Evaluation of Hemoglobin Concentration in Pregnancy and Correlation with Different Altitude: A Study from Balochistan Plateau of Pakistan

Zubaida Umar 1, Mahmood Rasool *, 2, Muhammad Asif 3, Sajjad Karim 2, Arif Malik 4, Gohar Mushtaq 5, Mohammad A Kamal 6, Arsala Mansoor 1
1 Bolan Medical College, Quetta, Pakistan
2 Center of Excellence in Genomic Medicine Research (CEGMR), King Abdulaziz University, Jeddah, Saudi Arabia
3 Department of Biotechnology and Informatics, BUITEMS, Quetta, Pakistan
4 Institute of Molecular Biology and Biotechnology (IMBB), The University of Lahore, Lahore, Pakistan
5 Department of Biochemistry, College of Science, King Abdulaziz University, Jeddah, Saudi Arabia
6 King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia

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© Umar et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Center of Excellence in Genomic Medicine Research (CEGMR), Post Box No. 80216, King Abdulaziz University, Jeddah 21589, Saudi Arabia. Tel: +966-6401000; Ext: 25479; Fax: +966-6952521; E-mail:



Anemia refers to a condition having low hemoglobin concentration. Anemia is considered a major risk factor for unfavorable pregnancy outcomes. This is the first study describing the pattern of hemoglobin concentration during pregnancy and its relationship to areas of high and low altitudes in Balochistan (the largest of Pakistan’s four provinces). The main objective of this study was to observe hemoglobin levels and prevalence of anemia among pregnant women living in the high or low altitude areas of Balochistan.


A randomized survey was conducted and blood samples were collected from 132 healthy full term pregnant women subjects and 110 unmarried females. The subjects of the current study were selected from two different areas of Balochistan (Quetta and Uthal). Hemoglobin levels of the subjects were analyzed on Microlab 300 by Merck kit. Dietary status of the subjects was assessed based on simplified associated food frequency questionnaire. The factors effecting hemoglobin in full term pregnancy at different altitudes were multi gravidity/parity (increased number of pregnancies/children), age, socio-economic and educational status.


Anemia was highly prevalent in low-altitude region (68.33%). We found statistically significant difference in mean hemoglobin level at high-altitude region (11.81 ± 1.02) and low-altitude region (10.20 ± 1.28) in pregnant females of Balochistan plateau (P < 0.001). Higher maternal age (> 35 years) has shown significantly higher anemic frequency at both high (57.89%; p < 0.002) and low (41.46%; p = 0.067) altitudes. A balanced-diet that is rich in meat products has also shown significant correlation with reduced incidences of anemia among pregnant women at both altitudes.


Hemoglobin concentration increases in the body with elevated altitudes and, thus, anemia was less frequent at high-altitude region. Factors affecting hemoglobin concentration in full term pregnancy at different altitudes included old maternal age, low body-mass index, education and diet.

Keywords: Anemia, altitude, diet, hemoglobin, pregnancy. .