Dietary Habits as a Determinant of Iron Deficiency Anaemia Among Pregnant Women in Karbala, Iraq: A Cross-Sectional Study

Abstract

abstract Background :Iron deficiency anaemia (IDA) is a major nutrition-related complication during pregnancy in Iraq. While there is a relatively high coverage rate of iron supplements among Iraqis, there continues to be a persistently high rate of anaemia among pregnant women. This highlights that the primary contributor to gestational anaemia is likely dietary factors, specifically low levels of food sources containing the highest levels of iron and high intake levels of agents that inhibit the absorption of iron.
Materials and Methods: An analytical cross-sectional study of 202 pregnant women attending the Obstetrics and Gynecology Teaching Hospital in Karbala City, Iraq between 20 November 2025 to the end of February  2026 was conducted for the purpose of this study. The women's dietary habits were assessed using a qualitative food frequency questionnaire (based on 20 items with scores from 1 to 3), and a score on the food frequency questionnaire of less than 40 represents poor dietary habits, whereas a score of 40 or more represents good dietary habits. Blood samples from the women were taken for analysis of hemoglobin (Hb), serum ferritin (SF), and mean corpuscular volume (MCV). Statistical analysis was performed using IBM SPSS version 29, using chi-square and Fisher's exact tests for significance at p ≤ 0.05.
Results: The average score on the food frequency questionnaire (40.1 ± 4.61), indicated that almost half of participants (43.6%) had poor eating habits. Twelve percent of the women reported that they always eat red meat (12.9%), while 46.5% never consume nuts and 63.4% always consume caffeinated drinks. Fifty-one percent of the women had anemia (hemoglobin ≤11 g/dL), with most being classified as having moderate anemia (37.6%) (mean hemoglobin: 10.64 ±1.65 g/dL). In addition, 36.1% of the women had iron deficiency anemia (ferritin <30 ng/mL), which corresponded to a median ferritin level of 45.76 ng/mL, while 48.0% of women had microcytic anemia (mean corpuscular volume <80 fL).
The overall dietary habit was found to be significantly correlated with moderate anemia (p-value = 0.013), where 48.9% of women with poor Dietary Habits had moderate anemia vs. 28.9% of women with good dietary Habits. A significant relationship was not found between dietary habit score and ferritin (p-value = 0.61) or MCV (p-value = 0.48). Regular iron supplementation showed a significant association with haemoglobin levels (p-value=0.003), while no significant associations were found between supplementation and ferritin (p-value=0.11) or MCV (p-value=0.74).
Conclusions: Gestational anaemia severity within Karbala City can be largely attributed to poor dietary choices. A high intake of foods that inhibit iron absorption, such as caffeinated drinks, and a low intake of iron-rich food items has led to this problem. Iron supplementation alone does not provide sufficient assistance if the dietary habits behind the problem are not addressed. There must be a component of structured dietary counselling integrated within any standard antenatal care practices in Iraq.