Anaemia in pregnancy, defined by the World Health Organization (WHO) as haemoglobin (Hb) levels <11 g/dL, affects millions of pregnant women worldwide, particularly in developing countries. [1] Anaemia is categorized as mild (Hb: 10–10.9 g/dL), moderate (Hb: 7–9.9 g/dL), and severe (Hb: <7 g/dL). [2] Maternal anaemia has been linked to increased risks of preterm birth, low birth weight, intrauterine growth restriction (IUGR), and postpartum haemorrhage (PPH). [3]

Pathophysiologically, anaemia during pregnancy leads to decreased oxygen-carrying capacity, resulting in hypoxia and placental insufficiency. ^[4] In severe cases, maternal cardiac output increases to compensate, potentially leading to heart failure and other complications. ^[5] Several studies have identified risk factors such as poor nutritional status, inadequate iron supplementation, and underlying infections as contributing factors. ^[6]

The global burden of maternal anaemia varies, with higher prevalence rates in South Asia and sub-Saharan Africa due to socio-economic factors, dietary deficiencies, and limited healthcare access. ^[7] Iron deficiency is the most common cause, followed by folate and vitamin B12 deficiencies, chronic diseases, and infections like malaria and hookworm infestation. ^[8] Anaemia is also influenced by maternal age, parity, and inter-pregnancy intervals. ^[9]

Various public health initiatives, such as iron and folic acid supplementation programs and nutritional interventions, aim to reduce the incidence of maternal anaemia. ^[10] Despite these efforts, adherence to supplementation remains suboptimal in many regions due to cultural beliefs, side effects, and lack of awareness. ^[11] Evaluating the effectiveness of these interventions and identifying gaps in maternal healthcare policies remain essential. ^[12]

This study aims to evaluate the outcomes of labouring women with moderate and severe anaemia by assessing maternal complications, delivery outcomes, and neonatal health parameters.

This is a Retrospective and observational study was conducted in the Department of OBGY. Pregnant women presenting in labour at a tertiary care hospital with documented moderate (Hb 7–9.9 g/dL) or severe (Hb <7 g/dL) anaemia.

Inclusion Criteria:

• Singleton pregnancies
• Gestational age >28 weeks
• Confirmed moderate or severe anaemia
• Women admitted for spontaneous or induced labour

Exclusion Criteria:

• Pregnancies complicated by multiple gestations
• Pre-existing haematological disorders
• Women receiving blood transfusion prior to labour admission
• Women with chronic illnesses that could confound the results

Data were collected from hospital records, including maternal haemoglobin levels, obstetric history, mode of delivery, birth outcomes, and neonatal APGAR scores. The presence of maternal complications such as postpartum haemorrhage (PPH), infections, and the need for blood transfusion were documented. Neonatal outcomes, including birth weight, prematurity, and NICU admissions, were also recorded.

Statistical Analysis:

Data were analyzed using SPSS software. Categorical variables were compared using the Chi-square test, while continuous variables were analyzed using an independent t-test. A p-value <0.05 was considered statistically significant.

Table 1: Baseline Characteristics of the Study Population

The proportion of primiparous women was similar in both groups (54.2% in moderate anaemia vs. 56.3% in severe anaemia), suggesting that parity did not influence the severity of anaemia. Antenatal Care Visits: Women with severe anaemia had slightly fewer antenatal care visits (3.8 ± 1.4) compared to those with moderate anaemia (4.1 ± 1.2), though this difference was not statistically significant (p=0.09). 

Table 2: Maternal Outcomes

The incidence of PPH was significantly higher in women with severe anaemia (25.0%) compared to moderate anaemia (12.5%, p=0.02). Blood Transfusion: A significantly higher proportion of women with severe anaemia required blood transfusions (62.5% vs. 20.8%, p<0.001), reflecting the critical need for intervention in this group. Puerperal Infections: Severe anaemia was associated with a higher rate of puerperal infections (18.8% vs. 8.3%, p=0.03), indicating that anaemia may compromise the immune system and increase susceptibility to infections. Maternal Mortality: Maternal mortality was observed only in the severe anaemia group (2.5%), highlighting the life-threatening nature of this condition.

Table 3: Mode of Delivery

Both moderate and severe anaemia groups had similar rates of vaginal delivery (70.8% vs. 62.5%) and caesarean section (29.2% vs. 37.5%, p=0.21). The rates of instrumental delivery were low and comparable in both groups (8.3% vs. 6.3%, p=0.59), suggesting that anaemia severity did not significantly impact the need for assisted delivery.

Table 4: Neonatal Outcomes

Neonates born to mothers with severe anaemia had significantly lower birth weights (2450 g vs. 2750 g, p<0.001), indicating intrauterine growth restriction (IUGR) associated with severe anaemia. Preterm Birth: The rate of preterm birth was higher in the severe anaemia group (31.3% vs. 16.7%, p=0.01), suggesting that severe anaemia increases the risk of premature delivery. APGAR Scores: Neonates in the severe anaemia group had lower APGAR scores at 5 minutes (7.5 vs. 8.2, p<0.001), reflecting poorer neonatal health at birth. NICU Admissions: A significantly higher proportion of neonates from the severe anaemia group required NICU admission (31.3% vs. 12.5%, p=0.001), indicating greater neonatal morbidity. Neonatal Mortality: Neonatal mortality was higher in the severe anaemia group (5.0% vs. 0.8%, p=0.04), underscoring the adverse impact of severe maternal anaemia on neonatal survival.

Table 5: Comparison of Maternal and Neonatal Complications

Women with severe anaemia had a significantly higher rate of maternal complications (56.3% vs. 25.0%, p<0.001), including PPH, infections, and the need for blood transfusions. Neonatal Complications: Neonates born to mothers with severe anaemia also experienced more complications (50.0% vs. 20.8%, p<0.001), such as low birth weight, prematurity, and NICU admissions.

This retrospective observational study highlights the significant impact of moderate and severe anaemia on maternal and neonatal outcomes in labouring women. The findings underscore the importance of early detection and management of anaemia during pregnancy to mitigate adverse outcomes.

Women with severe anaemia (Hb <7 g/dL) had significantly higher rates of postpartum haemorrhage (25.0% vs. 12.5%, p=0.02) and puerperal infections (18.8% vs. 8.3%, p=0.03) compared to those with moderate anaemia. The need for blood transfusion was also markedly higher in the severe anaemia group (62.5% vs. 20.8%, p<0.001), reflecting the greater physiological strain and reduced haemoglobin reserves in these women. Maternal mortality, though rare, was observed only in the severe anaemia group (2.5%), emphasizing the critical nature of this condition.

Neonates born to mothers with severe anaemia had poorer outcomes, including lower birth weight (2450 g vs. 2750 g, p<0.001), higher rates of preterm birth (31.3% vs. 16.7%, p=0.01), and increased NICU admissions (31.3% vs. 12.5%, p=0.001). The APGAR scores at 5 minutes were also significantly lower in the severe anaemia group (7.5 vs. 8.2, p<0.001), indicating compromised neonatal health. Neonatal mortality was higher in the severe anaemia group (5.0% vs. 0.8%, p=0.04), further highlighting the risks associated with untreated or poorly managed maternal anaemia.

There was no significant difference in the mode of delivery between the two groups, with similar rates of vaginal delivery, caesarean section, and instrumental delivery. ^[13] This suggests that anaemia severity does not directly influence the mode of delivery but rather exacerbates complications during and after delivery. ^[14]

The study findings reinforce the need for routine antenatal screening for anaemia and timely intervention, particularly in resource-limited settings. ^[15] Iron supplementation, dietary modifications, and treatment of underlying causes of anaemia should be prioritized to prevent progression to severe anaemia. ^[16] Additionally, healthcare providers should be vigilant in managing labour and delivery in anaemic women to reduce the risk of complications such as PPH and infections. ^[17]

This study has several limitations, including its retrospective design, which may introduce selection bias and incomplete data. The study was conducted at a single tertiary care centre, which may limit the generalizability of the findings. Future prospective studies with larger sample sizes and multi-centre participation are recommended to validate these results.

Severe anaemia in labouring women is associated with significantly worse maternal and neonatal outcomes compared to moderate anaemia. Early diagnosis, effective antenatal care, and prompt management of anaemia are crucial to improving outcomes for both mothers and their babies. Public health initiatives should focus on increasing awareness and access to anaemia prevention and treatment programs, particularly in high-risk populations.

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