575% in specific areas, and is much higher than the 18% of pregnant women diagnosed with anemia in developed countries. Iron deficiency during pregnancy is thought to be caused by combination of factors such as previously decreased iron supply, the iron requirements of the growing fetus, and expansion of maternal plasma volume.^{1}
Iron deficiency development is widely common among women especially pregnant ones since iron should be supported to the mother and her fetus which makes the intake crucial and important. And regarding that iron (heme and nonheme) has a low bioavailability, food enhancers and supplements are necessary for pregnant women especially in the begging and end of their pregnant period for support and growth. Enhancers of iron include meat, fish, and vitamin C as the most common ones while polyphenols, phytates in tea and coffee, and calcium represent the most important inhibitors of iron absorption. Good sources of iron should be taken with enhancers so that the absorption of iron increases. Pregnant women should be educated enough and well informed from their doctors to avoid or lessen the occurrence of such problem. This study was conducted in Lebanon to determine the prevalence and risk factors of low hemoglobin levels in pregnant women and the importance of iron intake in aiming changing these levels to decrease its risks.
Women of fertile age and pregnantlactating as well as their infants and young children are particularly affected with iron deficiency and its anemia resulting in serious health and functional consequences. It is estimated that about 2,150million people are iron deficient, and that this deficiency is severe enough to cause anemia in 1,200million people globally. About 90% of all anemias have an iron deficiency component. Roughly 47% of nonpregnant women and 60% of pregnant women have anemia worldwide, and including iron deficiency without anemia the figures may approach 60 and 90% respectively. In the industrial world as a whole, anemia prevalence during pregnancy averages 18%, and over 30% of these populations suffer from iron deficiency.^{2}
The woman’s diet is the main source of nourishment for the baby. In fact, the link between what the mothers consumes and the health of the baby is much stronger than once. Eating a healthy, varied diet in pregnancy will help get most of the vitamins and minerals that are essential during the period of pregnancy including iron and folic acid. It is best to get vitamins and minerals from the food, but pregnant women are in need of many supplements that are essential to their body as well to their babies including iron and folic acid. Iron is an essential mineral in the pregnancy period to the mother and to the baby as well. Supplementation of pregnant women with iron and folic acid reduces the incidence of hemoglobin <110 g/l to under 5%.
The hemoglobin concentration, hematocrit and red cell count fall during pregnancy because the expansion of the plasma volume is greater than that of the red cell mass. However, there is a rise in total circulating hemoglobin directly related to the increase in red cell mass. This in turn depends partly on the iron status of the individual. That’s why pregnant women are recommended to have a hemoglobin level of 1216g/DL and any value below 12 is considered as iron deficiency and below 10.5 as anemia.
Iron deficient anemic women have shorter pregnancies than nonanemic or even anemic but not iron deficient pregnant women. All anemic pregnant women had a higher risk of preterm delivery in relation to nonanemic women. The irondeficient, anemic group has twice the risk of those with anemia in general.^{3} There a five to sevenfold increase in preterm delivery and low birth weight if the lowest hemoglobin concentration during pregnancy (https://www.bmj.com/content/310/6978/489.full.print). Moreover results of randomized clinical trials in the United States and in Nepal that involved early supplementation with iron showed some reduction in risk of low birth weight or preterm low birth weight.^{4} Maternal hemoglobin levels are also associated with the weight of the baby at birth; a study done by The American Journal of Clinical Nutrition in 2000 conclude that the minimum incidence of low birth weight (<2.5kg) and of preterm labor (<37 completed weeks) occurred in association with a hemoglobin concentration of 95–105g/L. Such values are commonly considered to represent anemia.^{5} However the weight of the baby varies in the last trimester of pregnancy; According to the American Pregnancy Association, a fetus weigh around 2pounds at 27weeks (7^{th}month of pregnancy), 4 to 4.5 pounds by 32weeks (8^{th} month of pregnancy) and grows up to 6.5 to 10 pounds in full term delivery (till the 9^{th} month).^{6}
Several dietary factors can influence the absorption of iron. Absorption enhancing factor to meat, fish and poultry is ascorbic acid (vitamin C); inhibiting factors are plant components in vegetables, tea and coffee (e.g., polyphenols, phytates), and calcium. Specific attention should be paid to the effects of tea on iron absorption.^{7} Ascorbic acid is the only main absorption enhancer in vegetarian diets found in Broccoli, and Citrus fruits (oranges, and lemon) while phytate and phenols are the two main inhibitors of iron absorption that can reduce the bioavailability of iron by binding to it; these compounds are found in tea, coffee and chocolate. An excess of calcium rich dairy can limit iron absorption. Milk can prevent your body from absorbing an adequate amount of iron. Even though milk has a high content of iron it contains calcium, an essential mineral and the only known substance to inhibit absorption of both nonheme and heme iron.^{8}
Regarding the relation between hemoglobin levels of pregnant women and their disease status (diabetes type 1 and 2, gestational diabetes, hypertension and heart disease), studies differ in their results: some of them demonstrate that there is positive relation between hemoglobin/iron levels and disease status of individuals while others show a negative one. In a study done in 2003 by anemia and diabetes because the risk of becoming irondeficient increases when diabetes is present; according to this study diabetic patients are more prone to have lower hemoglobin/iron levels than diseasefree patients.^{9 }Another study done by Dr. Trevor J Orchard reveal that Hemoglobin levels may be higher as high as 18.8 g/dl in type 1 diabetes than in the general population.^{10} In 2008, the department of Cardiac Services and General Practice in School of Medicine in Canada conducted a study resulting in that the prevalence of anemia in hypertension, a condition characterized by endothelial dysfunction, is unclear yet.11However in 2012, it was revealed that hemoglobin level was positively associated with both systolic and diastolic blood pressures.^{12}
Age and exercise are two factors that are still being tested nowadays to determine if there is a relation with the level of hemoglobin/ iron in pregnant women. In a study carried out in Queen Elizabeth Central Hospital and Namitambo Health Centre Malawi, analysis showed an increased risk of anemia for women under 20years of age, but when corrected for gravidity and trimester at booking the increased risk with young age no longer.^{13} Studies conducted to measure the effect of exercise on hemoglobin level in pregnant women are so minimal knowing that exercise is safe during pregnancy and proper exercise during pregnancy will likely help with weight loss after delivery of your baby. Exercise does not put the woman at risk for miscarriage in a normal pregnancy.^{14} but there is no data concerning the relation between hemoglobin or iron and workout.
The data was collected over one month from three different gynecologists: Dr. Modi Farhat, Dr. Iman Mallak and Dr. Jouhaina Bou Chakra in Chouf area targeting pregnant women in their last trimester. The participants of the study were aged between 20 and 38years old. The main objective of these observations and research is to determine the prevalence and the effect of low hemoglobin levels on the pregnancy and the baby’s weight. A total of 50 pregnant women, 20 from each clinic, participated in the study and were asked to complete an 11 questions survey including yes/no questions and multiplechoice questions. The variables were set according to the risk factors of hemoglobin levels during pregnancy and the expected outcomes on the woman and her baby as proposed in the introduction and the literature review of the report.
The questionnaire consists on the following variables:
The main variables of the research were chosen with respect to the iron (as form of hemoglobin) enhancers and inhibitors and the number of parity, since many findings consist on these variables on affecting hemoglobin levels in pregnant women resulting in undesired effects on the pregnant and the baby’s health. The hemoglobin levels of each pregnant woman were measured through blood tests done on a regular basis. (Supported form the doctors). However the weight of the unborn baby was measured by the doctors (via Ultra Sound); the weight of the baby is compared to a standard weight range (normal) according to the American Pregnancy Association in order to specify if the weight of the baby is healthy for the month of pregnancy. IBM SPSS Software is used for the analysis of results. The data was entered and organized in order to be tabled and tested for analysis.
Descriptive statistics
Before testing all the variables that may affect the hemoglobin levels in pregnant women, detecting their daily food intake frequency is so important for the direction of the study (Figure 1), (Table 1).

Frequency 
Percent 
Valid percent 
Cumulative percent 

Valid 
12 
12 
20.0 
20.0 
20.0 
35 
39 
65.0 
65.0 
85.0 

>5 
9 
15.0 
15.0 
100.0 

Total 
60 
100.0 
100.0 

Table 1 Meals per day
Disease status
88.33% of the women in this study are disease free while 11.67% are diabetes type 1, diabetes type 2 and gestational diabetes patients (Figure 2), (Table 2).
Frequency 
Percent 
Valid percent 
Cumulative percent 

Valid 
Diabetes type 1 
4 
6.7 
6.7 
6.7 
Diabetes type 2 
1 
1.7 
1.7 
8.3 

Gestational diabetes 
2 
3.3 
3.3 
11.7 

None 
53 
88.3 
88.3 
100 

Total 
60 
100 
100 
Table 2 Disease status
Supplementation intake
Calcium supplementation recorded the lowest intake: 56.67% do not take calcium as supplement. More than 90% (93.33, 95 and 98.33%) take iron or folic acid or multivitamins and minerals supplementation during their pregnancy (Figure 3).
Number of pregnancy
71.67% of the participants have at least 1 child or more (45% have 1 or 2 children and 26.67% have 3 children or more) (Figure 4).
Hemoglobin levels status
This pie chart shows the distribution of hemoglobin level among the pregnant women where 58.33% are normal (1216g/dl) and 41.67% are abnormal (<12g/dl) (Figure 5).
Weight of the baby status
Using the ultra sound technique the weight of the unborn baby can be measured; 65% of the unborn babies are normal are of normal weight while 35% are of abnormal weight according to the month of pregnancy of the mother (Figure 6).
Age
The participants’ age varies between 20(minimum) and 38(maximum) with a mean age of 27years old (Table 3).
Statistics 


Age 

N 
Valid 
60 
Missing 
0 

Mean 
27.00 

Median 
26.00 

Mode 
25 

Minimum 
20 

Maximum 

38 
Table 3 Age
Meat Consumption per week
Meat consumption among the sample chosen is quite high since 85% of the pregnant consumes more than once per week meat products (Figure 7), (Table 4).

Weight of baby 
Total 


Normal 
Abnormal 

Hemoglobin Level 
Normal 
Count 
31 
4 
35 
% within Weight of Baby 
79.50% 
19.00% 
58.30% 

Deficiency 
Count 
8 
17 
25 

% within Weight of Baby 
20.50% 
81.00% 
41.70% 

Count 
39 
21 
60 

Total 

% within Weight of Baby 
100.00% 
100.00% 
100.00% 
Table 4 Hemoglobin Level* weight of baby cross tabulation
Hemoglobin level vs weight of the baby
Using Crosstabs:
79.5% (31 out of 39) of the babies are of normal weight with a normal mothers’ hemoglobin level while 20.5% (8 out of 39) of the babies are of normal weight with a deficient mothers’ hemoglobin level.
19% (4 out of 21) of the babies are of abnormal weight with a normal mother’s hemoglobin level while 81% (17 out of 21) of the babies are of abnormal weight with a deficient mothers’ hemoglobin level.
Inferential statistics:
Is there a correlation between age and hemoglobin level?
The applied test statistics: Non parametric correlation. The null hypothesis: There is a correlation between age and hemoglobin level. The alternative hypothesis: There is no correlation between age and hemoglobin level (Table 5).

Hemoglobin level 
Age 

Spearman's rho 
Hemoglobin Level 
Correlation Coefficient 
1.000 
0.203 
Sig. (2tailed) 
. 
0.12 

N 
60 
60 

Age 
Correlation Coefficient 
0.203 
1.000 

Sig. (2tailed) 
0.12 
. 

N 
60 
60 
Table 5 Correlations
As it is showed in the table above the correlation coefficient is 0.203 indicating that there is a weak positive correlation between hemoglobin levels and age of the pregnant women. These findings contradict the results of previous studies mentioned in the literature section of the report. Since there is a correlation between these two variables even if it is a weak one so we accept H0 and reject HA.
Research question
Is there a correlation between meat consumption and hemoglobin level?
The applied test statistics: Non parametric correlation.
The null hypothesis: There is a positive correlation between meat consumption and hemoglobin level.
The alternative hypothesis: There is no positive correlation between meat consumption and hemoglobin level (Table 6).

Hemoglobin level 
Meat consumption 

Spearman's rho 
Hemoglobin level 
Correlation Coefficient 
1.000 
.435** 
Sig. (2tailed) 
. 
0.001 

N 
60 
60 

Meat consumption 
Correlation Coefficient 
.435** 
1.000 

Sig. (2tailed) 
0.001 
. 

N 
60 
60 
Table 6 Correlations
**Correlation is significant at the 0.01 level (2tailed)
r=0.435 indicates a negative moderate correlation between meat consumption of pregnant women and their hemoglobin levels.
These surprising results does not apply to the knowing fact that meat consumption increase hemoglobin level since heme present in meat is the base of the hemoglobin compound. In other hand, the absorption of iron (hemoglobin) especially during pregnancy period is affected by some enhancers which are not consumed properly by our study participants justifying these results. So we accept HA and reject H0
Research question
Is there a correlation between number of pregnancy and hemoglobin level?
The applied test statistics: Non parametric correlation.
The null hypothesis: There is a correlation between number of pregnancy and hemoglobin level.
The alternative hypothesis: There is no correlation between number of pregnancy and hemoglobin level (Table 7).

Number of pregnancy 
Hemoglobin level 

Spearman's rho 
Number of Pregnancy 
Correlation Coefficient 
1.000 
.381** 
Sig. (2tailed) 
. 
0.003 

N 
60 
60 

Hemoglobin Level 
Correlation Coefficient 
.381** 
1.000 

Sig. (2tailed) 
0.003 
. 

N 
60 
60 
Table 7 Correlations
**. Correlation is significant at the 0.01 level (2tailed)
We accept H0 and reject HA since r=0.381 indicating a moderate positive correlation between number of pregnancy (parity) and hemoglobin levels in pregnant women. This confirms previous findings and increases the interest of pregnant women in their hemoglobin levels that decreases with higher parity.
Research question
Is the association between sport and hemoglobin level significant?
The applied test statistics: Chisquare test.
The null hypothesis: There is no significant association between sport and hemoglobin level.
The alternative hypothesis: There is significant association between sport and hemoglobin level (Table 8).
Sport 
Total 


Yes 
No 

Hemoglobin level 
Normal 
Count 
15 
20 
35 
Expected Count 
12.8 
22.2 
35.0 

Deficiency 
Count 
7 
18 
25 

Expected Count 
9.2 
15.8 
25.0 

Count 
22 
38 
60 

Total 
Expected Count 
22.0 
38.0 
60.0 
Table 8 Hemoglobin Level* sport cross tabulation
As we see in the table above, the expected count is the value that we expect to observe if there was no significant association between hemoglobin and sport. àWe expect to observe around 13 normal hemoglobin women who do sports and 22 normal hemoglobin women who do not do sports and so on.
These values are different among observed and expected counts. Chi square is the test used in this case. This test helps to determine if those observed count are different enough for the test to be significant (association to be significant). The results of this test are shown in the table below: (Table 9).

Value 
df 
Asymp. sig. (2sided) 
Exact sig. (2sided) 
Exact sig. (1sided) 
Pearson ChiSquare 
1.386a 
1 
0.239 


Continuity Correctionb 
0.82 
1 
0.365 

Likelihood Ratio 
1.408 
1 
0.235 

Fisher's exact test 
0.286 
0.183 

LinearbyLinear Association 
1.363 
1 
0.243 

N of Valid Cases 
60 




Table 9 Chisquare tests
a. 0 cells (0.0%) have expected count less than 5. The minimum expected count is 9.17
b. Computed only for a 2x2 table
In this case, the assumption of the chisquare test is not violated (<20%). The pvalue 0.239 (2.93%) is less than the 5% level of significance (alpha) so the results are statistically significant so we accept the alternative hypothesis that there is a significant association between hemoglobin levels and sport.
Hemoglobin level is dependent on sport.
To test how strong this significance is, the phi test is done since the sample size is small: (Table 10).
Symmetric Measures 



Value 
Approx. sig. 

Nominal by Nominal 
Phi 
0.152 
0.239 
Cramer's V 
0.152 
0.239 

N of Valid Cases 
60 

Table 10 Symmetric Measures
0.152 is the correlation coefficient (size of the effect) showing a weak association between hemoglobin level and sport, justifying what is mentioned in the literature of the report.
Research question:
Is there a correlation between disease status and hemoglobin level?
The applied test statistics: Non parametric correlation.
The null hypothesis: There is a positive correlation between disease status and hemoglobin level.
The alternative hypothesis: There is no positive correlation between disease status and hemoglobin level (Table11).

Hemoglobin level 
Disease status 

Spearman's rho 
Hemoglobin Level 
Correlation Coefficient 
1.000 
.086 
Sig. (2tailed) 
. 
.514 

N 
60 
60 

Disease Status 
Correlation Coefficient 
.086 
1.000 

Sig. (2tailed) 
.514 
. 

N 
60 
60 
Table 11 Correlations
We accept H0 and reject HA since there is a very weak positive correlation (0.086) between disease status of the pregnant women and their hemoglobin levels.
Research question:
Is there a correlation between coffee or tea consumption and hemoglobin level?
The applied test statistics: Non parametric correlation.
The null hypothesis: There is a negative correlation between coffee or tea consumption and hemoglobin level.
The alternative hypothesis: There is no negative correlation between coffee or tea consumption and hemoglobin level (Table 12).

Hemoglobin Level 
Coffee or Tea consumption 

Spearman's rho 
Hemoglobin Level 
Correlation Coefficient 
1.000 
.585** 
Sig. (2tailed) 
. 
.000 

N 
60 
60 

Coffee or Tea Consumption 
Correlation Coefficient 
.585** 
1.000 

Sig. (2tailed) 
.000 
. 

N 
60 
60 
Table 12 Correlations
According to the correlation table above, the hemoglobin levels decrease with the increase of coffee and tea consumption. As we know caffeine contained in coffee and tea is the main cause of iron / hemoglobin nonabsorption.
Spearman’s rho is 0.585 so a moderate negative correlation exists between coffee or tea consumption (caffeine) and hemoglobin levels so H0 is accepted.
Research question:
Is there a correlation between calcium supplementation and hemoglobin level?
The applied test statistics: Non parametric correlation.
The null hypothesis: There is a negative correlation between calcium supplementation and hemoglobin level.
The alternative hypothesis: There is no negative correlation between calcium supplementation and hemoglobin level (Table 13).

Hemoglobin level 
Calcium supplementation 

Spearman's rho 
Hemoglobin Level 
Correlation Coefficient 
10000 
.352** 
Sig. (2tailed) 
. 
0.006 

N 
60 
60 

Calcium Supplementation 
Correlation Coefficient 
.352** 
1 

Sig. (2tailed) 
0.006 
. 

N 
60 
60 
Table 13 Correlations
**Correlation is significant at the 0.01 level (2tailed)
In the pie chart in the descriptive statistics section, calcium supplementation intake among the participants recorded the lowest percentage (43.33%). This low value is justified by the correlation coefficient (0.352) of the table above: since a negative correlation between hemoglobin levels and calcium supplementation exists we can say that physicians avoid the prescription of calcium as supplements because hemoglobin levels fall when calcium is consumed due to its inhibition effect on hemoglobin absorption.
We accept H0 and reject HA.
Is there a correlation between weight of the baby and hemoglobin level?
The applied test statistics: Non parametric correlation.
The null hypothesis: There is a positive correlation between weight of the baby and hemoglobin level. The alternative hypothesis: There is no positive correlation between weight of the baby and hemoglobin level (Table 14).

Hemoglobin level 
Weight of baby 

Spearman's rho 
Hemoglobin Level 
Correlation Coefficient 
1.000 
.585** 
Sig. (2tailed) 
. 
0 

N 
60 
60 

Weight of Baby 
Correlation Coefficient 
.585** 
1.000 

Sig. (2tailed) 
0 
. 

N 
60 
60 
Table 14 Correlations
**Correlation is significant at the 0.01 level (2tailed)
A moderate positive correlation exists between hemoglobin levels and weight of the unborn baby. This result justifies the rapprochement in percentages of normal hemoglobin levels (58.33%) and normal weight baby (65%) considering that almost every normal hemoglobin pregnant will have a normal weight baby. So we accept H0 that there is a correlation between hemoglobin level and weight of the baby.
Is the association between number of meals per day and hemoglobin level significant?
The applied test statistics: Chisquare test.
The null hypothesis: There is no significant association between number of meals per day and hemoglobin level.
The alternative hypothesis: There is significant association between number of meals per day and hemoglobin level (Table 15).
Meals per day 
Total 


2Jan 
5Mar 
>5 

Hemoglobin Level 
normal 
Count 
4 
24 
7 
35 
Expected Count 
7.0 
22.8 
5.3 
35 

deficiency 
Count 
8 
15 
2 
25 

Expected Count 
5/0 
16.3 
3.8 
25.0 

Count 
12 
39 
9 
60 

Total 
Expected Count 
12.0 
39.0 
9.0 
60.0 
Table 15 Hemoglobin Level* Meals per Day Cross tabulation
As we see in the table above, the expected count is the value that we expect to observe if there was no significant association between hemoglobin and sport.
The chi square test helps to determine if those observed count are different enough for the test to be significant (association to be significant). The results of this test are shown in the table below: (Table 16).

Value 
df 
Asymp. Sig. (2sided) 

Pearson ChiSquare 
4.651a 
2 
0.098 
Likelihood Ratio 
4.722 
2 
0.094 
LinearbyLinear Association 
4.378 
1 
0.036 
N of Valid Cases 
60 


Table 16 Chisquare tests
a. 1cells (16.7%) have expected count less than 5. The minimum expected count is 3.75.
In this case, the assumption of the chisquare test is not violated (<20%). The pvalue 0.098 (0.98%) is less than the 5% level of significance (alpha) so the results are statistically significant so we accept the alternative hypothesis that there is a significant association between hemoglobin levels and number of meals per day.
Hemoglobin level is dependent on the number of meals consumed per day. To test how strong this significance is, the phi test is done since the sample size is small: (Table 17).

Value 
Approx. sig. 

Nominal by Nominal 
Phi 
0.278 
0.098 
Cramer's V 
0.278 
0.098 

N of Valid Cases 
60 

Table 17 Symmetric measures
a. Not assuming the null hypothesis.
b. Using the asymptotic standard error assuming the null hypothesis.
0.278 is the correlation coefficient (size of the effect) showing a weak association between hemoglobin level and number of meals consumed per day. Number of meals consumed per day by the pregnant woman and the quality of food is what make the association with the hemoglobin level.
Research question
Which variable affects positively or negatively hemoglobin levels in pregnant women?
The applied test statistics: Regression (Table 18).
Model 
Variables Entered 
Variables Removed 
Method 
1 
Coffee or Tea, Disease Status, Number of Pregnancy, Meat Consumptionb 
. 
Enter 
Table 18 Variables entered/Removeda
a. Dependent Variable: Hemoglobin Level
b. Dependent Variable: Hemoglobin Level
Model 
R 
R Square 
Adjusted R Square 
Std. Error of the Estimate 
1 
.683a 
0.467 
0.428 
0.376 
Table 18 a. Predictors, (Constant), Coffee or Tea, Disease Status, Number of Pregnancy, Meat Consumption
Coefficientsa 


Model 
Unstandardized coefficients 
Standardized coefficients 
t 
Sig. 

B 
Std. Error 
Beta 

1 
(Constant) 
2.124 
0.38 
5.582 
0 

Number of Pregnancy 
0.153 
0.068 
0.23 
2.242 
0.029 

Disease Status 
0.03 
0.044 
0.068 
0.684 
0.497 

Meat Consumption 
0.186 
0.086 
0.231 
2.165 
0.035 

Coffee or Tea 
0.482 
0.109 
0.466 
4.419 
0 
Table 18 a. Dependent Variable, Hemoglobin Level
As we see in the tables above, R is 0.683 which means that there is a correlation between hemoglobin and the others 4 variables (number of pregnancy, disease status, meat consumption and consumption of coffee or tea). According to the last table, number of pregnancy affects positively (0.153) the most hemoglobin levels among the pregnant women, while consumption of coffee or tea affects it negatively (0.482).
Research question
Which variable affects positively or negatively hemoglobin levels in pregnant women?
The applied test statistics: Regression (Table 19).
Model 
R 
R square 
Adjusted R square 
Std. Error of the estimate 
1 
.726a 
0.528 
0.484 
0.357 
Table 19 a. Predictors, (Constant), Spinach With Meat, Vegetables With Meat, Tomato With Meat, Broccoli With Meat, Lemon With Meat
ANOVAa 


Model 
Sum of squares 
df 
Mean square 
F 
Sig. 

1 
Regression 
7.695 
5 
1.539 
12.064 
.000b 
Residual 
6.889 
54 
0.128 

Total 
14.583 
59 



Table 19 a. Dependent Variable, Hemoglobin Level b. Predictors, (Constant), Spinach with Meat, Vegetables with Meat, Tomato with Meat, Broccoli with Meat, Lemon with Meat
Coefficientsa 


Model 
Unstandardized coefficients 
Standardized coefficients 
t 
Sig. 

B 
Std. Error 
Beta 

1 
(Constant) 
0.596 
0.464 
1.284 
0.205 

Tomato With Meat 
0.146 
0.112 
0.142 
1.313 
0.195 

Broccoli With Meat 
0.037 
0.116 
0.032 
0.32 
0.75 

Vegetables With Meat 
0.07 
0.106 
0.07 
0.66 
0.512 

Lemon With Meat 
0.653 
0.123 
0.662 
5.297 
0 

Spinach With Meat 
0.029 
0.104 
0.027 
0.277 
0.783 
Table 19 a. Dependent Variable: Hemoglobin Level
This test helps us how the type of food consumed with meat affect the hemoglobin levels. Knowing that some of these foods are inhibitors (tomato and broccoli) and enhancers (vegetables, lemon, spinach) of iron absorption, according to the table tomato and broccoli affect negatively hemoglobin levels justifying the finding in many previous studies. While vegetables, lemon and spinach affect it positively with a higher positive association with lemon consumption.
The results of this study were consistent with the recent findings of other studies concerning the effect of dietary habits on hemoglobin levels and its effects on the fetus. Some results contradict previous findings like the relation between age vs hemoglobin, sports vs hemoglobin and meat consumption vs hemoglobin. Furthermore, 85% of the participants consume meat products more than once per week resulting in a good quantity of iron (hemoglobin) but seems that the way of consuming meats is being incomplete because of the wrong consumption of enhancers to ensure the arrival of hemoglobin to the mother’s blood and in fact to the baby’s blood.
88.33% of the sample is disease free participants contributing in accurate results since diseases may cause changes in the metabolism of the individual or in the distribution of the foods’ ingested nutrients, minerals and other compounds including iron/hemoglobin. The highest correlation coefficient between hemoglobin and the variables is the 0.585 recorded from hemoglobin and the weight of the baby confirming several previous studies that the baby is so affected by the mother’s hemoglobin.
The hemoglobin levels in the pregnant woman are affected by not the quantity of heme and nonheme iron only but the enhancers of absorption. Good enhancers must be consumed by every woman, nonpregnant, preparing for pregnancy and pregnant one. In the pregnancy period the need for the mother is higher than ever since she’s eating for two. During this period, not only the weight of the baby is affected by low hemoglobin levels of the mother; many outcomes are scientifically proved that are caused by such deficiency affecting the whole life of the baby mentally and physically. Pregnancy requires additional maternal absorption of iron. Maternal iron status cannot be assessed simply from hemoglobin concentration because pregnancy produces increases in plasma volume and the hemoglobin concentration decreases accordingly. So many other factors must be considered in future research.
In previous studies, sport shows no relation with hemoglobin levels but since a correlation coefficient of 0.152 exists, a start for new research must be present.
Some of the limitations of our study are:
None.
Author declares that there is no conflict of interest.
©2018 Kadry, et al. This is an open access article distributed under the terms of the, which permits unrestricted use, distribution, and build upon your work noncommercially.
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