Anaemia remains one of the most prevalent and persistent public health challenges in developing countries, disproportionately affecting women, particularly during pregnancy. According to estimates by the World Health Organization (WHO)1,2, approximately 50% of women in developing nations are anaemic. Among these, pregnant women constitute the most severely impacted group. Data indicate that nearly half of women of reproductive age are anaemic. Significantly, nine out of ten anaemic individuals worldwide reside in developing countries3. The South-East Asia region, in particular, bears a heavy burden, with over 600 million people affected by iron deficiency anaemia. India, as part of this region, exhibits one of the highest prevalence rates of anaemia across all age groups4. The National Family Health Survey (NFHS-III) confirmed that India harbours the greatest number of anaemia cases globally. Supplementary reports from the National Nutrition Monitoring Bureau (NNMB), District Level Household Survey (DLHS), and the Indian Council of Medical Research (ICMR) have demonstrated that approximately 70% of pregnant women and adolescent girls in India are anaemic. In Indian females, anaemia often begins in childhood, worsens during adolescence, and further deteriorates during pregnancy due to increased physiological demands and inadequate nutritional support5-9.

Maternal anaemia is associated with several adverse outcomes and is a major contributing factor to maternal morbidity and mortality. A haemoglobin level below 11 g/dL in pregnant women is significantly linked to higher perinatal mortality rates. India alone accounts for approximately 80% of maternal deaths due to anaemia in the South-East Asia region10. Beyond maternal health, anaemia exerts profound effects on fetal and neonatal outcomes. It is correlated with preterm deliveries, low birth weight, intrauterine growth restriction, placental abruption, low APGAR scores, and extended neonatal hospitalisation. Furthermore, maternal anaemia compromises neonatal iron stores, and since iron content in breast milk of anaemic mothers is reduced, infants are at increased risk of developing iron deficiency anaemia by six months of age. This early onset of anaemia in infancy often persists due to the poor iron content in complementary and family foods consumed during early childhood11, thereby perpetuating a vicious intergenerational cycle. The implications of anaemia extend far beyond the perinatal period. Iron deficiency during early development has been associated with impaired neurocognitive development, stunted growth12, reduced immunity, and long-term consequences such as poor academic performance and decreased work productivity. In socioeconomically disadvantaged populations, such as those commonly found in India, these outcomes further entrench poverty and health inequities. A critical examination of the nutritional, educational, and healthcare factors contributing to anaemia in such settings is therefore essential13. Multiple studies have reinforced that maternal anaemia is not solely a medical concern but a complex social issue influenced by poverty, gender inequality, food insecurity, and inadequate access to healthcare. In particular, low literacy levels and lack of awareness regarding nutritional requirements during pregnancy further exacerbate the problem. Intervention strategies must therefore be multifaceted, encompassing both preventive and therapeutic components14,15. Effective public health approaches may include iron and folic acid supplementation, deworming, dietary diversification, food fortification, and targeted health education programs16-17. Furthermore, strengthening antenatal care services to include routine screening and early management of anaemia is essential. Given the high burden of disease and its preventable nature, anaemia must be addressed as a national health priority.

AIM

Study of effect of maternal hb on birth weight and APGAR score of baby

The present cross-sectional observational study was conducted from feb. 2024 to feb 2025 at the Departments of Obstetrics & Gynaecology, American institute of Medical Sciences, Udaipur. All antenatal patients admitted to labour room were included, with a calculated minimum sample size of 90. Antenatal patients with risk factors such as diabetes, hypertension, Rh negative pregnancies will excluded.

Table 1: Anemic status of mothers:

In our study, 59% (n=52) of participants were anemic, while 42% (n=38) were non-anemic.

Table2: Study population grouping according to maternal hemoglobin concentration

 42% (n=38) had normal hemoglobin levels (≥11 g/dL), while 17% (n=15) had mild anemia (10–10.9 g/dL), 23% (n=21) had moderate anemia (7–9.9 g/dL), and 18% (n=16) had severe anemia (<7 g/dL).

Table 3: Association of Age of mothers with Anemic status:

Among mothers aged <19–36 years, 26 were anemic and 22 non-anemic; in the 37–49 age group, 17 were anemic and 10 non-anemic; while among those >49 years, 9 were anemic and 6 non-anemic.

Table 4: association of Parity with Anemic status of study population:

Among anemic mothers, 22 were primiparous, 16 had parity 2, and 14 had parity ≥3, while among non-anemic mothers, 16 were primiparous, 12 had parity 2, and 10 had parity ≥3.

Table 5: Association of gestational age with Anemic status

Among anemic mothers, 13 had preterm, 28 term, and 11 post-term deliveries, while among non-anemic mothers, 7 had preterm, 26 term, and 5 post-term deliveries.

Table 6: Distribution of birth weight of neonate according to Anemic status

Among anemic mothers, 6 babies weighed <1000 g, 12 weighed 1001–1500 g, 21 weighed 1501–2500 g, and 13 weighed >2500 g, while among non-anemic mothers, 1 baby weighed <1000 g, 3 weighed 1001–1500 g, 9 weighed 1501–2500 g, and 25 weighed >2500 g.

Table 7: APGAR SCORE OF neonates according to Anemic status of mothers:

Among babies born to anemic mothers, 5 had an APGAR score of 0–3, 17 had scores of 4–6, and 30 had scores of 7–10, while among those born to non-anemic mothers, 1 had a score of 0–3, 2 had scores of 4–6, and 35 had scores of 7–10.

Our study addresses the effects of maternal anemia on neonatal outcomes providing critical insights to decrease the anemia prevalence during pregnancy in order to reduce

neonatal morbidity and mortality.

In the present study, 59% (n=52) of the participants were found to be anemic, indicating a high prevalence of anemia. In contrast, 42% (n=38) were non-anemic. This highlights the significant burden of anemia in the studied population.

In our study, 42% (n=38) of the participants had normal hemoglobin levels (≥11 g/dl).Mild anemia (10.0–10.9 g/dl) was observed in 17% (n=15) of the cases. Moderate anemia (7.0–9.9 g/dl) was present in 23% (n=21) of the individuals. Severe anemia (<7 g/dl) was identified in 18% (n=16) of the subjects. These findings highlight a significant burden of moderate to severe anemia among the study population. A study by Kalaivani18 (2009) reported that in India, moderate anemia was the most common category among pregnant women, accounting for approximately 61%, while severe anemia was found in about 9%.

In our study, among mothers aged <19–36 years, 26 were anemic while 22 were non-anemic. In the 37–49 years age group, 17 mothers were anemic and 10 were non-anemic. Among those aged >49 years, 9 were anemic compared to 6 non-anemic mothers. Anemia was more prevalent in the younger age group (<36 years).However, a consistent presence of anemia was noted across all age groups. Similarly, a study by Kaur et al. (2006) 19in North India reported that women aged 20–35 years had significantly higher rates of anemia compared to older women, attributing this to the nutritional demands of childbearing and lactation during early adulthood. Our study aligns with broader epidemiological patterns, showing that while anemia is more common among younger women, especially those of reproductive age, it remains a significant concern across all age brackets.

In our study, the distribution of anemic and non-anemic mothers was analyzed based on gestational age. Among anemic mothers, 13 delivered preterm, 28 had term deliveries, and 11 delivered post-term. Among non-anemic mothers, 7 delivered preterm, 26 had term deliveries, and 5 delivered post-term. Preterm deliveries were more common among anemic mothers compared to non-anemic mothers. Term deliveries were the most frequent in both anemic and non-anemic groups. Post-term deliveries also showed a slightly higher occurrence in anemic mothers. A global perspective from Rahman et al. 20(2016)—a comprehensive meta-analysis—also confirmed that maternal anemia is significantly associated with preterm birth, with an odds ratio of 1.23 for women with any anemia, compared to those without.

The distribution of birth weight among neonates born to anemic and non-anemic mothers showed a notable difference. Among mothers with anemia, 6 babies had a birth weight of less than 1000 grams, compared to only 1 in the non-anemic group. In the 1001–1500 grams range, 12 babies were born to anemic mothers, while only 3 were from non-anemic mothers. Similarly, 21 babies born to anemic mothers weighed between 1501–2500 grams, whereas 9 belonged to the non-anemic group. Interestingly, the highest birth weight category (>2500 grams) had a reversal in trend, with 25 babies from non-anemic mothers compared to only 13 from anemic mothers. This suggests that maternal anemia is associated with lower birth weight in neonates. In a large-scale Indian study by Bentley and Griffiths (2003)21 highlighted that maternal anemia, particularly moderate to severe anemia, was strongly associated with intrauterine growth restriction and low birth weight, a consequence of impaired oxygen delivery to the fetus. Similarly, Rahman et al. (2016)20 in a meta-analysis of 95 studies across 29 countries found that maternal anemia significantly increased the risk of low birth weight (odds ratio ~1.29) and preterm birth. These findings are in agreement with our study, supporting the conclusion that maternal anemia contributes substantially to lower birth weights and is an important modifiable risk factor in perinatal health.

In our study, Apgar scores were notably lower among neonates born to anemic mothers compared to those born to non-anemic mothers. Among anemic mothers, 5 babies had Apgar scores between 0–3, while only 1 baby born to a non-anemic mother fell in this category. Apgar scores between 4–6 were observed in 17 babies of anemic mothers, compared to 2 in the non-anemic group. Higher Apgar scores (7–10) were seen in 30 babies of anemic mothers. In contrast, 35 babies born to non-anemic mothers had Apgar scores between 7–10.These findings indicate a clear association between maternal anemia and lower neonatal Apgar scores. Similarly a study by Kidanto et al.22 (2009) in Tanzania found that maternal anemia was significantly associated with low Apgar scores at 1 and 5 minutes. Their data showed that infants born to anemic mothers had a higher risk of scoring less than 7 at 5 minutes compared to those born to non-anemic mothers. Moreover, a study by Mumbare et al. (2012)23 also emphasized this link, reporting that maternal anemia was a strong predictor of poor perinatal outcomes, including low Apgar scores and increased neonatal morbidityThese findings are in alignment with our study, reinforcing the conclusion that maternal anemia has a direct, negative impact on immediate neonatal well-being, as reflected by Apgar scores.

Our study highlights a high prevalence (59%) of maternal anemia, with a significant burden of moderate to severe cases. Anemia was more prevalent among younger, reproductive-aged women and consistently observed across all age groups. Maternal anemia was associated with increased rates of preterm deliveries and low birth weight neonates. Neonates of anemic mothers also had significantly lower Apgar scores, indicating compromised immediate postnatal health. These findings align with national and international research. Addressing maternal anemia is essential to improving neonatal outcomes and reducing perinatal morbidity and mortality.

1. Hussein L Kidanto, Ingrid Mogren, Gunilla Lindmark, Siriel Massawe, Lennarth Nystrom,Risks for preterm delivery and low birth weight are independently increased by severity of maternal anaemia. February 2009, Vol. 99, No. 2 SAMJ.
2. Gruenwald P: fetal l Growth and Development, Williams Obstetrics, 23e > Chapter 43.
3. Chandra S, Anil Kumar T Anemia: A Brief Overview Regards the Pregnant State. J Womens Health, Issues Care, 2014; 3:1.
4. Ballard JL, Khoury JC, Wedig K, Wang L, Eilers-Walsman BL, Lipp R. New Ballard Score, expanded to include extremely premature infants. J Pediatr. 1991 Sep; 119(3):417-23.
5. Sumithra Muthayya ,Maternal nutrition & low birth weight - what is really important?Division of Nutrition, St. John’s Medical College & Research Institute, St. John’s National Academy of HealthSciences, Bangalore, India. Indian J Med Res 130, November 2009, pp 600-608.
6. G. Viveki,A.B. Halappanavar,P.R. Vivek,S.B. Halki,V.S. Maled, P.S. Deshpande ,Prevalence of Anaemia and Its Epidemiological Determinants in Pregnant Women2012, AJMS US National Library of Medicine enlisted journal).
7. Levy A, Fraser D, Katz M, Mazor M, Sheiner E.,Maternal anemia during pregnancy is an independent risk factorfor low birthweight and preterm delivery.2005;122(2):182–186.International Journal of Gynaecology & Obstetrics. [PubMed]
8. Malhotra M, Sharma JB, Batra S, Sharma S, Murthy NS, Arora R. Maternal and perinatal outcome in varying degrees of anemia. Int J Gynaecol Obstet. 2002 Nov;79(2):93-100. [PubMed]
9. Bondevik GT, Lie RT, Ulstein M, Kvåle G. Maternal hematological status and risk of low birth weight and preterm delivery in Nepal. Acta Obstet Gynecol Scand. 2001 May;80(5):402-8. [PubMed]
10. NadiaMudher Al-Hilli,The Effect of Maternal Anaemia on Cord Blood Haemoglobin& Newborn Birth Weight,2010,Karbala Journal of Medicine, 2(8-9), 2010.
11. Singla PN, Tyagi M, Kumar A, Dash D, Shankar R. Fetal growth in maternal anaemia. J Trop Pediatr. 1997 Apr; 43(2):89-92. [PubMed]
12. Ronnenberg AG, Wood RJ, Wang X, Xing H, Chen C, Chen D, et al. Preconception hemoglobin and ferritin concentrations are associated with pregnancy outcome in a prospective cohort of Chinese women. J Nutr. 2004;134(10):2586–91. doi: 10.1093/jn/134.10.2586. [DOI] [PubMed] [Google Scholar]
13. Sukrat B, Wilasrusmee C, Siribumrungwong B, McEvoy M, Okascharoen C, Attia J, et al. Hemoglobin concentration and pregnancy outcomes: a systematic review and meta-analysis. Biomed Res Int. 2013;2013:769057. doi: 10.1155/2013/769057. [DOI] [PMC free article] [PubMed] [Google Scholar]
14. Scanlon KS, Yip R, Schieve LA, Cogswell ME. High and low hemoglobin levels during pregnancy: differential risks for preterm birth and small for gestational age. Obstet Gynecol. 2000;96(5 Pt 1):741–8. doi: 10.1016/s0029-7844(00)00982-0. [DOI] [PubMed] [Google Scholar]
15. Hanieh S, Ha TT, Simpson JA, Casey GJ, Khuong NC, Thoang DD, et al. The effect of intermittent antenatal iron supplementation on maternal and infant outcomes in rural Viet Nam: a cluster randomised trial. PLoS Med. 2013;10(6) doi: 10.1371/journal.pmed.1001470. [DOI] [PMC free article] [PubMed] [Google Scholar]
16. Restrepo-Mesa SL, Estrada-Restrepo A, Gonzalez-Zapata LI, Agudelo-Suarez AA, Ronda-Perez E. [Factors related to birth weight: a comparison of related factors between newborns of Spanish and Colombian immigrant women in Spain]. Arch Latinoam Nutr. 2010;60(1):15–22. [PubMed] [Google Scholar]
17. Malhotra M, Sharma JB, Batra S, Sharma S, Murthy NS, Arora R. Maternal and perinatal outcome in varying degrees of anemia. Int J Gynecol Obstet. 2002;79(2):93–100. doi: 10.1016/s0020-7292(02)00225-4. [DOI] [PubMed] [Google Scholar]
18. [Kalaivani K. (2009). Prevalence & consequences of anaemia in pregnancy. Indian J Med Res, 130(5), 627–633].
19. [Kaur S, Deshmukh PR, Garg BS. (2006). Epidemiological correlates of nutritional anemia in adolescent girls of rural Wardha. Indian J Community Med, 31(4), 255–258].
20. [Rahman MM, et al. (2016). Association between maternal anemia and low birth weight: a meta-analysis. Am J Clin Nutr, 103(2), 495–504].
21. [Bentley ME, Griffiths PL. (2003). The burden of anemia among women in India. Eur J Clin Nutr, 57(1), 52–60].
22. [Kidanto HL, et al. (2009). Effects of maternal anaemia on perinatal outcomes in Dar-es-Salaam, Tanzania. Tanzan J Health Res, 11(4), 219–226].
23. [Mumbare, S. S., et al. (2012). Maternal risk factors associated with term low birth weight neonates: a matched-pair case control study. Indian Pediatr, 49(1), 25–28].