Associations between iron status and psychosocial well-being among pregnant women in Cape Coast, Ghana: a longitudinal study

Abstract Objective: To determine the associations among Fe status, depressive/anxiety symptoms and quality of life (QoL) throughout pregnancy. Design: This longitudinal study recruited participants in their first trimester (< 13 weeks; n 116) and followed in their second ( n 71) and third ( n 71) trimesters. Socio-demographic, food security, anxiety, depressive symptoms and QoL questions were collected. Hb, ferritin (Ft) and transferrin saturation (TSAT) were determined. Women were categorised as iron improvers or non-improvers based on changes in Fe status. Associations were assessed using difference-in-difference analyses. Setting: Cape Coast, Ghana between October 2017 and September 2018. Participants: Pregnant women, 18–38 years. Results: Improvement in Ft levels from the first to second trimester was associated with reduced depressive symptoms (–2·96 v . –0·58, P = 0·028) and higher overall QoL (13·99 v . 1·92, P = 0·006) particularly role physical (23·32 v . –2·55, P = 0·025) and role emotional (27·50 v . 10·06, P = 0·025) subscales. Improvement in Hb levels during the same period was linked to less anxiety, particularly fear factor (–2·62 v . –0·51, P = 0·020), and worsened physical health aspect of QoL (–21·80 v . –3·75, P = 0·005). Improvement in TSAT levels from second to third trimester was associated with increased total anxiety (1·56 v . –0·64, P = 0·030) and panic factor (0·45 v . –0·26, P = 0·004) and decreased total QoL (–1·08 v . 7·94, P = 0·017), specifically role physical (–10·98 v . 11·93, P = 0·018). Conclusion: Increases in Fe status from first to second trimester were related to improvements in psychosocial well-being, implying potential benefit of Fe supplementation on affect in early pregnancy. Larger studies are needed to confirm these findings.