Multivariate patterns of trace elements in anemia during pregnancy: Insights from principal component analysis in a hospital-based study from North India.

BACKGROUND: Anemia in pregnancy is traditionally attributed to iron deficiency, but emerging evidence highlights the contribution of other trace elements to hematopoiesis and oxidative defense. Limited studies from India have systematically evaluated their multivariate interactions. AIM: This study assesses serum concentrations of eight trace elements in anemic and non-anemic pregnant women and identifies latent clustering patterns using principal component analysis (PCA). METHODS: This hospital-based cross-sectional study enrolled 100 pregnant women (< 14 weeks gestation) at a tertiary care center in Lucknow, India. Serum concentrations of iron (Fe), zinc (Zn), copper (Cu), selenium (Se), magnesium (Mg), manganese (Mn), cobalt (Co), and chromium (Cr) were measured using inductively coupled plasma mass spectrometry. Data were analyzed using independent t-tests, Pearson's correlation, and PCA with exploratory factor analysis. RESULTS: Anemic women had significantly lower serum Fe (43.10 ± 26.47 μg/dL) compared to controls (77.88 ± 37.71 μg/dL, P < 0.001). Hemoglobin correlated positively with Fe (r = +0.590, P < 0.01) and weakly, negatively with Cu (r = -0.201, P < 0.05). PCA revealed four clusters explaining 70.7% of variance: Fe-Zn-Se, Mn-Cr, Mg-Co, and Cu. These clusters suggest synergistic and competitive roles of trace elements in red cell metabolism beyond iron deficiency alone. CONCLUSION: Iron deficiency remains the predominant cause of anemia in pregnancy. However, PCA underscores the collective influence of trace element clusters, highlighting potential secondary modulators of anemia risk. Broader micronutrient-based strategies, alongside iron supplementation, might improve maternal anemia outcomes in India.