Anaemia and iron deficiency in pregnancy and adverse perinatal outcomes in Southern India

Authors : Finkelstein JL, Kurpad AV, Bose B, Thomas T, Srinivasan K, Duggan C

Publication Year : 2019

Abstract :

We examined the prevalence of anaemia, iron deficiency, and inflammation during pregnancy and their associations with adverse pregnancy and infant outcomes in India.

Three hundred and sixty-six women participating in a randomised trial of vitamin B12 supplementation were monitored to assess haemoglobin (Hb), serum ferritin (SF), hepcidin, C-reactive protein (CRP), and alpha-1-acid glycoprotein (AGP) during pregnancy. Women received vitamin B12 supplementation (50 µg per day) or placebo daily; all women received daily prenatal iron-folic acid supplementation. Binomial and linear regression models were used to examine the associations of maternal iron biomarkers with pregnancy and infant outcomes.

Thirty percent of women were anaemic (Hb less than 11.0 g/dl), 48% were iron deficient (SF less than 15.0 µg/l), and 23% had iron deficiency anaemia at their first prenatal visit. The prevalence of inflammation (CRP greater than 5.0 mg/l: 17%; AGP greater than 1.0 g/l: 11%) and anaemia of inflammation (Hb less than 11.0 g/dl, SF greater than 15.0 µg/l, plus CRP greater than 5.0 mg/l or AGP greater than 1.0 g/l: 2%) were low. Infants born to anaemic women had a twofold higher risk of low birth weight (less than 2500 g; risk ratio [RR]: 2.15, 95%CI: 1.20-3.84, p = 0.01), preterm delivery (RR: 2.67 (1.43-5.00); p = 0.002), underweight (WAZ less than -2; RR: 2.20, 95%CI: 1.16-4.15, p = 0.02), and lower MUAC (ß(SE): -0.94 (0.45)cm, p = 0.03). Similarly, maternal Hb concentrations predicted higher infant birth weight (p = 0.02) and greater gestational age at delivery (ß(SE): 0.28 (0.08) weeks, p = 0.001), lower risk of preterm delivery (less than 37 weeks; RR: 0.76, 95%CI: 0.66-86, p less than 0.0001); and higher infant MUAC (ß(SE): 0.36 (0.13) cm, p = 0.006). Maternal SF concentrations were associated with greater birth length (ß(SE): 0.44 (0.20) cm, p less than 0.03). Findings were similar after adjusting SF concentrations for inflammation. IDA was associated with higher risk of low birth weight (RR: 1.99 (1.08-3.68); p = 0.03) and preterm birth (RR: 3.46 (1.81-6.61); p = 0.0002); and lower birth weight (p = 0.02), gestational age at birth (p = 0.0002), and infant WAZ scores (p = 0.02).

The prevalence of anaemia and iron deficiency was high early in pregnancy and associated with increased risk of adverse pregnancy and infant outcomes. A comprehensive approach to prevent anaemia is needed in women of reproductive age, to enhance haematological status and improve maternal and child health outcomes.