Background: Maternal anemia remains one of the most common nutritional and hematological disorders during pregnancy, especially in developing countries. It is associated with adverse maternal and neonatal outcomes including operative deliveries, postpartum complications, and poor neonatal health. Objective: To evaluate the impact of maternal anemia on mode of delivery, surgical interventions, and neonatal outcomes among pregnant women delivering in a tertiary care hospital. Methods: A prospective hospital-based observational study was conducted among 300 pregnant women admitted for delivery. Participants were divided into two groups: anemic mothers (Hb <11 g/dL; n=180) and non-anemic mothers (Hb ≥11 g/dL; n=120). Maternal demographic details, mode of delivery, surgical interventions, maternal complications, and neonatal outcomes were recorded and analyzed. Results: Cesarean section rate was significantly higher among anemic mothers (38.9%) compared to non-anemic mothers (23.3%). Instrumental delivery was also more frequent in anemic women (11.1% vs 5.8%). Postpartum hemorrhage, blood transfusion requirement, and prolonged hospital stay were significantly higher among anemic mothers. Neonates born to anemic mothers had significantly higher rates of low birth weight, NICU admission, low Apgar score, and prematurity. Conclusion: Maternal anemia was significantly associated with increased operative delivery, surgical complications, and poor neonatal outcomes. Early detection and treatment of anemia during pregnancy are essential to improve maternal and neonatal health.
Maternal anemia is a major public health concern worldwide and is particularly prevalent in low- and middle-income countries. According to the World Health Organization, anemia affects nearly 40% of pregnant women globally. Iron deficiency remains the most common cause, followed by folate deficiency, infections, and chronic diseases.
Anemia during pregnancy reduces oxygen-carrying capacity, leading to maternal fatigue, poor uterine contractility, increased risk of operative intervention, postpartum hemorrhage, and infections. It also adversely affects fetal growth and survival, resulting in low birth weight, preterm birth, birth asphyxia, and increased neonatal intensive care admissions.
India carries a substantial burden of maternal anemia despite national supplementation programs. Understanding its impact on delivery outcomes is essential for planning interventions. Therefore, the present study was conducted to assess the effect of maternal anemia on mode of delivery, surgical interventions, and neonatal health outcomes.
Study Design and Setting Prospective observational study conducted in the Department of Obstetrics and Gynecology of a tertiary care teaching hospital from January 2020 to December 2020. Study Population A total of 300 pregnant women admitted for delivery after 37 weeks gestation were enrolled. Inclusion Criteria • Singleton pregnancy • Term pregnancy (≥37 weeks) • Women willing to participate Exclusion Criteria • Multiple pregnancy • Known hematological disorders • Major fetal congenital anomaly • Severe chronic systemic illness Grouping • Group A: Anemic mothers (Hb <11 g/dL) = 180 • Group B: Non-anemic mothers (Hb ≥11 g/dL) = 120 Data Collection Data recorded included age, parity, hemoglobin level, mode of delivery, cesarean indications, instrumental delivery, maternal complications, neonatal birth weight, Apgar score, NICU admission, and prematurity. Statistical Analysis Data analyzed using SPSS version 22. Chi-square test and Student’s t-test were used. p<0.05 considered statistically significant.
A total of 300 pregnant women were included in the study. Among them, 180 women (60.0%) were anemic and 120 women (40.0%) were non-anemic.
Table 1: Demographic Profile
|
Variable |
Anemic Mothers (n=180) |
Non-anemic Mothers (n=120) |
|
Mean age (years) |
25.8 ± 4.3 |
27.1 ± 4.6 |
|
Primigravida |
102 (56.7%) |
58 (48.3%) |
|
Multigravida |
78 (43.3%) |
62 (51.7%) |
|
Mean Hb (g/dL) |
9.2 ± 1.1 |
11.8 ± 0.7 |
The mean maternal age in the anemic group was slightly lower (25.8 ± 4.3 years) compared with non-anemic mothers (27.1 ± 4.6 years). Primigravida women were more common among anemic mothers (56.7%), whereas multigravida women predominated slightly in the non-anemic group.
Table 2: Mode of Delivery and Surgical Interventions
|
Outcome |
Anemic Mothers |
Non-anemic Mothers |
p-value |
|
Normal vaginal delivery |
90 (50.0%) |
85 (70.8%) |
0.001 |
|
Cesarean section |
70 (38.9%) |
28 (23.3%) |
0.006 |
|
Instrumental delivery |
20 (11.1%) |
7 (5.8%) |
0.04 |
Normal vaginal delivery was significantly lower among anemic mothers (50.0%) compared with non-anemic mothers (70.8%).
Cesarean section rate was significantly higher among anemic mothers, occurring in 70 women (38.9%) compared with only 28 women (23.3%) in the non-anemic group (p=0.006).
Instrumental vaginal delivery (forceps/vacuum) was also significantly higher in anemic mothers (11.1%) than non-anemic mothers (5.8%) (p=0.04).
These findings suggest that maternal anemia is strongly associated with increased operative and assisted deliveries.
Table 3: Maternal Complications
|
Outcome |
Anemic Mothers |
Non-anemic Mothers |
p-value |
|
Postpartum hemorrhage |
22 (12.2%) |
6 (5.0%) |
0.03 |
|
Blood transfusion |
28 (15.6%) |
4 (3.3%) |
<0.001 |
|
Wound infection |
12 (6.7%) |
3 (2.5%) |
0.08 |
|
Fever |
16 (8.9%) |
5 (4.2%) |
0.09 |
|
Mean hospital stay (days) |
5.6 ±1.5 |
4.1 ±1.0 |
<0.001 |
Postpartum hemorrhage occurred in 22 anemic mothers (12.2%), significantly higher than 6 women (5.0%) in the non-anemic group.
Table 4: Neonatal Outcomes
|
Outcome |
Anemic Mothers |
Non-anemic Mothers |
p-value |
|
Low birth weight (<2.5 kg) |
58 (32.2%) |
16 (13.3%) |
<0.001 |
|
Low Apgar (<7 at 5 min) |
26 (14.4%) |
7 (5.8%) |
0.02 |
|
NICU admission |
34 (18.9%) |
9 (7.5%) |
0.007 |
|
Prematurity |
30 (16.7%) |
8 (6.7%) |
0.01 |
|
Neonatal jaundice |
18 (10.0%) |
8 (6.7%) |
0.29 |
Blood transfusion requirement was markedly higher among anemic mothers (15.6%) compared with non-anemic mothers (3.3%), showing high statistical significance.
Wound infection and postpartum fever were also more common among anemic mothers, although not statistically significant.
Mean hospital stay was significantly prolonged in anemic mothers (5.6 ±1.5 days) compared with non-anemic mothers (4.1 ±1.0 days), reflecting delayed recovery and increased morbidity.
Low birth weight was significantly more common among babies born to anemic mothers (32.2%) compared with non-anemic mothers (13.3%).
Low Apgar score at 5 minutes occurred in 14.4% of neonates in the anemic group, significantly higher than 5.8% in the non-anemic group.
NICU admission was required in 18.9% of neonates born to anemic mothers versus 7.5% among non-anemic mothers.
Prematurity was significantly higher in anemic pregnancies (16.7%) compared to non-anemic pregnancies (6.7%).
Neonatal jaundice was slightly more common in the anemic group but did not show statistical significance.
The present study demonstrated that maternal anemia significantly increased the risk of cesarean section, instrumental delivery, postpartum hemorrhage, blood transfusion, and prolonged hospitalization.
Additionally, neonates born to anemic mothers had significantly higher rates of low birth weight, prematurity, low Apgar score, and NICU admission.
These findings highlight the critical need for early diagnosis, iron supplementation, nutritional counseling, and regular antenatal monitoring.
The neonatal effects observed in this study are likely due to chronic placental hypoxia and impaired fetal growth. Similar findings have been reported in several Indian and international studies.
Maternal anemia is significantly associated with adverse delivery outcomes and neonatal morbidity. Strengthening antenatal screening and effective anemia management programs can substantially improve pregnancy outcomes.
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