This study aims to describe adverse maternal and neonatal outcomes in women diagnosed with anemia in pregnancy.
This was a retrospective cohort study of California live births from 2007–2012, linked to maternal and infant hospital discharge records. Relative risks of adverse maternal and neonatal outcomes were calculated for women with and without anemia.
Anemic mothers were more likely to be diagnosed with hypertension, diabetes, placental abruption, or chorioamnionitis, or require a blood transfusion or admission to the intensive care unit (aRRs 1.2–6.8). Infants born to anemic mothers were more likely to be born preterm (8.9% versus 6.5%), but not more likely to suffer morbidities associated with prematurity.
In a population-based study, the diagnosis of anemia in pregnancy carries a higher risk of peri-partum, intra-partum, and post-partum complications for the mother, and a higher risk of preterm birth for the infant.
Access optionsAccess options
Subscribe to Journal
Get full journal access for 1 year
only $20.67 per issue
All prices are NET prices.
VAT will be added later in the checkout.
Rent or Buy article
Get time limited or full article access on ReadCube.
All prices are NET prices.
Stevens GA, Finucane MM, De-Regil LM, Paciorek CJ, Flaxman SR, Branca F, et al. Global, regional, and national trends in haemoglobin concentration and prevalence of total and severe anaemia in children and pregnant and non-pregnant women for 1995-2011: a systematic analysis of population-representative data. Lancet Glob Health. 2013;1:e16–25.
McLean E, Cogswell M, Egli I, Wojdyla D, de Benoist B. Worldwide prevalence of anaemia, WHO Vitamin and Mineral Nutrition Information System, 1993-2005. Public Health Nutr. 2009;12:444–54.
Levy A, Fraser D, Katz M, Mazor M, Sheiner E. Maternal anemia during pregnancy is an independent risk factor for low birthweight and preterm delivery. Eur J Obstet Gynecol Reprod Biol. 2005;122:182–6.
Scanlon KS, Yip R, Schieve LA, Cogswell ME. High and low hemoglobin levels during pregnancy: differential risks for preterm birth and small for gestational age. Obstet Gynecol. 2000;96 5 Pt 1:741–8.
Zhou LM, Yang WW, Hua JZ, Deng CQ, Tao X, Stoltzfus RJ. Relation of hemoglobin measured at different times in pregnancy to preterm birth and low birth weight in Shanghai, China. Am J Epidemiol. 1998;148:998–1006.
Drukker L, Hants Y, Farkash R, Ruchlemer R, Samueloff A, Grisaru-Granovsky S. Iron deficiency anemia at admission for labor and delivery is associated with an increased risk for Cesarean section and adverse maternal and neonatal outcomes. Transfusion. 2015;55:2799–806.
Bakacak M, Avci F, Ercan O, Köstü B, Serin S, Kiran G, et al. The effect of maternal hemoglobin concentration on fetal birth weight according to trimesters. J Matern Fetal Neonatal Med. 2015;28:2106–10.
Hämäläinen H, Hakkarainen K, Heinonen S. Anaemia in the first but not in the second or third trimester is a risk factor for low birth weight. Clin Nutr. 2003;22:271–5.
Dai AI, Demiryürek S, Aksoy SN, Perk P, Saygili O, Güngör K. Maternal iron deficiency anemia as a risk factor for the development of retinopathy of prematurity. Pediatr Neurol. 2015;53:146–50.
Tandu-Umba B, Mbangama AM. Association of maternal anemia with other risk factors in occurrence of Great obstetrical syndromes at university clinics, Kinshasa, DR Congo. BMC Pregnancy Childbirth. 2015;15:183.
Daru J, Zamora J, Fernández-Félix BM, Vogel J, Oladapo OT, Morisaki N, et al. Risk of maternal mortality in women with severe anaemia during pregnancy and post partum: a multilevel analysis. Lancet Glob Health. 2018;6:e548–54.
Mathews F, Youngman L, Neil A. Maternal circulating nutrient concentrations in pregnancy: implications for birth and placental weights of term infants. Am J Clin Nutr. 2004;79:103–10.
Lu ZM, Goldenberg RL, Cliver SP, Cutter G, Blankson M. The relationship between maternal hematocrit and pregnancy outcome. Obstet Gynecol. 1991;77:190–4.
Sox HC. Routine iron supplementation during pregnancy. JAMA. 1993;270:2848.
Masukume G, Khashan AS, Kenny LC, Baker PN, Nelson G. SCOPE Consortium. Risk factors and birth outcomes of anaemia in early pregnancy in a nulliparous cohort. PLoS ONE. 2015;10:e0122729.
Abbaspour N, Hurrell R, Kelishadi R. Review on iron and its importance for human health. J Res Med Sci. 2014;19:164–74.
Institute of Medicine (US) Committee on Nutritional Status During Pregnancy and Lactation. Nutrition during pregnancy: part I weight gain: part II nutrient supplements. Washington, DC: National Academies Press (US); 1990.
Anonymous. Recommendations to prevent and control iron deficiency in the United Stats. MMWR Recomm Rep. 1998; 47:1–36.
Lelic M, Bogdanovic G, Ramic S, Brkicevic E. Influence of maternal anemia during pregnancy on placenta and newborns. Med. Arch. 2014;68:184–7.
Ali E, Kumar M, Naqvi SE, Trivedi SS, Singh A. Fetal vascular adaptation before and after treatment of severe maternal anemia in pregnancy. Int J Gynaecol Obstet. 2016;133:284–6.
Whittaker P, Macphail S, Lind T. Serial hematologic changes and pregnancy outcome. Obstet. Gynecol. 1996;88:33–9.
American Medical Association. Internal Classification of Diseases: ICD-9-CM 2008. Chicago: American Medical Association; 2007.
Baer RJ, Norton ME, Shaw GM, Flessel MC, Goldman S, Currier RJ, et al. Risk of selected structural abnormalities in infants after increased nuchal translucency measurement. Am J Obstet Gynecol. 2014;211:675.e1–19.
Talge NM, Mudd LM, Sikorskii A, Basso O. United States birth weight reference corrected for implausible gestational age estimates. Pediatrics. 2014;133:844–53.
Kotelchuck M. The Adequacy Of Prenatal Care Utilization Index: its US distribution and association with low birthweight. Am J Public Health. 1994;84:1486–9.
Shachar BZ, Mayo JA, Lyell DJ, Baer RJ, Jeliffe-Pawlowski LL, Stevenson DK, et al. Interpregnancy interval after live birth or pregnancy termination and estimated risk of preterm birth: a retrospective cohort study. BJOG. 2016;123:2009–17.
Reddy UM, Bettegowda VR, Dias T, Yamada-Kushnir T, Ko CW, Willinger M. Term pregnancy: a period of heterogeneous risk for infant mortality. Obstet Gynecol. 2011;117:1279–87.
Machado LC, Passini R, Rosa IR, Carvalho HB. Neonatal outcomes of late preterm and early term birth. Eur J Obstet Gynecol Reprod Biol. 2014;179:204–8.
Jelliffe-Pawlowski LL, Baer RJ, Blumenfeld YJ, Ryckman KK, O’Brodovich HM, Gould JB, et al. Maternal characteristics and mid-pregnancy serum biomarkers as risk factors for subtypes of preterm birth. BJOG. 2015;122:1484–93.
Baer RJ, Chambers CD, Bandoli G, Jelliffe-Pawlowski LL. Risk of preterm birth by subtype among Medi-Cal participants with mental illness. Am J Obstet Gynecol. 2016;215:519.e1–9.
Baer RJ, Chambers CD, Ryckman KK, Oltman SP, Norton ME, Jelliffe-Pawlowski LL. Risk of preterm birth among women using drugs during pregnancy with elevated α-fetoprotein. J Perinatol. 2017;37:220–5.
Rahman MM, Abe SK, Rahman MS, Kanda M, Narita S, Bilano V, et al. Maternal anemia and risk of adverse birth and health outcomes in low- and middle-income countries: systematic review and meta-analysis. Am J Clin Nutr. 2016;103:495–504.
Pfeiffer CM, Sternberg MR, Caldwell KL, Pan Y. Race-ethnicity is related to biomarkers of iron and iodine status after adjusting for sociodemographic and lifestyle variables in NHANES 2003-2006. J Nutr. 2013;143:977S–85S.
Kadyrov M, Kosanke G, Kingdom J, Kaufmann P. Increased fetoplacental angiogenesis during first trimester in anaemic women. Lancet. 1998;352:1747–9.
Stangret A, Wnuk A, Szewczyk G, Pyzlak M, Szukiewicz D. Maternal hemoglobin concentration and hematocrit values may affect fetus development by influencing placental angiogenesis. J Matern Fetal Neonatal Med. 2017;30:199–204.
Allen LH. Biological mechanisms that might underlie iron’s effects on fetal growth and preterm birth. J Nutr. 2001;131(2S-2):581S–589S.
Alwan NA, Cade JE, McArdle HJ, Greenwood DC, Hayes HE, Simpson NA. Maternal iron status in early pregnancy and birth outcomes: insights from the Baby’s Vascular health and Iron in Pregnancy study. Br J Nutr. 2015;113:1985–92.
The work was funded in part by the UCSF California Preterm Birth Initiative.
Conflict of interest
The authors declare that they have no conflict of interest.
Publisher’s note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.