Maternal anemia, characterized by reduced hemoglobin (Hb) levels, is a significant public health concern, particularly in low- and middle-income countries (1). The World Health Organization (WHO) defines anemia in pregnancy as an Hb concentration of less than 11 g/dL, further classified as mild (10–10.9 g/dL), moderate (7–9.9 g/dL), and severe (<7 g/dL) (2). Iron deficiency is the most common cause, though deficiencies in folate, vitamin B12, and chronic infections also contribute (3).

nemia during early pregnancy has been associated with adverse maternal and neonatal outcomes. Pregnant women with anemia have an increased risk of gestational hypertension, postpartum hemorrhage, and infections due to impaired oxygen delivery and immune function (4,5). Neonates born to anemic mothers are at higher risk of preterm birth, low birth weight (LBW), and being small for gestational age (SGA) due to placental insufficiency and intrauterine growth restriction (6,7). The severity of anemia directly correlates with the risk of complications, emphasizing the need for timely diagnosis and intervention (8).

Early detection through routine antenatal screening is critical for preventing complications and ensuring optimal maternal and fetal health. Laboratory investigations, including complete blood count (CBC), serum ferritin, and transferrin saturation levels, help in the early identification of iron deficiency anemia (9). Supplementation with iron and folic acid, dietary interventions, and management of underlying causes are essential in mitigating the risks associated with anemia in pregnancy (10).

Despite existing guidelines recommending early screening and treatment, anemia remains a widespread issue in maternal health (11). Understanding its impact and reinforcing early detection strategies are crucial for improving pregnancy outcomes. This study evaluates the association between maternal anemia in early pregnancy and adverse maternal and neonatal outcomes, emphasizing the importance of timely laboratory diagnosis and intervention.

Study Design and Participants

This prospective cohort study was conducted at a tertiary maternal and child health hospital. A total of 1,000 pregnant women, aged 18 years or older, were enrolled during their first antenatal visit, which occurred between 8 and 14 weeks of gestation. Participants were selected based on inclusion criteria that required singleton pregnancies and no pre-existing conditions such as chronic hypertension, diabetes, or hematological disorders.

Data Collection

Baseline demographic and clinical information was obtained through structured interviews and medical record reviews. Hemoglobin (Hb) levels were measured using an automated hematology analyzer, and anemia was categorized following the World Health Organization (WHO) criteria: mild (10–10.9 g/dL), moderate (7–9.9 g/dL), and severe (<7 g/dL).

Outcome Measures

The study examined the association between anemia severity and maternal and neonatal outcomes. Maternal complications included gestational hypertension and postpartum hemorrhage, while neonatal outcomes included preterm birth (delivery before 37 weeks of gestation), low birth weight (LBW, <2,500 g), and small for gestational age (SGA, birth weight below the 10th percentile for gestational age).

Statistical Analysis

Data were analyzed using logistic regression models to determine the adjusted odds ratios (aORs) for maternal and neonatal complications in relation to anemia severity. Adjustments were made for potential confounders such as maternal age, parity, body mass index (BMI), and socioeconomic status. A significance level of p < 0.05 was considered statistically significant.

Prevalence of Anemia in Early Pregnancy

Among the 1,000 pregnant women enrolled, 180 (18%) were diagnosed with anemia. The distribution of anemia severity was as follows: 90 women (9%) had mild anemia, 60 (6%) had moderate anemia, and 30 (3%) had severe anemia (Table 1).

Maternal Complications and Anemia Severity

The occurrence of maternal complications varied significantly based on anemia severity. Gestational hypertension was observed in 12% of women with mild anemia, 18% with moderate anemia, and 30% with severe anemia, compared to 8% in non-anemic women. Postpartum hemorrhage was recorded in 14% of mild anemia cases, 20% of moderate anemia cases, and 35% of severe anemia cases, while only 10% of non-anemic women experienced this complication (Table 2). Logistic regression analysis showed that the adjusted odds ratios (aOR) for gestational hypertension were 1.20 (95% CI: 0.90–1.60) for mild anemia, 1.50 (95% CI: 1.10–2.10) for moderate anemia, and 3.00 (95% CI: 2.00–4.50) for severe anemia (Table 3).

Neonatal Outcomes and Anemia Severity

Neonatal complications were significantly associated with maternal anemia. Preterm birth occurred in 15% of infants born to mothers with mild anemia, 22% with moderate anemia, and 40% with severe anemia, compared to 10% in the non-anemic group. Low birth weight was recorded in 18% of neonates from mild anemia cases, 25% from moderate anemia cases, and 45% from severe anemia cases, whereas only 12% of neonates from non-anemic mothers had low birth weight. Similarly, small for gestational age (SGA) infants were noted in 13% of mild anemia cases, 17% of moderate anemia cases, and 28% of severe anemia cases (Table 4).

Summary of Findings

The findings indicate a strong association between anemia severity and adverse pregnancy outcomes. Women with severe anemia had the highest risk of maternal and neonatal complications. The results highlight the need for early detection and intervention to prevent anemia-related adverse outcomes.

Table 1: Prevalence and Severity of Anemia in Early Pregnancy

Table 2: Maternal Complications Based on Anemia Severity

Table 3: Adjusted Odds Ratios (aOR) for Maternal Complications

Table 4: Neonatal Outcomes Based on Maternal Anemia Severity

(Tables 1–4 provide a summary of anemia prevalence, maternal complications, and neonatal outcomes.)

Maternal anemia in early pregnancy is a significant public health concern due to its impact on both maternal and neonatal health. This study demonstrated a strong association between anemia severity and adverse pregnancy outcomes, reinforcing the need for early detection and management. The prevalence of anemia in our cohort was 18%, with 9% classified as mild, 6% as moderate, and 3% as severe. These findings align with global estimates, where anemia affects 15–25% of pregnant women, particularly in low-resource settings (1,2).

Our results indicated that maternal complications such as gestational hypertension and postpartum hemorrhage were significantly associated with anemia severity. Women with severe anemia had three times the risk of developing gestational hypertension and four times the risk of postpartum hemorrhage compared to non-anemic women. These findings are consistent with previous studies that have reported an increased risk of hypertensive disorders due to reduced oxygen transport and endothelial dysfunction in anemic mothers (3,4). Iron deficiency anemia has been linked to impaired vascular adaptation during pregnancy, contributing to increased blood pressure and preeclampsia risk (5).

Postpartum hemorrhage, observed in 35% of women with severe anemia in this study, is another major concern. Anemic women have reduced oxygen-carrying capacity and impaired hemostatic function, which predisposes them to excessive blood loss during delivery (6,7). Several studies have reported similar trends, highlighting anemia as a major contributor to maternal mortality due to hemorrhagic complications (8). Timely iron supplementation and correction of anemia before delivery are essential to reducing these risks (9).

Neonatal complications such as preterm birth, low birth weight (LBW), and small for gestational age (SGA) were significantly associated with maternal anemia. Preterm birth occurred in 40% of infants born to mothers with severe anemia, a finding consistent with previous research indicating a two- to three-fold increase in preterm birth risk among anemic mothers (10,11). Inadequate oxygen and nutrient supply to the fetus due to anemia may lead to premature activation of labor pathways (12).

LBW was noted in 45% of neonates from severely anemic mothers, compared to 12% in the non-anemic group. The strong correlation between anemia and fetal growth restriction can be attributed to placental insufficiency and chronic hypoxia, which impair intrauterine growth (13,14). Studies have also shown that iron deficiency in early pregnancy disrupts fetal brain development and may have long-term neurodevelopmental consequences (15).

SGA prevalence was higher in anemic mothers, with the highest risk seen in the severe anemia group. These findings are consistent with earlier studies reporting a direct relationship between maternal Hb levels and fetal growth parameters (16,17). Effective antenatal screening and supplementation programs can help mitigate these risks and improve neonatal outcomes (18).

The findings of this study underscore the importance of early anemia detection through routine antenatal screening. Current guidelines recommend screening for anemia during the first trimester and initiating iron supplementation if Hb levels are below 11 g/dL (19). However, adherence to these guidelines varies, and many cases remain undiagnosed until later stages of pregnancy, when interventions are less effective (20).

Preventive strategies should focus on early identification and correction of iron deficiency through dietary counseling, oral iron therapy, and, in severe cases, intravenous iron administration. Fortification of staple foods with iron and folic acid has been successful in reducing anemia prevalence in many countries (21,22). Additionally, addressing underlying causes such as malaria, infections, and inadequate maternal nutrition is essential for a comprehensive approach to anemia management (23).

This study had certain limitations. The analysis was based on a single-center cohort, which may limit the generalizability of the findings. Additionally, other potential risk factors, such as genetic hemoglobinopathies and micronutrient deficiencies, were not assessed. Future research should focus on multicenter studies with a larger sample size to confirm these associations. Longitudinal studies evaluating the long-term effects of maternal anemia on child development and health outcomes are also warranted.

Maternal anemia in early pregnancy is associated with a significantly increased risk of maternal complications such as gestational hypertension and postpartum hemorrhage, as well as neonatal adverse outcomes, including preterm birth, low birth weight, and SGA. The severity of anemia directly correlates with the risk of these complications. Early laboratory diagnosis and timely interventions, including iron supplementation and nutritional support, are crucial to improving maternal and neonatal health outcomes. Strengthening antenatal screening programs and ensuring adherence to anemia prevention guidelines can play a vital role in reducing the burden of anemia-related complications.

1. Allen LH. Anemia and iron deficiency: effects on pregnancy outcome. Am J Clin Nutr. 2000 May;71(5 Suppl):1280S-4S.
2. Balarajan Y, Ramakrishnan U, Özaltin E, Shankar AH, Subramanian SV. Anaemia in low-income and middle-income countries. Lancet. 2011 Dec 17;378(9809):2123-35.
3. Beard JL. Why iron deficiency is important in infant development. J Nutr. 2008 Dec;138(12):2534-6.
4. Breymann C. Iron deficiency anemia in pregnancy. Semin Hematol. 2015 Oct;52(4):339-47.
5. Daru J, Zamora J, Fernández-Félix BM, Vogel J, Oladapo OT, Morisaki N, Tunçalp Ö, Torloni MR, Mittal S, Jayaratne K, Lumbiganon P, Thangaratinam S, Gulmezoglu AM, Khan KS. Risk of maternal mortality in women with severe anaemia during pregnancy and post partum: a multilevel analysis. Lancet Glob Health. 2018 May;6(5):e548-54.
6. Geng F, Mai X, Zhan J, Xu L, Zhao Z, Georgieff M, Shao J. Impact of fetal-neonatal iron deficiency on recognition memory at 2 months of age. J Pediatr. 2015 Dec;167(6):1226-32.e1.
7. Iqbal S, Ekmekcioglu C. Maternal anemia and iron deficiency in pregnancy: an overview of effects on the offspring and the need for early intervention. J Matern Fetal Neonatal Med. 2019 May;32(9):1528-40.
8. Kozuki N, Lee AC, Katz J; Child Health Epidemiology Reference Group. Moderate to severe, but not mild, maternal anemia is associated with increased risk of small-for-gestational-age outcomes. J Nutr. 2012 Feb;142(2):358-62.
9. Milman N. Iron and pregnancy—a delicate balance. Ann Hematol. 2011 Jul;90(7):733-9.
10. Peña-Rosas JP, De-Regil LM, Garcia-Casal MN, Dowswell T. Daily oral iron supplementation during pregnancy. Cochrane Database Syst Rev. 2015 Jul 22;(7):CD004736.
11. Rahman MM, Abe SK, Kanda M, Narita S, Rahman MS, Bilano V, Ota E, Gilmour S, Shibuya K. Maternal anemia and risk of adverse birth and health outcomes in low- and middle-income countries: systematic review and meta-analysis. Am J Clin Nutr. 2016 Feb;103(2):495-504.
12. Scholl TO. Iron status during pregnancy: setting the stage for mother and infant. Am J Clin Nutr. 2005 May;81(5):1218S-22S.
13. Sholeye OO, Badejo CA, Jeminusi OA. Anemia in pregnancy and its associated factors among primary care clients in Sagamu, southwestern Nigeria: a facility-based study. J Family Med Prim Care. 2017 Apr-Jun;6(2):323-9.
14. Sifakis S, Pharmakides G. Anemia in pregnancy. Ann N Y Acad Sci. 2000 Apr;900:125-36.
15. Sukumar N, Rafnsson SB, Kandala NB, Bhopal R, Yajnik CS, Saravanan P. Prevalence of vitamin B-12 insufficiency during pregnancy and its effect on offspring birth weight: a systematic review and meta-analysis. Am J Clin Nutr. 2016 May;103(5):1232-51.
16. Turner RE, Langkamp-Henken B. The effect of vitamin B12 on the growth of infants: a literature review. J Nutr Educ. 1992 Jan-Feb;24(1):21-8.
17. VanderJagt DJ, Brock HS, Melah GS, El-Nafaty AU, Crossey MJ, Glew RH. Nutritional factors associated with anemia in pregnant women in northern Nigeria. J Health Popul Nutr. 2007 Mar;25(1):75-81.
18. World Health Organization. Nutritional anaemias: tools for effective prevention and control. Geneva: WHO; 2017.
19. World Health Organization. The global prevalence of anaemia in 2011. Geneva: WHO; 2015.
20. Young MF, Oaks BM, Tandon S, Martorell R, Dewey KG, Wendt AS. Maternal hemoglobin concentrations across pregnancy and maternal and child health: a systematic review and meta-analysis. Ann N Y Acad Sci. 2019 Aug;1450(1):47-68.
21. Zhou LM, Yang WW, Hua JZ, Deng CQ, Tao X, Stoltzfus RJ. Relation of hemoglobin measured at different times in pregnancy to preterm birth and low birth weight in Shanghai, China. Am J Epidemiol. 1998 Dec 1;148(10):998-1006.
22. Zhu L, Fang H, Zhou L, Tao F, Zhang Y, Zhang H, Cao H, Zhu P. Effect of maternal anemia during pregnancy on infant development: a prospective birth cohort study in China. J Matern Fetal Neonatal Med. 2015;28(17):2101-5.
23. Zhu T, Tang J, Zhao F, Qu Y, Mu D. Association between maternal anemia and neural tube defects in offspring: a meta-analysis. Arch Gynecol Obstet. 2015 Oct;292(4):777-84.