The Association between Iron-deficiency Anemia and Adverse Pregnancy Outcomes: A Retrospective Report from Pakistan

Abstract

Background Anemia is one of the most common conditions that affect pregnancies, with dietary iron deficiency being its most common cause. Maternal anemia has been associated with increased risks of both maternal and neonatal adverse outcomes. This study aimed to analyze the maternal and neonatal outcomes in women with third-trimester anemia. Methods This was a retrospective report from a Pakistani public hospital. It included data records of the childbirths in the hospital, with at least one record that documented the hemoglobin (Hb) level in women in the first or second trimester and one in the third trimester. The duration of the study was from January 1, 2019 to June 30, 2019. Women with Hb level of <10mg/dL in the third trimester were categorized as anemic, and those with Hb level of >10mg/dL were categorized as non-anemic. Pregnancy outcomes were assessed for both mothers and babies. All data were processed through SPSS version 21.0 for Windows (IBM Corp., Armonk, NY). Results The study evaluated 235 (37.8%) anemic and 387 (62.2%) non-anemic women. Adverse maternal outcomes were compared between the two groups. In anemic women, gestational hypertension (56% vs. 27%; p: <0.0001), preeclampsia (65% vs. 25%; p: <0.0001), antepartum hemorrhage (32% vs. 19%; p: =0.0001), postpartum hemorrhage (79% vs. 28%; p: <0.0001), transfusions (94% vs. 5%; p: <0.0001), prolonged/obstructed labor (49% vs. 20%; p: <0.000), urgent induction of labor (24% vs. 2%; p: <0.0001), and urgent caesarean section (CS) (45% vs. 29%; p: 0.0001) were significantly more common as compared to non-anemic women. Adverse neonatal outcomes such as low birth weight (LBW) (59% vs. 29%; p: <0.0001), small-forgestational-age (SGA) (73% vs. 23%; p: <0.0001), preterm delivery (39% vs. 15%; p: <0.0001), stillbirth (8% vs. 3%; p: 0.01), and early neonatal death (9% vs. 2%; p: 0.000) were associated more with anemia. There was no report of maternal mortality in either group. Conclusion:

Prevalence of Anemia and Its Associate Factors among Women of Reproductive Age in Lao PDR: Evidence from a Nationally Representative Survey

“…At the individual level, we found that women who had any adverse pregnancy outcomes have higher odds of developing anemia. It is well documented that maternal anemia leads to poor neonatal outcomes such as low birth weight, stillbirth, preterm delivery, and early neonate death [ 20 ], women who had abortion reported a higher risk of developing anemia [ 8 , 21 ]. Also, this might be due to iron deficiency [ 20 , 22 ].…”

Hemoglobin concentrations and adverse birth outcomes in South Asian pregnant women: findings from a prospective Maternal and Neonatal Health Registry

“…Similarly, the highest anemia-attributable proportion of PTB was observed in Pakistan (54%) followed by India (27%) and Iran (18%) [6]. Further, studies have also revealed that women with low Hb concentrations during pregnancy are at higher risk of antepartum and postpartum hemorrhage, obstructed labor, and cesarean-section delivery when compared to the women with normal hemoglobin concentrations [7][8][9][10].…”

Factors affecting birthweight decline in recent Japan based on birth certificates

“…Another maternal condition that lowers birthweight is anemia and parasitic infections. In Pakistan, the relationship between iron-de ciency anemia and LBW was identi ed [28], and in Sudan [29], the effects of maternal malaria on LBW have been reported. Among Japanese mothers living in urban area, hemoglobin change during pregnancy was inversely associated with birthweight.…”