Association between maternal anaemia and pregnancy outcomes: a cohort study in Assam, India

Abstract

ObjectivesTo examine the association between maternal anaemia and adverse maternal and infant outcomes, and to assess the feasibility of conducting epidemiological studies through the Indian Obstetric Surveillance System–Assam (IndOSS-Assam).DesignRetrospective cohort study using anonymised hospital records. Exposure: maternal iron deficiency anaemia; outcomes: postpartum haemorrhage (PPH), low birthweight, small-for-gestational age babies, perinatal death.Setting5 government medical colleges in Assam.Study population1007 pregnant women who delivered in the 5 medical colleges from January to June 2015.Main outcome measuresORs with 95% CIs to estimate the association between maternal iron deficiency anaemia and the adverse maternal and infant outcomes. Potential interactive roles of infections and induction of labour on the adverse outcomes were explored.Results35% (n=351) pregnant women had moderate–severe anaemia. Women with severe anaemia had a higher odds of PPH (adjusted OR (aOR) =9.45; 95% CI 2.62 to 34.05), giving birth to low birthweight (aOR=6.19; 95% CI 1.44 to 26.71) and small-for-gestational age babies (aOR=8.72; 95% CI 1.66 to 45.67), and perinatal death (aOR=16.42; 95% CI 4.38 to 61.55). Odds of PPH increased 17-fold among women with moderate–severe anaemia who underwent induction of labour, and 19-fold among women who had infection and moderate–severe anaemia.ConclusionsMaternal iron deficiency anaemia is a major public health problem in Assam. Maternal anaemia was associated with increased risks of PPH, low birthweight, small-for-gestational age babies and perinatal death. While the best approach is prevention, a large number of women present with severe anaemia late in pregnancy and there is no clear guidance on how these women should be managed during labour and delivery.

Prevalence of maternal anemia and its impact on perinatal outcome in a rural area of Dakshina Kannada

“…It may be because of complicated pregnancies and late approach to health-care center during the period of labor pain and delivery. Among anemic mothers, the risk of perinatal mortality was high, which was similar to the study conducted by Nair et al [15] and Lone et al [16] The study showed a significant association between maternal anemia and perinatal mortality, which was already established in many studies. Nair et al [17] and Sangeeta and Pushpalatha [18] also showed that the risk of IUGR was more in anemic mothers and the findings are similar to our study.…”

Prevalence of Maternal Anemia in Pregnancy: The Effect of Maternal Hemoglobin Level on Pregnancy and Neonatal Outcome

“…Nair et al in a recent study observed a 17-fold increased risk of PPH among pregnant women with moderate-severe anemia [24]. In consideration with the mode of delivery, the incidence of cesarean delivery was 31% in group I Vs 40.3% in group II, which was significant.…”

“…Koura et al stated that prevalence of maternal anemia at delivery was 39.5%, in Benin [23]. Nair et al in another study showed that 35% of pregnant Indian women had moderate to severe anemia, while Levy et al showed that 14% -62% of women in developing countries, and 16% -29% in developed countries are suffering from anemia [24] [25].…”

Principles of the diagnosis and treatment of iron deficiency anemia during pregnancy and the postnatal period

“…Хорошо известно, что ЖДА представляет собой важный фактор риска в отношении материнской и плодовой заболеваемости и смертности [6,8,11]. В многочисленных исследованиях подтверждены увели-чение риска преждевременных родов, нарушений пла-центации, возрастание количества случаев отслойки пла-центы и кровотечений в родах, чаще регистрируются синдром задержки развития плода и низкий вес новорож-денного [11,12]. Наличие анемии во время беременности значительно повышает частоту переливания крови в родах и послеродовом периоде, особенно у пациенток с ожидае-мой высокой кровопотерей (предлежание и врастание плаценты, большая миома и т.…”

“…В послеродовом периоде ЖДА тесно связана с послеро-довой депрессией, стрессом, тревожностью, когнитивными нарушениями, способствует повышению частоты инфекци-онно-воспалительных осложнений и ассоциируется с увели-чением длительности пребывания в стационаре, что приво-дит к повышению экономических затрат на проводимое лечение [11,18].…”