Anaemia in pregnancy is a persistent maternal health problem that reflects nutritional deficiency, social disadvantage, repeated reproductive stress, and uneven access to antenatal care. Globally, anaemia continues to affect a large proportion of women of reproductive age, and the burden remains higher among pregnant women in low- and middle-income countries [1,2]. Pregnancy increases iron requirement because of maternal red cell expansion, placental development, fetal growth, and blood loss expected at delivery. When dietary intake, iron stores, and supplementation are inadequate, haemoglobin concentration declines and clinical anaemia develops. The condition is therefore both a biological disorder and a marker of wider maternal health inequity.

The clinical relevance of anaemia in pregnancy extends beyond laboratory haemoglobin values. Maternal anaemia has been linked with fatigue, reduced work capacity, infections, postpartum complications, transfusion requirement, and poor tolerance to obstetric blood loss. Evidence from systematic reviews has also shown associations with low birth weight, preterm birth, perinatal morbidity, and maternal mortality, particularly when anaemia is moderate or severe [3-7]. Iron deficiency remains the leading cause, but folate deficiency, vitamin B12 deficiency, parasitic infestation, chronic inflammation, haemoglobinopathies, and short interpregnancy intervals can contribute in different settings. These causes frequently coexist and reinforce one another in vulnerable populations.

In India, anaemia among pregnant women remains a major public health concern despite long-standing antenatal supplementation programmes and policy attention. Hospital-based and community-based studies from different regions have reported a wide variation in prevalence because of differences in dietary pattern, socioeconomic status, educational level, access to healthcare, gestational age at enrolment, and adherence to iron-folic acid supplementation [8-11]. Women from rural backgrounds, those with limited education, lower socioeconomic status, multigravida status, and inadequate antenatal visits are repeatedly identified as high-risk groups [8,9,12,13]. Identification of these locally relevant risk factors is essential for strengthening antenatal screening and targeted counselling.

Tertiary care hospitals provide an important opportunity to detect anaemia early, classify severity, initiate appropriate therapy, and counsel women regarding diet, compliance with supplementation, birth spacing, and follow-up. However, hospital data are also useful for understanding the clinical profile of pregnant women who seek antenatal care in a given region. The present study was therefore conducted with the objectives of estimating the prevalence and severity of anaemia among pregnant women attending the antenatal outpatient department of a tertiary care hospital and assessing selected demographic, obstetric, and healthcare-related risk factors associated with anaemia.

Study design and setting: This hospital-based cross-sectional observational study was conducted in the antenatal outpatient department of Prathima Institute of Medical Sciences, Karimnagar, Telangana, India. The institution caters to pregnant women from urban and rural areas of Karimnagar and surrounding districts, providing routine antenatal care, laboratory screening, obstetric consultation, inpatient care, and referral services. A cross-sectional design was selected because it is suitable for estimating the prevalence of anaemia and studying associated risk factors at a defined point in antenatal care [8,9,13].

Study period: The study was carried out over three months from February 2025 to April 2025. Pregnant women attending the antenatal outpatient department during this period were screened for eligibility and enrolled after obtaining informed consent.

Study population: A total of 100 pregnant women were included in the study. Pregnant women of any trimester who were willing to participate and for whom hemoglobin estimation was available were included. Women with acute bleeding, known hematological malignancy, recent blood transfusion, severe chronic systemic illness requiring emergency care, or incomplete clinical data were excluded. The sample size was fixed at 100 for descriptive analysis and assessment of major risk-factor patterns in the study setting.

Data collection procedure: Data were collected using a structured proforma. Information regarding age, residence, education status, socioeconomic status, gravida status, trimester of pregnancy, number of antenatal visits, iron-folic acid intake, and symptoms suggestive of anaemia was recorded. Clinical features including easy fatigability, pallor, dizziness, breathlessness on exertion, and palpitations were documented. Obstetric information was verified from antenatal records wherever available.

Hemoglobin assessment and classification: Hemoglobin concentration was recorded from routine antenatal laboratory testing. Pregnant women with hemoglobin level of 11.0 g/dL or above were considered non-anemic. Anemia was classified as mild when hemoglobin was 10.0-10.9 g/dL, moderate when hemoglobin was 7.0-9.9 g/dL, and severe when hemoglobin was below 7.0 g/dL. This classification allowed uniform reporting of prevalence and severity categories.

Statistical analysis: Data were entered and analysed using descriptive and inferential statistical methods. Continuous variables were expressed as mean and standard deviation, while categorical variables were summarized as frequencies and percentages. The association between anemia and selected risk factors was assessed using the chi-square test. A p-value less than 0.05 was considered statistically significant.

Ethical considerations: Institutional ethical approval was obtained before initiation of the study. Written informed consent was obtained from all participants. Confidentiality of personal information was maintained throughout the study, and the data were used only for academic and research purposes.

A total of 100 pregnant women attending the antenatal outpatient department were included in the study. The mean age of the study population was 24.8 ± 4.2 years. Most participants belonged to the 20-24 years age group. Rural residence was observed in 58.0% of women. Multigravida women constituted 60.0% of the study population, and most participants were in the second or third trimester. The baseline demographic and obstetric profile is shown in Table 1.

Table 1. Baseline demographic and obstetric profile of pregnant women

The mean hemoglobin level among the study participants was 10.3 ± 1.4 g/dL. Anaemia was observed in 64 pregnant women, giving an overall prevalence of 64.0%. Among anaemic women, moderate anaemia was the most common type, observed in 34.0%, followed by mild anaemia in 24.0% and severe anaemia in 6.0%, as presented in Table 2.

Table 2. Prevalence and severity of anaemia among pregnant women

Anaemia was more common among rural women compared with urban women, and the difference was statistically significant. A higher prevalence of anaemia was also noted among women with lower educational status, lower socioeconomic status, multigravida status, third trimester pregnancy, fewer antenatal visits, and irregular iron-folic acid supplementation. The association of anaemia with selected risk factors is summarized in Table 3.

Table 3. Association of anaemia with selected risk factors

Clinical symptoms suggestive of anaemia were observed in a substantial proportion of women. Easy fatigability was the most common symptom, reported by 56.0% of participants, followed by pallor in 52.0%, dizziness in 34.0%, and breathlessness on exertion in 22.0%. The distribution of clinical features is shown in Table 4.

Table 4. Clinical features among pregnant women

Overall, the findings indicate that anaemia was highly prevalent among pregnant women attending the tertiary care hospital. Rural residence, low educational status, lower socioeconomic class, multigravida status, advanced gestational age, inadequate antenatal visits, and irregular iron-folic acid supplementation were significantly associated with anaemia.

The present cross-sectional study demonstrated a high prevalence of anaemia among pregnant women attending a tertiary care hospital in Telangana. Anaemia was identified in 64.0% of participants, and moderate anaemia was the dominant category. This pattern is consistent with the continuing public health burden of maternal anaemia reported globally and in South Asian settings. The mean haemoglobin level of 10.3 ± 1.4 g/dL also indicates that a considerable proportion of antenatal women enter pregnancy care with depleted iron reserves or inadequate correction of nutritional deficiency during gestation.

The observed prevalence is comparable to several Indian hospital-based studies that reported anaemia as a common finding among antenatal women [8,9,12,13]. However, differences across studies occur because of variation in dietary habits, parity profile, socioeconomic background, timing of antenatal registration, and adherence to supplementation. The higher proportion of moderate anaemia in the present study deserves attention because moderate anaemia contributes to impaired maternal reserve and increases vulnerability during delivery and postpartum blood loss. International evidence has shown that anaemia is linked with adverse maternal and perinatal outcomes, including low birth weight, preterm birth, and increased maternal morbidity [7].

Rural residence, low educational status, and lower socioeconomic class were significantly associated with anaemia in this study. These findings reflect the influence of social determinants on maternal nutrition and healthcare utilization. Women with limited education often have reduced awareness regarding iron-rich foods, supplementation schedules, warning symptoms, and the importance of follow-up haemoglobin testing. Socioeconomic disadvantage restricts dietary diversity and access to timely care, while rural residence adds barriers related to travel, continuity of antenatal visits, and health literacy. Similar associations have been reported in Indian studies and national analyses of maternal anaemia [8-11].

Multigravida status and third trimester pregnancy were also significantly associated with anaemia. Repeated pregnancies without adequate restoration of iron stores increase the risk of progressive depletion, especially when dietary intake remains insufficient. The increase in anaemia during the later trimester is biologically plausible because maternal plasma volume expansion and fetal iron demand become more pronounced as pregnancy advances. Women with fewer than four antenatal visits had a higher prevalence of anaemia, suggesting that inadequate contact with antenatal services reduces opportunities for early detection, counselling, supplementation, and treatment adjustment. Irregular or absent iron-folic acid intake showed a strong association with anaemia. This supports evidence that regular antenatal supplementation improves maternal haemoglobin status and reduces the risk of anaemia-related complications [10,11,14]. The common clinical features in this study, particularly easy fatigability and pallor, are useful screening clues but cannot replace haemoglobin estimation. The findings emphasize the need for routine haemoglobin assessment at booking and during follow-up, strict monitoring of supplementation compliance, counselling on diet and spacing, and focused attention to rural and socioeconomically vulnerable pregnant women.

Limitations

This was a hospital-based cross-sectional study with a modest sample size, limiting generalizability to the wider community. Dietary intake, serum ferritin, vitamin B12, folate, stool examination, and inflammatory markers were not assessed. The temporal relationship between risk factors and anaemia could not be established because exposure and outcome were measured at the same point.

Anaemia was highly prevalent among pregnant women attending the tertiary care hospital, with moderate anaemia forming the largest subgroup. Significant associations were observed with rural residence, low educational status, lower socioeconomic class, multigravida status, advanced trimester, inadequate antenatal visits, and irregular iron-folic acid intake. These findings highlight the importance of early antenatal registration, routine haemoglobin screening, timely correction of anaemia, dietary counselling, and strict monitoring of supplementation compliance. Focused interventions for rural and socioeconomically vulnerable women are essential to reduce maternal anaemia and its adverse consequences. Strengthening antenatal services at primary and tertiary levels can improve maternal health and support better pregnancy outcomes in this population.

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