European Journal of Cardiovascular Medicine

Anaemia during pregnancy, particularly iron deficiency anaemia (IDA), is a prevalent and critical health issue affecting millions of women globally, with a higher incidence in developing countries^1,2. In India, the prevalence of anaemia in pregnancy is reported to be as high as 80%, making it one of the leading causes of maternal morbidity and mortality³. Iron deficiency is the most common cause of anaemia, contributing to a wide range of complications during pregnancy, labor, and the postpartum period⁴. Anaemia during pregnancy can lead to insufficient oxygen delivery to both the mother and fetus, resulting in adverse outcomes such as preterm birth, low birth weight, and increased risk of maternal complications like postpartum hemorrhage and infection⁵.

Pregnancy is a state of increased iron demand due to the expansion of blood volume, fetal growth, and placental development⁶. However, the availability of iron is often insufficient, especially in women with inadequate dietary intake, poor iron absorption, or other underlying conditions such as hookworm infestations or malarial infections. The impact of maternal anaemia on fetal outcomes is also significant, as it can lead to intrauterine growth restriction, birth asphyxia, and higher perinatal mortality rates⁷.

Despite the known risks, there remains a gap in understanding the full extent of maternal and fetal outcomes associated with anaemia in pregnancy, particularly in cases with varying degrees of iron deficiency. This study aims to compare maternal and perinatal outcomes between anaemic pregnancies with iron deficiency and non-anaemic pregnancies, emphasizing the need for timely diagnosis, prevention, and management of anaemia to improve maternal and neonatal health outcomes.

This prospective randomized case-control study was conducted from December 2020 to November 2022 at the Department of Obstetrics and Gynecology, KIMS & RF, Amalapuram, Andhra Pradesh. The study aimed to evaluate the maternal and perinatal outcomes in anaemic pregnancies with iron deficiency and non-anaemic pregnancies.

A total of 200 pregnant women were included in the study, with 100 women in the anaemic group and 100 women in the control (non-anaemic) group. The inclusion criteria for the anaemic group were pregnant women with hemoglobin levels less than 11 g/dl (as per WHO guidelines), while the control group comprised healthy pregnant women with normal hemoglobin levels (≥11 g/dl). Pregnant women with chronic medical conditions, multiple pregnancies, or those receiving iron supplementation prior to pregnancy were excluded from the study.

Study Design

This was a randomized case-control study. The subjects were randomly assigned to either the anaemic or control group, with a cutoff for anemia set at 10 g/dl. The anaemic group was further classified into three categories based on the severity of anaemia:

Mild anaemia (Hb 8-10 g/dl)

Moderate anaemia (Hb 6.5-8 g/dl)

Severe anaemia (Hb < 6.5 g/dl)

Data Collection

Data were collected through a combination of clinical examinations, laboratory tests, and maternal and fetal health assessments. The following parameters were recorded:

Demographic and Clinical Information: Age, socioeconomic status, parity, antenatal care (ANC) visits, and birth spacing were noted.

Severity of Anaemia: Hemoglobin levels were measured, and the degree of anaemia was categorized based on WHO guidelines.

Maternal Outcomes: Incidence of preterm birth, postpartum hemorrhage, maternal morbidity, and mode of delivery were recorded.

Fetal Outcomes: Preterm birth, stillbirth, early neonatal death (ENND), low birth weight, birth asphyxia, and neonatal morbidity were assessed.

Neonatal Morbidity: Neonatal complications such as respiratory distress syndrome (RDS), jaundice, meconium aspiration syndrome (MAS), and birth asphyxia were documented.

Statistical Analysis

The data were analyzed using SPSS version 21.0. Descriptive statistics were used to summarize demographic data and outcomes. Chi-square tests were employed to compare the frequencies of maternal and fetal outcomes between the anaemic and control groups. A p-value of less than 0.05 was considered statistically significant.

Ethical Considerations

Ethical approval for the study was obtained from the Institutional Ethics Committee of KIMS & RF, Amalapuram. Informed consent was obtained from all participants before their inclusion in the study, and confidentiality of the data was ensured throughout the research process.

The study included 200 pregnant women, with 100 participants in the anaemic group and 100 in the control group. The distribution of study subjects by age is shown in Table 1. The majority of participants in both groups were between 20-29 years of age, with 79% in the anaemic group and 84% in the control group. There was no significant difference between the two groups in terms of age distribution (p = 0.66, Chi-square test).

Table 1: Distribution of Study Subjects by Age

Table 2 presents the distribution of subjects according to socioeconomic status (SES). A significantly higher percentage of the anaemic group (67%) came from lower SES backgrounds compared to the control group (15%).

Table 2: Distribution of Subjects According to Socioeconomic Status (SES)

Figure No:1. Distribution of Subjects According to Socioeconomic Status

The severity of anaemia in the anaemic group is detailed in Table 3. Of the 100 participants in the anaemic group, 58% were mildly anaemic (Hb 8-10 g/dl), 23% were moderately anaemic (Hb 6.5-8 g/dl), and 21% were severely anaemic (Hb < 6.5 g/dl).

Table 3: Distribution According to Severity of Anaemia

Figure No:2. Distribution According to Severity of Anaemia

Maternal outcomes were assessed and are presented in Table 4. The anaemic group had a significantly higher incidence of preterm birth (8%) compared to the control group (2%), postpartum hemorrhage (7% vs. 1%), and maternal morbidity (17.5% vs. 2%).

Table 4: Maternal Outcomes in Anaemic vs. Non-Anaemic Groups

Figure No:3. Maternal Outcomes in Anaemic vs. Non-Anaemic Groups

Fetal outcomes, as shown in Table 5, indicated a higher prevalence of adverse outcomes in the anaemic group compared to the control group. Preterm birth was observed in 8% of the anaemic group versus 2% in the control group. Additionally, the anaemic group had higher rates of stillbirth (3% vs. 0%), early neonatal death (ENND) (4% vs. 0%), low birth weight (22% vs. 3%), birth asphyxia (7% vs. 2%), and neonatal morbidity (17.5% vs. 6%).

Table 5: Fetal Outcomes in Anaemic vs. Non-Anaemic Groups

Figure No:4. Fetal Outcomes in Anaemic vs. Non-Anaemic Groups

Neonatal morbidity in the anaemic group is further broken down in Table 6. Respiratory distress syndrome (RDS) was more common in the anaemic group (3%) compared to the control group (1%), while meconium aspiration syndrome (MAS) occurred in 10% of the anaemic group, compared to only 1% in the control group. Statistically, neonatal morbidity in the anaemic group was significantly higher than in the control group (p = 0.05).

Table 6: Neonatal Morbidity in Anaemic vs. Non-Anaemic Groups

p = 0.05 (Significant)

Figure No:5. Neonatal Morbidity in Anaemic vs. Non-Anaemic Groups

Table 7 shows the perinatal mortality data. The anaemic group had a perinatal mortality rate of 7%, with 3% stillbirth and 4% early neonatal death (ENND). In contrast, there was no perinatal mortality observed in the control group.

Table 7: Perinatal Mortality in Anaemic vs. Non-Anaemic Groups

Maternal morbidity, detailed in Table 8, was also higher in the anaemic group. The anaemic group experienced higher rates of failed lactation (4%), wound dehiscence (6%), febrile morbidity (5%), and subinvolution of the uterus (1%) compared to the control group, which reported a total maternal morbidity rate of 2%.

Table 8: Maternal Morbidity in Anaemic vs. Non-Anaemic Groups

Anaemia in pregnancy, particularly iron deficiency anaemia, remains a significant public health issue due to its detrimental effects on both maternal and fetal health. The findings from this study highlight a stark contrast between anaemic and non-anaemic pregnancies, with significant differences in maternal morbidity, preterm birth, and fetal outcomes.

The results indicate that anaemia is associated with increased rates of preterm birth, postpartum hemorrhage, and maternal morbidity. These findings are consistent with previous research, suggesting that anaemia can lead to complications such as impaired uteroplacental blood flow, which may contribute to premature labor and an increased risk of hemorrhage (Iglesias-Vázquez et al., 8; Parks et al., 10). The higher maternal morbidity in anaemic women, especially with severe anaemia, may be attributed to the reduced oxygen-carrying capacity of the blood, compromising tissue perfusion and raising the likelihood of complications during labor (Levy et al., 13).

Fetal outcomes in the anaemic group also showed concerning trends. Higher rates of stillbirth, early neonatal death, low birth weight, and neonatal morbidity were observed, supporting the hypothesis that anaemia, particularly iron deficiency, compromises fetal health. Iron is a critical nutrient for fetal growth and development, and an insufficient supply can lead to impaired fetal oxygenation and growth restriction (Charan et al., 12; Bone et al., 14). The higher incidence of neonatal complications, such as respiratory distress syndrome and meconium aspiration syndrome, further underscores the negative impact of anaemia on fetal well-being (Stephen et al., 11; Safarzadeh et al., 9).

These findings emphasize the importance of early diagnosis and management of anaemia in pregnancy. Screening for anaemia should be a routine part of prenatal care, particularly in regions where iron deficiency is prevalent. Timely intervention with iron supplementation or other therapeutic measures can help reduce the risks of adverse outcomes and improve both maternal and neonatal health (Iglesias-Vázquez et al., 8; Parks et al., 10).

Anaemia, particularly iron deficiency anaemia, significantly affects maternal and fetal health, as evidenced by higher rates of preterm birth, postpartum hemorrhage, maternal morbidity, stillbirth, early neonatal death, low birth weight, and neonatal complications in anaemic pregnancies. The findings highlight the critical need for early screening and intervention to prevent and manage anaemia during pregnancy. Iron supplementation and other therapeutic measures can improve maternal and neonatal outcomes by addressing the underlying deficiency. Given the potential consequences of untreated anaemia, it is crucial to implement routine screening and appropriate management strategies to reduce risks and enhance overall maternal and fetal health. Early diagnosis and intervention remain key to mitigating the adverse effects of anaemia during pregnancy.

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