CORRELATION OF IRON DEFICIENCY ANEMIA WITH VAGINAL MICROBIAL DYSBIOSIS AND CERVICAL HISTOPATHOLOGICAL ABNORMALITIES IN RURAL AND URBAN WOMEN

Abstract

Background: Anemia due to iron deficiency (IDA) is a prevalent nutritional problem in women that can affect immune function, epithelial integrity and susceptibility to genital tract infections. Vaginal disturbances in the microbial environment and continued cervical inflammation could be linked to poor reproductive health. The potential association between iron deficiency anemia, vaginal microbial dysbiosis and cervical histopathological abnormalities is still not well explored, especially in women of rural and urban areas. Objective: To determine the correlation of iron deficiency anemia with vaginal microbial dysbiosis and cervical histopathological abnormalities among rural and urban women. Methods: The analytical cross sectional study was conducted at Muhammad College of Medicine, Peshawar, from January 2025 to June 2025. The total number of women that were enrolled was 85 using non-probability consecutive sampling. Demographic and reproductive data was collected and participants had a hematological evaluation (Hb, serum ferritin, serum iron and mean corpuscular volume). The Nugent score was used to analyse vaginal flora and the microbial characteristics of the vaginal secretions were evaluated for abnormalities such as bacterial vaginosis, Candida species and mixed dysbiosis. Histopathological examination of cervical specimens was performed for chronic cervicitis, squamous metaplasia, cervical intraepithelial abnormalities and other pathological changes. Appropriate statistical tests were used to evaluate the associations which resulted in a p value of less than 0.05. Results: Among the 85 participants, 45 (52.9%) had iron deficiency anemia, which was more frequent among rural than urban women (65.1% vs. 40.5%, p = 0.023). Vaginal microbial dysbiosis was identified in 36 (42.4%) participants and occurred significantly more often in women with iron deficiency anemia than in those without anemia (57.8% vs. 25.0%, p = 0.002). Cervical histopathological abnormalities were found in 31 (36.5%) women and were also more frequent among anemic participants (48.9% vs. 22.5%, p = 0.012). The prevalence of both vaginal dysbiosis and cervical abnormalities increased progressively with anemia severity. Hemoglobin and serum ferritin demonstrated significant inverse correlations with Nugent score. Conclusion: Iron deficiency anemia was significantly associated with vaginal microbial dysbiosis and cervical histopathological abnormalities, with a greater burden observed among rural women. Increasing anemia severity was accompanied by progressively higher frequencies of microbial dysbiosis and abnormal cervical histology. These findings highlight the potential importance of identifying and managing iron deficiency as part of comprehensive reproductive healthcare.