Anaemia is a global public health concern that is especially common in underdeveloped nations among expectant mothers. Anaemia, defined by the World Health Organisation (WHO) as a haemoglobin concentration below 11 g/dL during pregnancy, affects around 40% of pregnant women globally and is a major cause of morbidity and death for both mothers and perinatals (WHO, 2016).[1] Anaemia is still a major concern despite decades of public health initiatives, particularly in low- and middle-income nations like India where socioeconomic factors and nutritional deficiencies significantly increase the prevalence of the condition (Kalaivani, 2015 and Pasricha et al., 2018).[2,3]

Because pregnancy increases the need for iron to sustain the growth of the foetus and the expansion of the mother's blood volume, pregnant women are physiologically predisposed to anaemia. About half of all cases of anaemia worldwide are caused by iron deficiency, although depending on the location, other factors like hemoglobinopathies, infections (like malaria or hookworm), and deficiencies in vitamin B12 and folate can also be important (Balarajan et al., 2011; WHO, 2015).[4,5] Widespread poverty, food insecurity, restricted access to healthcare, and traditional dietary patterns all contribute to iron deficiency anaemia (IDA) in India by impeding proper micronutrient intake (NFHS-4, 2017).[6]

Pregnancy-related anaemia has serious repercussions. Preterm delivery, low birth weight, intrauterine growth restriction (IUGR), maternal death, and poor cognitive development in kids are all linked to maternal anaemia (Kassebaum et al., 2016; Peña-Rosas et al., 2015).[7,8] Perinatal mortality, postpartum haemorrhage, and heart failure are all markedly increased by severe anaemia (Zeng et al., 2019).[9] Additionally, anaemia can have a detrimental impact on a woman's productivity, quality of life, and capacity to provide for her family (Pasricha et al., 2018).[3]

Despite government initiatives like the National Iron Plus Initiative (Anaemia Mukt Bharat), which aims to lower the prevalence of anaemia by encouraging iron-folic acid supplementation, deworming, and nutrition education, the prevalence of anaemia among pregnant women in India is still shockingly high (MoHFW, 2018).[10] The National Family Health Survey (NFHS-4, 2015-16) found that 50.3% of pregnant Indian women were anaemic, with prevalence rates as high as 70–80% in some states (IIPS, 2017). Similar high prevalence rates are seen in Gujarat, the study's location, particularly in rural areas with little access to healthcare (Das et al., 2017).[11]

Important sociodemographic and obstetric risk factors linked to anaemia during pregnancy have been found by a number of research. These include dietary practices, prenatal care use, mother age, parity, socioeconomic position, educational attainment, and the time between pregnancies (Balarajan et al., 2011; Das et al., 2017; Pandey et al., 2018).[4,11,12] Due to societal and biological reasons, younger moms and women who are multigravida are especially at risk (Tuyet et al., 2018).[13] The risk of anaemia is increased by low socioeconomic position and low educational attainment, which restrict access to wholesome diets and medical care (Pasricha et al., 2018).[3]

In order to enable early diagnosis and treatment, screening for anaemia is an essential part of prenatal care (ANC). During pregnancy, the World Health Organisation advises regular haemoglobin assessment, preferably during the first ANC visit and again in the third trimester (WHO, 2016). [1] Iron-folic acid supplements, infection therapy, and nutritional counselling are all part of management (Peña-Rosas et al., 2015).[8] However, in many situations, obstacles such low health literacy, side effects, and poor compliance make treatments less successful (Pasricha et al., 2018).[3]

The purpose of the current study is to determine the prevalence of anaemia in pregnant patients who visit the ANC outpatient service at the G. G. Hospital and Shri M. P. Shah Government Medical College in Jamnagar, Gujarat. Serving a mixed urban-rural population, this tertiary care facility offers a representative sample for assessing the load in the area. In order to identify high-risk populations and guide focused treatments, the study also investigates sociodemographic and obstetric variables linked to anaemia.

In order to optimise resource allocation and customise public health policies, it is essential to comprehend the local incidence and drivers of anaemia. Persistently high anaemia rates, in spite of national initiatives, point to implementation difficulties and emphasise the necessity for context-specific remedies. By supplementing national surveys and regional research with up-to-date data from a Gujarati tertiary care context, this study adds to the body of knowledge.

Study Design and Setting

A cross-sectional observational study was conducted over two months (March-April 2025) at the Antenatal Care Outpatient Department of Shri M. P. Shah Govt. Medical College and G. G. Hospital, Jamnagar, Gujarat, India. This tertiary care center caters to a diverse patient population from urban and rural areas.

Sample Size and Sampling

A total of 100 pregnant women attending the ANC OPD during the study period were enrolled consecutively. Inclusion criteria were: all pregnant women regardless of gestational age willing to participate and give informed consent. Women with chronic illnesses affecting hemoglobin levels (e.g., hemoglobinopathies, chronic kidney disease) were excluded.

Data Collection

Data were collected by personal interview using a pre-designed questionnaire covering sociodemographic variables (age, education, socioeconomic status), obstetric history (parity, gestational age), dietary habits, and clinical symptoms related to anemia.

Clinical Examination and Hemoglobin Estimation

General physical examination was conducted with emphasis on pallor and vital signs. Hemoglobin estimation was performed using a standardized automated hematology analyzer in the hospital laboratory.

Definition of Anemia

Anemia was defined according to WHO criteria as Hb < 11 g/dL in pregnancy. It was classified as mild (10.0-10.9 g/dL), moderate (7.0-9.9 g/dL), and severe (<7.0 g/dL) (WHO, 2016).

Ethical Considerations

The study was approved by the Institutional Ethics Committee of Shri M. P. Shah Govt. Medical College. Written informed consent was obtained from all participants before enrollment.

Statistical Analysis

Data were entered and analyzed using SPSS version 22. Descriptive statistics (means, percentages) were calculated. Chi-square test was used to assess associations between anemia and categorical variables. A p-value <0.05 was considered statistically significant.

Table 1: Sociodemographic Characteristics of Study Participants (N=100)

                                             *Based on Modified BG Prasad classification.

The distribution of the study population by age, socioeconomic position, and level of education is shown in this table. The bulk of participants (45%) were in the 20–25 age range, with 25% falling into the 26–30 age range. According to the Modified BG Prasad categorisation, the majority of the sample (68%) belonged to the lowest socioeconomic class. Only 15% of participants had completed graduation or higher, and 40% of participants had only completed basic school or were illiterate, suggesting a poorer general educational profile among the research group.

Table 2: Obstetric Characteristics of Participants

The distribution of participants' parity and gestational ages is shown in this table. Primigravida women made up 40% of the sample, whilst multigravida women made up 60%. At the time of data collection, more than half (55%) were in their second trimester, 30% were in their third trimester, and 15% were in their first trimester.

Table 3: Prevalence and Severity of Anemia

                                            *Percentages calculated among anemic women.

The frequency and severity of anaemia in the individuals are shown in this table. In 62% of the research participants, anaemia (defined as haemoglobin <11 g/dL) was observed. Mild anaemia was seen in 56.45% of the anaemic subjects, moderate anaemia in 35.48%, and severe anaemia in 8.06%. These results demonstrate that anaemia, in varied degrees of severity, afflicted a considerable percentage of pregnant women.

Table 4: Association of Anemia with Selected Variables

                           *Statistically significant at p < 0.05.

The statistical relationship between anaemia and important dietary and demographic variables is examined in this table. Women over 25 (p = 0.04), multigravida women (p = 0.03), those with lower socioeconomic level (p = 0.02), and those who reported consuming insufficient amounts of iron-rich foods (p = 0.01) were all much more likely to suffer from anaemia. All of these correlations were statistically significant (p < 0.05), indicating that these variables could be involved in the research group's increased anaemia prevalence.

One of the most prevalent health issues in the world, especially in low- and middle-income nations, is anaemia during pregnancy. The purpose of this cross-sectional study was to determine the prevalence of anaemia among 100 pregnant patients who visited the Antenatal Care (ANC) OPD of Shri M. P. Shah Government Medical College and G. G. Hospital in Jamnagar. According to our findings, 64% of the women had anaemia, which is a worrying percentage and in line with comparable research done in India.

Haemoglobin (Hb) values below 11 g/dL are considered anaemia in pregnancy by the World Health Organisation (WHO). The observed prevalence rate of 64% is consistent with the findings of the National Family Health Survey-5 (NFHS-5), which found that over 50% of Indian pregnant women suffer from anaemia [6]. Despite national initiatives to prevent anaemia, this significant burden suggests persistent public health issues. Upon stratification by severity, mild anaemia (Hb 10–10.9 g/dL) accounted for the majority of our anaemic individuals, followed by moderate anaemia (Hb 7–9.9 g/dL) and a tiny proportion with severe anaemia (Hb <7 g/dL). These results are in line with Shah AR et al. (2016)[14] and other research conducted in Gujarat and nearby states. Although mild anaemia is frequently clinically undetectable, if treatment is not received, it can lead to poor neonatal outcomes, lethargy, and diminished job ability.

According to sociodemographic data, women between the ages of 21 and 30 were most impacted, which is in line with the age group that visits ANC clinics the most frequently. The prevalence of anaemia was statistically significantly inversely correlated with education level. Anaemia rates were greater among women who were illiterate (78%) than among those who had at least a secondary education (35%). This confirms the results of Toteja et al. and Kalaivani K et al. that link low maternal education to unhealthy eating patterns and a decrease in health-seeking behaviour [15,16].

The prevalence of anaemia was also impacted by socioeconomic level and employment. Anaemia was more common among homemakers and women from low-income households, highlighting the interaction of poverty, inadequate nutrition, and restricted access to medical treatment Bentley ME et al. [17]. Perhaps as a result of shared family resources and support, women from joint families reported better dietary behaviours than those from nuclear households.

The major causes of anaemia during pregnancy continue to be nutritional deficits, particularly those related to iron and folate. Dietary history showed poor adherence to iron-folic acid (IFA) supplementation, low intake of iron-rich foods, and insufficient dietary diversification. Even though daily IFA pills are advised by national policy throughout pregnancy, only 58% of participants said they regularly took them. In other Indian trials, noncompliance was related to lack of knowledge, forgetfulness, and gastrointestinal side effects Mithra P et al. [18]. Additionally, the deworming state was not ideal. In order to reduce parasite blood loss in endemic areas, deworming treatment is crucial, yet only 34% of pregnant women reported having had it. The WHO advises deworming in the second trimester for women in high-burden settings because parasitic infections, particularly hookworm, aggravate anaemia and increase iron loss [19]. The occurrence of anaemia was similarly impacted by parity. Because of cumulative nutritional depletion and a lack of attention to maternal nutrition in future pregnancies, multigravida women had greater anaemia rates than primigravida women. Numerous observational studies have documented this tendency Balarajan Y, et al. [20]. Our setting's high anaemia incidence necessitates focused public health initiatives. There are still implementation gaps despite India's Anaemia Mukt Bharat (AMB) program's goal of reducing anaemia among pregnant women by 3% annually. The issue might be lessened by enhancing community-level screening, enhancing prenatal nutrition counselling, guaranteeing IFA availability, and removing obstacles to compliance. Serious maternal and foetal problems, such as premature labour, low birth weight, intrauterine growth restriction, and elevated maternal mortality, are linked to anaemia during pregnancy Lone FW et al. [21]. Screening for anaemia should be a crucial part of ANC visits as early identification and care can avert many of these consequences.

The significance of behavioural change communication (BCC) techniques is further emphasised by our study. Health professionals should emphasise the advantages of IFA and deworming and offer individualised counselling on the use of iron-rich foods (such as legumes, green leafy vegetables, and fortified foods). Furthermore, as they frequently have an impact on food choices in the home, male partners and family elders should be included in health education initiatives. In conclusion, pregnant women who visit the ANC clinic in Jamnagar continue to suffer greatly from anaemia. Its occurrence is largely influenced by sociodemographic characteristics including parity, economic level, and education. Increased education, awareness, and consistent healthcare delivery are necessary to increase maternal nutrition and supplements compliance.

Anaemia was found to be highly prevalent (64%) among pregnant women who visited the prenatal care outpatient department (OPD) at Shri M. P. Shah Government Medical College and G. G. Hospital in Jamnagar, according to this cross-sectional study. The most prevalent kind of anaemia was mild anaemia, which mostly afflicted women from lower socioeconomic origins, those with less education, and those with multiple sclerosis. Significant contributing causes included inadequate nutrition, noncompliance with iron-folic acid intake, and insufficient deworming.

Our results highlight the necessity of bolstering curative and preventative approaches, particularly through better nutrition education, higher iron supplements compliance, regular deworming, and early screening. To successfully lower the incidence of anaemia, comprehensive prenatal programs must incorporate community-based treatments and behaviour change communication. Achieving improved maternal and foetal health outcomes requires empowering women via education and guaranteeing fair access to healthcare. Careful ANC services and targeted public health policies can help close the gaps and make a significant contribution to national objectives like Anaemia Mukt Bharat.

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