An intervention package with WhatsApp-based follow-ups appears to improve clinical guidance adherence and hemoglobin levels among pregnant patients with anemia, according to research published in the International Journal of Environmental Research and Public Health.

Previously published data suggest that approximately 40% of all pregnant women are anemic, which is defined as insufficient hemoglobin levels or red blood cell count for meeting the physiological needs of the focal patient. Data have also showed that iron-deficiency anemia is the most common variety.

Anemia during pregnancy is linked with many adverse clinical outcomes, including stillbirth, preterm labor, growth restriction, low birth weight, postpartum bleeding, infection, and maternal mortality. Fetal growth restriction and low birth rate are similarly linked with shorter lifespan, diabetes, and obesity.

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Although researchers have previously identified risk factors for anemia during pregnancy as well as determined strong strategies for managing the condition, anemia persists in many pregnant patients. Iron supplementation is, for example, free for patients in many countries, but poor compliance has been identified as a major factor for persistent anemia.

Researchers previously established the Arabic-language based Health Information Package Program (HIPP), which aims to improve awareness of anemia and enhance patient compliance with iron supplementation. Moreover, HIPP educates patients about choosing iron-, vitamin C-, and protein-rich foods and uses the WhatsApp social media tool for follow-up. For this study, researchers evaluated whether, compared with a control, routine care population, HIPP improves outcomes among pregnant patients with anemia.

Overall, of 196 patients who enrolled in the study, 98 were assigned to the HIPP and control group each. In the HIPP and control groups, the mean ages were 25.76 and 26.1 years, respectively, and 52% and 59.2% were educated until at least the university level.

Analysis showed that, from an initial pretest to a post-intervention post-test, knowledge about anemia, food selection ability, and hemoglobin levels all significantly improved in the HIPP group (all P <.001) but not in the control group (all P >.05).

High supplement compliance was, furthermore, noted in 90.8% of patients in the HIPP group vs 66.4% of patients in the control group.

“Nurses, midwives, and obstetricians could use the Health Information Package Program as an effective educational intervention among pregnant women, which is evidenced by the improvement in hemoglobin levels,” the authors wrote. “Further and more detailed surveys on anemia during pregnancy and its associated factors should be conducted to ensure the representativeness of the results to the population.”


Elsharkawy NB, Abdelaziz EM, Ouda MM, Oraby FA. Effectiveness of health information package program on knowledge and compliance among pregnant women with anemia: a randomized controlled trial. Int J Environ Res Public Health. 2022;19(5):2724. doi:10.3390/ijerph19052724