Anemia in pregnancy is a major public health problem worldwide, particularly in developing countries where nutritional deficiencies remain common. According to the World Health Organization (WHO), anemia in pregnancy is defined as a hemoglobin concentration of less than 11 g/dL. Iron deficiency is the leading cause, although folate deficiency, vitamin B12 deficiency, infections, hemoglobinopathies, and chronic diseases may also contribute.

Globally, approximately one-third of pregnant women are affected by anemia. In India, despite national iron supplementation programs and improved antenatal care services, maternal anemia continues to be highly prevalent and remains an important cause of maternal and neonatal morbidity.

Maternal anemia has been associated with several adverse maternal outcomes, including postpartum hemorrhage, puerperal infections, prolonged hospitalization, need for blood transfusion, cardiac failure in severe cases, and intensive care unit admission. The fetus is also affected, with increased frequencies of preterm birth, low birth weight, intrauterine growth restriction, small for gestational age, birth asphyxia, neonatal anemia, respiratory distress syndrome, neonatal intensive care unit admission, and perinatal mortality.

Early identification and prompt treatment with oral iron, parenteral iron preparations, or blood transfusion in severe cases remain the cornerstone of management. Assessing maternal and neonatal outcomes among anemic mothers helps identify areas for improving antenatal care and neonatal management.

Aim

To evaluate maternal and neonatal outcomes among pregnant women with anemia.

Objectives

1. To determine the severity of maternal anemia among the study population.
2. To assess the treatment modalities used for correction of anemia.
3. To evaluate maternal complications associated with anemia.
4. To describe neonatal outcomes among infants born to mothers with anemia.

Study Design A hospital-based descriptive observational study. Study Setting The study was conducted in the Department of Obstetrics and Gynaecology, in collaboration with the Department of Pediatrics, Shri Atal Bihari Vajpayee Medical College and Research Institute (SABVMCRI), Bengaluru, Karnataka, India. Study Duration The study was conducted over a period of six months, from January 2024 to June 2024. Study Population Pregnant women diagnosed with anemia who delivered at SABVMCRI during the study period. Sample Size A total of 82 pregnant women with anemia were included in the study. Inclusion Criteria • Pregnant women with hemoglobin <11 g/dL. • Women who delivered during the study period. • Availability of complete maternal and neonatal records. Exclusion Criteria • Pregnancies with major fetal congenital anomalies. • Incomplete maternal or neonatal records. • Women with known hematological disorders other than nutritional anemia (if excluded in your protocol). Data Collection Maternal demographic details, obstetric history, hemoglobin level, severity of anemia, treatment received, gestational age at delivery, maternal complications, neonatal birth weight, NICU admission, neonatal morbidities, and neonatal outcomes were extracted from hospital records using a structured data collection form. Definition of Anemia Maternal anemia was classified according to WHO criteria: • Mild anemia: Hemoglobin 10.0–10.9 g/dL • Moderate anemia: Hemoglobin 7.0–9.9 g/dL • Severe anemia: Hemoglobin <7.0 g/dL Outcome Measures Maternal Outcomes • Postpartum hemorrhage • Infection • Prolonged hospital stay • Intensive care unit admission Neonatal Outcomes • Birth weight • Small for gestational age • Intrauterine growth restriction • Birth asphyxia • NICU admission • Neonatal anemia • Hypoglycemia • Respiratory distress syndrome • Neonatal death • Intrauterine death Statistical Analysis Data were entered into Microsoft Excel and analyzed using SPSS version 26.0 (IBM Corp., Armonk, NY, USA). Categorical variables were summarized as frequencies and percentages. Continuous variables, where applicable, were expressed as mean ± standard deviation. The findings were presented using tables and descriptive statistics.

A total of 82 pregnant women with anemia were included in the study. Among them, 80 pregnancies resulted in live births, while 2 pregnancies ended in intrauterine fetal death (IUD).

Table 1. Maternal demographic characteristics (n = 82)

The majority of mothers (57.3%) belonged to the 18–25 years age group.

Table 2. Severity of maternal anemia (n = 82)

Mild anemia was the most common presentation (48.8%), followed by moderate (30.5%) and severe anemia (20.7%).

Table 3. Treatment received (n = 82)

Nearly one-third of the women required blood transfusion, while 24.4% received parenteral iron therapy.

Table 4. Gestational age at delivery (n = 82)

Among the study participants, 56.1% delivered at term, whereas 37.8% had preterm deliveries.

Table 5. Maternal complications (n = 82)

Infection (43.9%) was the most frequently observed maternal complication, followed by prolonged hospital stay (42.7%).

Table 6. Birth weight of live-born neonates (n = 80)

Half of the live-born neonates had a birth weight of 2.5–4.0 kg, while the remaining 50.0% weighed less than 2.5 kg.

Table 7. Neonatal outcomes (n = 80 live births)

NICU admission was the most common neonatal outcome, occurring in 62.5% of live-born infants. Neonatal anemia was observed in 37.5% of neonates, followed by IUGR (31.3%), SGA (25.0%), hypoglycemia (22.5%), respiratory distress syndrome (18.8%), birth asphyxia (12.5%), and neonatal death (6.3%).

Pregnancy outcome

Of the 82 pregnancies included in the study, 80 (97.6%) resulted in live births, while 2 (2.4%) ended in intrauterine fetal death.

Maternal anemia remains one of the leading nutritional disorders complicating pregnancy and is associated with considerable maternal and neonatal morbidity. In the present hospital-based descriptive observational study conducted at Shri Atal Bihari Vajpayee Medical College and Research Institute, Bengaluru, the majority of mothers were between 18 and 25 years of age (57.3%). Mild anemia was the most common type, accounting for 48.8% of cases, followed by moderate (30.5%) and severe anemia (20.7%). Nearly one-third of women required blood transfusion, reflecting the burden of moderate to severe anemia in the study population. Similar findings have been reported in previous studies, where severe maternal anemia was associated with an increased need for intensive management, including parenteral iron therapy and blood transfusion. More than one-third (37.8%) of pregnancies resulted in preterm delivery. Although the present study did not include a comparison group of non-anemic mothers, preterm birth was a common finding among women with anemia. Previous studies and systematic reviews have also reported higher frequencies of preterm birth among anemic mothers. Maternal complications were frequent. Infection (43.9%) and prolonged hospital stay (42.7%) were the most commonly observed complications, while postpartum hemorrhage and ICU admission occurred in 12.2% of mothers each. These findings highlight the importance of early antenatal screening and timely correction of anemia to reduce maternal morbidity. Among the 80 live-born infants, 50.0% had a birth weight below 2.5 kg. Intrauterine growth restriction (31.3%) and small for gestational age (25.0%) were common observations, indicating impaired fetal growth in pregnancies complicated by maternal anemia. These findings are consistent with published literature reporting reduced fetal growth among infants born to mothers with anemia. NICU admission was required in 62.5% of live-born infants, making it the most frequent neonatal outcome observed in this study. Neonatal anemia (37.5%), hypoglycemia (22.5%), respiratory distress syndrome (18.8%), birth asphyxia (12.5%), and neonatal death (6.3%) were also observed. These findings emphasize the need for careful neonatal monitoring and early intervention in infants born to mothers with anemia. Overall, the present study demonstrates a considerable burden of maternal and neonatal morbidity among pregnancies complicated by maternal anemia. Since this was a descriptive observational study without a non-anemic comparison group, the findings should be interpreted as outcomes observed among women with anemia rather than evidence of a causal relationship. Strengths • Inclusion of both maternal and neonatal outcome measures. • Assessment of anemia severity and treatment modalities. • Provides hospital-based data from a tertiary care teaching institution. Limitations • Single-center study. • Small sample size. • Descriptive study design without a comparison group. • Limited ability to establish causality.

Maternal anemia remains an important challenge in obstetric practice and was accompanied by substantial maternal and neonatal morbidity in the present study. Infection, prolonged hospital stay, postpartum hemorrhage, and ICU admission were among the common maternal complications. Neonatal outcomes included preterm birth, low birth weight, intrauterine growth restriction, NICU admission, neonatal anemia, respiratory distress syndrome, hypoglycemia, and neonatal mortality.

Strengthening antenatal screening, ensuring adequate iron and folic acid supplementation, early diagnosis of moderate and severe anemia, and timely treatment with parenteral iron or blood transfusion when indicated may help improve maternal and neonatal outcomes. Larger multicenter studies with an appropriate comparison group are recommended to further evaluate these associations.

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