The most prevalent hematological condition during pregnancy is anemia, which is a global health issue [1]. One of the most prevalent nutritional deficiencies that pregnant women face is anemia, which affects 14% of women in wealthy nations, 51% of women in poor nations, and between 65% and 75% of pregnant women in India.[2, 3] About 80% of maternal deaths in South East Asia are attributable to anemia, making it the second most prevalent cause of maternal death in India.[4] According to the World Health Organization, anemia is defined as hemoglobin levels below 11 gm/dl in the first and third trimesters and less than 10.5 gm/dl in the second. The Indian Council of Medical Research (ICMR) has further divided it into three categories: mild anemia (10–10.9 gm%), moderate anemia (7–10 gm %), and severe anemia (<7 gm%) [5]. Due to cultural disparities in pregnancy-related health-seeking behaviors, lifestyles, and socioeconomic position, the frequency of anemia in pregnant women varies [6]. Given the physiological changes that occur during pregnancy, the Centers for Disease Control (CDC) advises that pregnant women's hemoglobin levels should not drop below 10.5 g/dl during the second trimester [7]. Pregnancy complications like hypertension, preeclampsia, premature rupture of membranes, postpartum hemorrhage, and puerperal infection can all be made more likely by anemia, according to studies [8], and children born to anemic mothers have a 50% higher chance of also being anemic [9]. The fetus may suffer from low birth weight (LBW), early birth, abnormal development, or even fetal death as a result of maternal anemia. Early detection of severe anemia can reduce the danger of blood transfusions and parenteral iron therapy during pregnancy [10]. Therefore, it is essential to prevent and treat maternal anemia. Through the national program, the Indian government has been continuously attempting to address the issue of anemia [11].

Aims & objectives: The prospective observational study is undertaken to estimate the prevalence and to study maternal and early neonatal morbidity and mortality associated with anemia in a pregnant woman.

This hospital-based prospective study was conducted in the department of gynecology and obstetrics, in a tertiary care Medical College and Research institute, India. A total of 200 pregnant women attending our antenatal clinic during the study period were enrolled.

Inclusion criteria 

• All pregnant women with anemia from 18 years to 35 years
• Women with singleton pregnancy having anemia (Hb% <11 gm %) admitted in labour room
• Women who provided written informed consent for the study

Exclusion criteria 

• Pregnant women with hemolytic anemia
• Anemia secondary to acute hemorrhagic events
• All pregnant women <18 years
• Women who not willing for the study

The HB measurements of the pregnant woman were measured using HemoCue analyzer. Anemia was classified based on the WHO criteria; HB concentration of <11 g/dl was considered as anemia. HB concentration of 10–10.9 g/dl, 7–9.9 g/dl, and <7 g/ dl was considered as mild, moderate, and severe anemia, respectively.

All the participants, relevant data were collected using a prevalidated questionnaire. The information collected included socio-demographic parameters such as age, residence, socio-economic class, education level, and dietary habits. Information about parity, registration during pregnancy, symptoms, number of antenatal visits, history of heavy menstrual bleeding, past history of abortions, cesarean section, anemia, history of iron and folic acids tablets received, and the spacing interval was also collected. Prevalence of anemia was estimated based on the hemoglobin level Detailed records were maintained about blood profiles such as Hb level, peripheral blood smear presentation, mode of delivery, maternal and fetal outcome, number of blood transfusions, and duration of hospitalization.

Statistical analysis: The data were analyzed using IBM SPSS Statistics V22.0. The quantitative measures are presented by mean and standard deviation and qualitative variables by proportions. Chi-square test, correlation coefficient, and logistic regression were used for testing significance. P ≤ 0.05 was considered statistically significant

A total of 200 pregnant women were enrolled and analysed in the present study. The prevalence of anemia was observed in 120 (60%) in pregnant women, and the most common affected age group was 20-24 years (44.2%). Majority of them resided at rural area (65%) and belong to middle socio-economic class (40.8%). Maximum women had house wife (90.8%) and educated upto secondary school (46.6%). Anemia was commonly observed (63.8%) in multigravida, pregnancy duration was >24 week in 47.5% and most of them delivered by vaginally (62.5%).

Table 1: Demographic variables of anemic pregnant women

The majority of the pregnant women (50.8%) had moderate anemia, followed by mild (35.8%) and 10% had severe anemia.

Graph 1: Severity of anemia among study population

The peripheral blood smear examination showed microcytic hypochromic picture in 56.6% cases followed by Dimorphic in 24.2%, Normocytic Normochromic in 14.2% and macrocytic in 5% cases. Grade of anemia was significantly differing among various morphological types of anemia.

Table-2: Comparison of grade of anemia with morphological type of anemia

The majority of patients (91. 8%) had symptomatic, while 8.2% were asymptomatic. Breathlessness was the commonest presenting symptom (75%) followed by fatigability/giddiness (67.5%), loss of appetite (54.2%) and quality of life affected in 45.8% of cases

Graph 2: Clinical presentation of anemia patients

Preterm labor (17.5%) was the commonest adverse maternal outcome followed by puerperal sepsis (10%), PPH (8.3%), preeclampsia/eclampsia (5%), ICU admission (4.2%), abortions (3.3%) and maternal mortality in 1.6% cases; whereas the commonest adverse fetal outcome was LBW-IUGR (39.1%), followed by NICU admission (10.6%), birth asphyxia (4.2%), intrauterine device (IUD)/stillbirth (2.5%) and neonatal death in 0.83% cases

Table 3: Maternal and fetal outcomes among study subjects

Anemia in pregnancy is a major health problem in rural part of India due to illiteracy, poverty, lack of awareness about the need for regular antenatal care and presence of super added infections.

The prevalence rate of anemia in pregnant women was 60% observed in the present study, similar to many other Indian studies:  Suryanarayana R, et al [12], Siddalingappa et al [13], and Mahashabde et al [14], reported prevalence of anemia in pregnant women were 63%, 62.4%, and 63% respectively. In contrast to our study, very high prevalence (96.5%) was observed by Gautam et al [15]. The factors contributing to high prevalence of anemia may be low dietary iron and folic acid intake or chronic blood loss owing to infections. In India, the other factors attributing to high prevalence of anemia in pregnancy includes early marriage, teenage pregnancy, less birth spacing, multiple pregnancies, phytate rich Indian diet and worm infestations.

In our study majority of the anemic women was 20-24 years of age group, in agreement with the Bhise M. et al [16].

Present study observed that the prevalence of anemia was more in women belonging to lower socio-economic group, housewives, residing in rural areas and women whose education levels were below 10th standard, our result were comparable with the Pereira E, et al [17] and Nair M, et al [18].

Anemia was more common in multigravida and third trimester of pregnancy in the current research, findings correlates with the Sudha R, et al [19]. The prevalence of anemia increased with the duration of pregnancy Anemia in pregnancy is more common in women of high parity due to frequent pregnancy and inadequate spacing.

Prevalence of moderate anemia was higher than mild and severe anemia in this study, in accordance to the Pathak I, et al [20].

The most common clinical presentation of anemia patients in this study were breathlessness, fatigability/giddiness and loss of appetite, our findings consistent to Nimbalkar VB, et al [21].

Most of the pregnant women were delivered by LSCS in the present study, concordance with the Kothapalli, et al [22].

In the present study, it showed Microcytic hypochromic anemia to be the most predominant type of morphological anemia, constant observation seen by Rawat K, et al [23].

Maternal anemia is considered as risk factor for poor pregnancy outcomes, and it threatens the life of fetus. In the present study, Preterm labor, puerperal sepsis, PPH, preeclampsia, ICU admission, abortions and maternal mortality were the common maternal outcomes in anemic pregnant women, similar results observed by Sapre SA, et al [24] and Devi NB, et al [25].

High incidence of adverse fetal outcome in the form of Low birth weight, IUGR, NICU admission, birth asphyxia, IUFD and neonatal death were seen in present study. These were comparable with the observation Angelitta JN, et al [26] and Sangeetha VB, et al [27].

High prevalence of anemia in pregnant women indicates that anemia continues to be a major public health problem in our areas. Anemia in pregnancy increases the maternal and fetal risks. Gravida status, female literacy, and bad obstetric history were important risk factors contributing for anemia in pregnant women. The diagnosis of anemia during antenatal visit is very essential as it can help to institute intervention at an early stage thus preventing the complications of anemia and decreasing the maternal and perinatal mortality.

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