P1504: hematological implications in adolescent greek roma pregnants

Topic: 29. Iron metabolism, deficiency and overload Background: Globally, each year, about 23.5 million girls under the age of 19 become mothers. The trend of teenage pregnancies is declining with the teenage birth rate in Greece being 11.6 per 1000. Adolescent pregnancy often occurs in marginalized communities with low education attainments and cultural pressure for early marriages, as is the case for the Roma community. Aims: A retrospective analysis of the medical documentation and hematological data of the first prenatal visit of Roma pregnant adolescents in a tertiary hospital was conducted. The aim was to determine the “hematological” profile of the adolescent pregnant Roma women (12–19-year-old), during a ten-year period in Northern Greece. Iron deficiency (ID) and anemia were defined according to WHO recommendations. Methods: A complete blood count (CBC), together with the peripheral smear microscopy, ferritin levels, Hb HPLC (high performance liquid chromatography) and electrophoresis were carried out for all subjects of this study. All pregnant adolescents were given therapeutic support and dietary advice. A total of 112 Roma pregnant adolescents were screened either as individuals or, very few (6), as couples at the Thalassemia Prevention Unit. Results: The mean age of the pregnants was 15.9±1.48 years. The percentage of pregnancy in very young girls (12-15 years) was 40.2% and 59.8% were between 16-19 years. 39% of women came to the outpatient clinic in the first trimester of pregnancy, 40% in the second and 21% in the third trimester. Anemia was found in 35.7% of cases and iron deficiency in 54.4% respectively. Anemia was mild in 85% and moderate in 15% of cases. No cases of severe anemia were found. During the first trimester, the mean age of pregnants was 15.6±1.33 years and anemia and iron deficiency was found in 25% and 34% respectively. The mean Hb level was 11.6±1.09 g/dL, mean ferritin level 40.0±35.1 ng/ml, mean MCV level 83.2±8.8 fL, mean MCH level 27.1±3.15 pg and mean RDW 14.4±3.7%. During the second trimester, the mean age of pregnants was 15.9±1.5 years, and anemia and iron deficiency were found in 35.5% and 60% of cases respectively. The mean Hb level was 11.2±0.8, g/dL, mean ferritin level 23.7±22ng/ml, mean MCV 89.1±5.2 fL, mean MCH 29.2±1.7pg and mean RDW 13.5±1.1%. Finally, in the third trimester, the mean age of pregnants was 16.4±1.59, and anemia and iron deficiency were found in 56.5% and 82% respectively, while the mean Hb level was 10.89±1.02, g/dL, mean ferritin level 12.2±7.2 ng/ml, mean MCV 87.1±7.1 fL, mean MCH 28.4±2.7pg and mean RDW 14.1±1.69. Thalassemia carrier state was detected in 7.1% (75% β thalassemia carriers and 25% α thalassemia carriers), all detected in the first trimester of pregnancy. All the young girls had dropped out of school. Summary/Conclusion: The Greek state has achieved a basic level of housing, education and healthcare for the Roma people but still, they are classified as a “vulnerable social group”. There are few records of the health state of Greek Roma adolescent mothers due to mobility and ineffective civil registration. The Roma people are characterized by a set of values which include early marriages, usually between the ages of 13-17, intermarriages, limitedadherence to a legal basis, high numbers of offsprings, and low divorce rates. ID anemia in Greece has been reported as a serious public health problem especially in infancy and childhood. From our data, anemia and ID pose a serious threat for adolescent Roma pregnants that could lead to several consequences during postpartum both for mother and baby. Roma pregnant adolescents were prescribed iron therapeutic support and were given dietary advice, though the lack of pregnancy monitoring was a severe problem. Keywords: Pregnancy, Iron deficiency anemia, Adolescents