Spillover Effects of Maternal Anemia on Neonatal Outcomes and Cord-Blood Ferritin: A Cross-Sectional Study at Ulin General Hospital, Banjarmasin

Background: Maternal anemia, a common pregnancy complication, affects fetal development and placental function. The placental ratio, a key indicator of placental efficiency, is influenced by maternal hemoglobin levels. Objective: This study aims to assess the impact of maternal anemia on placental ratio among women admitted for delivery in a tertiary care hospital. Methodology: A total of 120 pregnant women were categorized into anemic (n=60) and non-anemic (n=60) groups. Placental weight, birth weight, and placental-to-birth weight ratio were analyzed. Results and Discussion: This study analyzed 120 pregnant women, divided into anemic (n = 60) and non-anemic (n = 60) groups based on hemoglobin levels. The anemic group had significantly lower hemoglobin (8.7 ± 1.2 g/dL) than the non-anemic group (12.4 ± 0.9 g/dL). Anemic mothers had larger placental weight (680 ± 120 g) and placental ratio (0.23 ± 0.04) compared to non-anemic mothers (560 ± 100 g; 0.17 ± 0.03). Despite placental hypertrophy, birth weight was lower in the anemic group (2950 ± 420 g vs. 3300 ± 350 g). Neonates of anemic mothers had higher NICU admissions (30% vs. 12%), low Apgar scores, and preterm births. Findings highlight the need for early anemia management to improve neonatal outcomes. Conclusion: Maternal anemia significantly impacts placental ratio, birth weight, and neonatal outcomes. This study suggests that placental hypertrophy compensates for reduced oxygen availability, yet fetal growth remains compromised. Anemic mothers had lower birth weights and higher preterm deliveries, NICU admissions, and low Apgar scores. Early diagnosis, iron supplementation, and enhanced prenatal care are essential to improving maternal and neonatal health outcomes globally.

BackgroundThe purpose of this study was to evaluate the effect of third-trimester maternal iron deficiency and iron deficiency anemia on neonatal cord-blood hemoglobin (Hgb), and serum ferritin levels.MethodsPregnant women who gave birth between 370/7 and 406/7 weeks of gestation, and their neonates were included. Maternal hemoglobin and ferritin levels were assessed. They were divided into two groups based on Hgb values as anemic and non-anemic. Furthermore, the anemic group was classified as mild, moderate, and severe anemia. Maternal and cord Hgb, hematocrit and ferritin levels were compared between groups. The study population was stratified into two groups according to iron supplementation status.ResultsAmong 627 women included, 226(36%) were diagnosed as anemic, of which 130(57.5%) had mild, 94(41.6%) moderate, and 2(0.9%) severe anemia. Mean maternal Hb levels were 9.9±0.9 g/dl and 12.1±0.9 g/dl in the anemic and non-anemic groups, respectively. The mean maternal serum ferritin of anemic and non-anemic mothers were 11.7 ng/ml and 15.8 ng/ml, respectively (p < 0.001). The mean cord-blood serum ferritin of neonates born from anemic and non-anemic mothers was 113±68.8 ng/ml and 134±95.0 ng/ml, respectively (p = 0.012). Cord-blood Hb levels of neonates born from anemic and non-anemic mothers were 15.1±1.8 g/dl and 15.5±2.0 g/dl, respectively (p = 0.006). The 5th, 25th, 50th, 75th, and 95th percentiles of cord blood serum ferritin concentrations were 32.6, 72.2, 107.5, 154.1, and 272.6 ng/ml, respectively. Among neonates born from mild, moderate, and severe anemic mothers, there was no significant difference regarding cord-blood serum ferritin and blood count parameters (p > 0.05). Cord-blood serum ferritin concentrations were found to be 119 ± 85.7 ng/ml and 136.4 ± 87.9 ng/ml in the low and normal maternal serum ferritin groups, respectively (p = 0.015).ConclusionMaternal anemia is common and associated with lower neonatal cord blood hemoglobin and ferritin levels. However, lack of iron supplementation during pregnancy, rather than anemia itself, was the strongest independent predictor of neonatal anemia. These findings highlight the importance of routine antenatal iron supplementation to support fetal iron status and improve perinatal outcomes. Further randomized controlled trials are needed to evaluate the effects of maternal iron supplementation on fetal iron stores and long-term outcomes.

Background: Maternal anemia is a significant global health problem, particularly in low- and middle-income countries, contributing to impaired fetal growth and adverse neonatal outcomes. While its association with low birth weight is well documented, less is known about its impact on a broader range of neonatal anthropometric measurements (AMs) in term neonates, particularly in South Asian populations where anemia prevalence is high. Objective: To compare AMs at birth between term neonates of anemic and non-anemic mothers to assess the impact of maternal anemia on neonatal growth patterns in a local Pakistani population. Methods: This cross-sectional observational study was conducted from October 2024 to March 2025 at the Divisional Headquarters Teaching Hospital, Mirpur, AJK. We enrolled 100 pregnant women aged 18–40 years delivering singleton term neonates (≥38 weeks), classified into anemic (hemoglobin &lt;11 g/dL, n=50) and non-anemic (hemoglobin ≥11 g/dL, n=50) groups. Neonatal AMs—birth weight (BW), crown-heel length (CHL), head circumference (HC), chest circumference (CC), mid-upper arm circumference (MUAC), and ponderal index (PI)—were measured within 24 hours of birth using standardized techniques. Group differences were analyzed using independent t-tests and chi-square tests with adjustment for potential confounders. Results: Neonates of anemic mothers had significantly lower mean BW (2265.2±113.2 g vs. 2353.9±222.4 g, p=0.01), CHL (46.22±0.42 cm vs. 46.56±1.05 cm, p=0.04), HC (31.56±1.05 cm vs. 32.26±1.44 cm, p=0.01), CC (29.76±0.80 cm vs. 31.50±0.99 cm, p&lt;0.0001), and MUAC (8.5±0.51 cm vs. 9.9±0.79 cm, p&lt;0.0001). The proportion of neonates with PI &lt;2.2 was higher in the anemic group (20% vs. 6%, p=0.04). Conclusion: Maternal anemia is associated with significantly reduced neonatal anthropometric parameters and an increased frequency of disproportional growth restriction at birth, underscoring the importance of early identification and correction of anemia in pregnancy to optimize neonatal outcomes.

The purpose of this work was to assess the effect of severe maternal iron-deficiency anemia and nutritional status on cord blood and breast milk iron status. We conducted a prospective observational study over a 6-month period in a teaching hospital in central India. The study population consisted of 55 anemic (hemoglobin: < 110 g/L) and 20 healthy nonanemic (hemoglobin: > or = 110 g/L) pregnant women who delivered singleton live births at term gestation. We measured hemoglobin, iron, and ferritin levels in paired maternal and cord blood and iron levels in early (day 3 +/- 1) and late (day 15 +/- 3) transitional milk. Maternal anthropometry, including weight, height, midarm circumference, triceps skinfold thickness, and placental weight, were recorded. The main outcome measure of the study was to find out the relationship of maternal hemoglobin, iron, ferritin, and anthropometry with hemoglobin, iron, and ferritin in cord blood and iron levels in breast milk. Concentrations of hemoglobin, iron, and ferritin were significantly lower in the cord blood of anemic mothers and showed linear relationships with maternal hemoglobin and ferritin levels. Breast milk iron content was significantly reduced in severely anemic mothers but not in those with mild-to-moderate anemia. Breast milk iron level correlated with maternal hemoglobin and iron levels but not with ferritin levels. Maternal anthropometry had significant correlations with indices of iron nutriture in maternal and cord blood but showed no relationship with breast milk iron content. Placental weight was comparable between anemic and nonanemic mothers. Maternal anemia, particularly the severe type, adversely affects cord blood and breast milk iron status. Maternal nutritional status exerts a significant influence on fetal iron status but has little influence on breast milk iron content.

Maternal and neonatal characteristics and outcomes among COVID-19 infected women: An updated systematic review and meta-analysis

Background:Pre-delivery haemoglobin and serum ferritin concentrations of anaemic and non-anaemic mothers were determined, and cord blood haemoglobin and serum ferritin concentrations of their newborns were compared. This is to establish the mean values for pre-delivery haemoglobin and serum ferritin concentrations of anaemic and non-anaemic mothers and the cord blood haemoglobin and serum ferritin concentrations of their newborns at term.Materials and Methods:A case–control study was done involving 142 pregnant women and their newborns. They were divided into two groups - the anaemic group (n = 65) and the non-anaemic (n = 77) group. Five millilitres of blood was collected from each woman and 2 ml was collected from the cord of their newborns into ethylenediaminetetraacetic acid (EDTA) bottle and plain bottle for full blood count analysis and ferritin assay, respectively.Results:The mean pre-delivery haemoglobin concentrations of the women in anaemic group and non-anaemic group were 9.5 ± 1.01 g/dl and 12.15 ± 1.07 g/dl, respectively, and their mean serum ferritin concentrations were 64.45 ± 138.76 μg/l and 32.83 ± 35.36 μg/l, respectively. The mean cord blood haemoglobin concentrations for anaemic and for non-anaemic groups were 12.54 ± 2.54 g/dl and 13.44 ± 2.23 g/dl (P = 0.02), respectively, and the mean cord blood serum ferritin concentrations (non-anaemic, 69.38 ± 78.88 μg/l; anaemic, 7.26 ± 115.60 μg/l) (P = 0.00) were higher in the newborns of non-anaemic than of anaemic mothers. Significant association was found between maternal anaemia and cord blood ferritin concentrations (P = 0.025).Conclusion:Maternal anaemia has significant effects on cord blood haemoglobin and serum ferritin concentrations.

Background: Anemia in pregnancy is still a major public health problem in developing countries and plays an important role in adverse perinatal outcomes. The low hemoglobin levels reduce oxygen delivery to the fetus and has complications such as intrauterine growth restriction, preterm birth and perinatal morbidity. Early diagnosis and treatment are necessary for better maternal and neonatal outcomes. Objective: To ascertain the effects of maternal anemia on perinatal outcomes such as birth weight, preterm delivery and neonatal morbidities in pregnant mothers receiving care at the tertiary level hospitals. Study design: A prospective study at Watim General Hospital from Jan 2024 to December 2024. Methods: This is a prospective study of 100 pregnant women. Hb was determined with standard laboratory methods and categorized according to WHO criteria. Maternal characteristics, obstetric history, and neonatal outcomes were extracted. Continuous variables were presented as the mean ± SD. Chi square and t-tests were used to compare outcomes among anemic versus non-anemic subjects. All analyses were performed by SPSS version 24.0 and p&lt;0.05 was considered as the level of significance. Results: The mean maternal age was 27.4 ± 4.6 years in a cohort of 100 subjects. Anemia prevalence was 52%. The frequency of low birth weight was 46% as against 21% among anemic and non-anemic mothers respectively (p=0.01). Anemic women had significantly more preterm deliveries (33% vs. 12%, p=0.02). Twenty nine percent of anemic mother's babies versus 10% in the nonanemic group needed to be admitted to NICU (p=0.01). Perinatal mortality were also significantly higher in the anemic group (8% vs. 2%, p=0.04), reflecting a clear relationship between maternal anemia and adverse perinatal outcomes. Conclusion: Maternal anemia was significantly associated with higher odds of adverse perinatal outcomes including low birth weight, preterm birth, admission to NICU and perinatal mortality. These results underscore the demand for antenatal screening and correct intervention of anemia in order to enhance maternal and neonatal survival. Public health measures emphasizing prevention, early diagnosis and nutrition supplementation are vital in decreasing anemia related perinatal morbidity and mortality

Introduction: Anemia is one of the most prevalent nutritional deficiency problem affecting pregnant women. It is defined by World Health Organization as hemoglobin (Hb) level of less than 11 g/dl. Hemoglobin level of 9.0- 10.9 g/dl is mild, 7.0-8.9 g/dl is moderate and less than 7 g/dl is severe anemia respectively. Maternal anemia in pregnancy is commonly considered as a risk factor for poor pregnancy outcome and can result in complications that threaten the life of both mother and fetus.&#x0D; Aims: To find out neonatal outcome delivered to anemic mothers.&#x0D; Methods: A prospective case control study was carried out among 75 newborns delivered to pregnant women with hemoglobin below 10.9g/dL. Another 75 newborns were taken delivered at the same time, matched age and sex wise as a control group to mothers whose hemoglobin was more than 11g/dl.&#x0D; Results: Out of total 75 cases 35(46.7%) mothers had mild, 32(42.6%) had moderate and 8(10.7%) had severe anemia respectively. Similarly, the risk of having preterm baby among anemia group was 4.42 times higher than that in control group (p 0.033). The risk of having low birth weight in anemia group was 3.9 times higher than that in control group (p 0.04). The mean of head circumference (HC) among the anemia group was 33.9cm +1.40 (Mean+SD) and among the control group was 34.4cm+1.24(Mean+SD) with a mean difference of 0.5cm (p 0.032). The mean of length among anemia group was 45.3cm+1.97 (Mean+ SD) and among the control group was 46.2cm+1.69 (Mean+ SD) with a mean difference of 0.9 cm (p 0.003).&#x0D; Conclusion: Maternal anemia in pregnancy is associated with increased risk of adverse neonatal outcome. Efforts must be made to reduce the prevalence of anemia especially during pregnancy to reduce neonatal morbidity and mortality.

Low Birth Weight and Congenital Heart Disease: Current Status and Future Directions

Objectives: To determine the prevalence of anemia in pregnant women and characterize its effect on neonatal outcome in Northeast India.Patients and methods: Four hundred and seventy mothers and their newborn infants during a one month period were included. The association between maternal hemoglobin (Hb) at delivery and neonatal outcomes were determined.Results: Anemia (Hb < 110 g/L) was present in 421 (89.6%) mothers with 35 (8.3%) having severe anemia(Hb < 70 g/L). After adjusting for maternal and neonatal variables, each 10 g/L decrease in maternal Hb was associated with 0.18 week decrease in gestational length (p = 0.003) and 21 g decrease in birth weight (p = 0.093). Severe maternal anemia was associated with 0.63week (95% CI, 0.03–1.23week) shorter gestation, 481 g (95% CI, 305–658 g) lower birth weight and 89% increased risk of small-for-gestation (OR 1.89, 95% CI, 1.25–2.86)in the offspring, compared with those born to mothers without anemia (p < 0.001).Conclusion: Maternal anemia was highly prevalentin this population. Lower gestational age and birth weight, and increased risk of small-for-gestation were associated with maternal anemia, especially when maternal Hb was <80 g/L. Maternal anemia needs urgent attention to improve neonatal outcome in this population.

Objective: The objective of this study is to evaluate the relationship between maternal anemia and fetal birth weight and how other variables impact fetal birth weight. Study Design: Comparative, Cross-sectional, Multi-centric study. Setting: Labor Room Jinnah Hospital Lahore, Labor Room Allied Hospital Faisalabad, Labor Room Holy Family Hospital Rawalpindi. Period: 01-08-2020 to 31-10-2020. Material &amp; Methods: The data for this comparative, cross-sectional, multi-centric study was collected using a structured questionnaire from 360 subjects with equal representation among 3 major tertiary care centers of Punjab, Pakistan. Sample size was calculated using Open-Epi software at 95 percent confidence interval, taking frequency of anticipated factor (frequency of LBW babies among anemic females) as 64 percent. The calculated sample was 353 and we recruited 360 subjects for the study. 120 subjects from each study setting were recruited and divided into anemic and non-anemic groups of 60 subjects each. The sample size was equally divided among anemic and non-anemic groups to achieve comparative analysis of both groups for a variety of variables. Data analysis was performed on R v 4.0.2. Results: This study demonstrated a significant association between maternal anemia and low fetal Birth weight. In Anemic group, 28.88% of the babies were born with Low Birth weight, as compared to 17.77% Low Birth weight babies in the Non-Anemic group, the difference being statistically significant (p&lt;0.012). Conclusion: Maternal anemia and fetal birth weight have a significant negative correlation. Mothers with Anemia are more likely to give birth to babies with Low weight at Birth.

BackgroundSARS-CoV-2 infection during pregnancy may cause adverse maternal, neonatal and placental outcomes. While tissue hypoxia is often reported in COVID-19 patients, pregnant women with anemia are suspected to be more prone to placental hypoxia-related injuries.MethodsThis hospital-based cross-sectional study was conducted between August-November 2021, during COVID-19 second wave in India. Term pregnant women (N=212) admitted to hospital for delivery were enrolled consecutively. Since hospital admission mandated negative RT-PCR test for SARS-CoV-2 virus, none had active infection. Data on socio-demography, COVID-19 history, maternal, obstetric, and neonatal outcomes were recorded. Pre-delivery maternal and post-delivery cord blood samples were tested for hematological parameters and SARS-CoV-2 IgG. Placentae were studied for histology.ResultsOf 212 women, 122 (58%) were seropositive for SARS-CoV-2 IgG, but none reported COVID-19 history; 134 (63.2%) were anemic. In seropositive women, hemoglobin (p=0.04), total WBC (p=0.009), lymphocytes (p=0.005) and neutrophils (p=0.02) were significantly higher, while ferritin was high, but not significant and neutrophils to lymphocytes (p=0.12) and platelets to lymphocytes ratios (p=0.03) were lower. Neonatal outcomes were similar. All RBC parameters and serum ferritin were significantly lower in anemic mothers but not in cord blood, except RDW that was significantly higher in both, maternal (p=0.007) and cord (p=0.008) blood from seropositive anemic group compared to other groups. Placental histology showed significant increase in villous hypervascularity (p=0.000), dilated villous capillaries (p=0.000), and syncytiotrophoblasts (p=0.02) in seropositive group, typically suggesting placental hypoxia. Maternal anemia was not associated with any histological parameters. Univariate and multivariate logistic regression analyses of placental histopathological adverse outcomes showed strong association with SARS-CoV-2 seropositivity but not with maternal anemia. When adjusted for several covariates, including anemia, SARS-CoV-2 seropositivity emerged as independent risk factor for severe chorangiosis (AOR 8.74, 95% CI 3.51-21.76, p<0.000), dilated blood vessels (AOR 12.74, 95% CI 5.46-29.75, p<0.000), syncytiotrophoblasts (AOR 2.86, 95% CI 1.36-5.99, p=0.005) and villus agglutination (AOR 9.27, 95% CI 3.68-23.32, p<0.000).ConclusionAsymptomatic COVID-19 during pregnancy seemed to be associated with various abnormal placental histopathologic changes related to placental hypoxia independent of maternal anemia status. Our data supports an independent role of SARS-CoV-2 in causing placental hypoxia in pregnant women.

Low birth weight (LBW) remains a global health concern, especially in sub-Saharan African countries with fewer resources, such as Sudan. Despite ongoing preventive measures, LBW is still one of the main health problems and it is a leading risk factor for several adverse perinatal and neonatal outcomes. To assess the prevalence of and factors associated (mainly maternal anemia) with LBW at Rabak Maternity Hospital, White Nile, Central Sudan. A cross-sectional study was conducted involving live singleton newborns and their mothers who presented to Rabak Maternity Hospital from September to December 2021. Questionnaires were completed via face-to-face interviews to gather maternal information (maternal age, parity, history of miscarriage, educational status, and level of antenatal care [ANC]). Maternal hemoglobin levels were measured using an automated hematology analyzer. The neonate's birth weight and sex were recorded. Two hundred and fifty-three newborns were enrolled in this study, 40 (15.8%) of whom were LBW neonates. The median (interquartile range) maternal age and parity were 25 (21.0-30.0) years and 2 (1-4), respectively. While gestational age, maternal hemoglobin, and maternal anemia were associated with LBW, maternal age, parity, a history of miscarriage, education level, and level of ANC were not associated with LBW in the univariate analysis. Multivariate analysis showed that gestational age (adjusted odds ratio [AOR] = 0.80, 95% confidence interval [CI] = 0.66-0.96) and maternal hemoglobin (AOR = 0.76, 95% CI = 0.52-0.86) were inversely associated with LBW. Maternal anemia was associated with LBW (AOR = 4.70, 95% CI = 2.06-10.94). LBW is a major health concern in White Nile, Sudan. Maternal age and maternal anemia are associated with LBW. Preventive measures for managing maternal anemia may help reduce the incidence of LBW.

Background: Synonymous with low- and middle-income countries (LMICs), micronutrient deficiencies during pregnancy is a serious public health issue. It is estimated that 38% of pregnant women around the world are anaemic and this is mainly due to iron deficiencies but other risks are posed by poor consumption of folate and vitamin B twelve. These shortcomings are a reason of poor maternal and neonatal outcomes, including preterm birth, low birth weight and fetal growth restriction. Multivitamin minerals (MMS) have been an attractive alternative to the conventional iron and folic acid (IFA) program. Objective: The purpose of this review is to examine barriers to implementation of supplementation programs, and to examine strategies including simulation frameworks, and real time data analytics, to enhance these interventions. Methods: Systematic literature review using scientific databases namely; PubMed, Scopus, and Google Scholar to identify studies targeting clinical subjects published between 2020 and 2025 was conducted. Qualitative thematic analysis approach was used for synthesizing the findings on maternal health, neonatal outcomes, as well as the program implementation challenges. The selected and included studies were based on the PRISMA framework. Results: MMS has been found to offer broader benefits than IFA in that it appears to reduce risks for preterm birth, low birth weight, and small-for-gestational-age, with the benefits accumulated when folate is also fortified. Although IFA continues to be an effective measure for tackling the problem of maternal anaemia and reducing neonatal mortality rates, as evidenced by its proven results in a host of observed cases, the nutritional support it provides is not comprehensive enough, unlike its counterpart MMS. The poor adherence, limited accessibility, socioeconomic barriers, and insufficient education were identified to be multiple barriers for implementation. We suggested strategies including SMS reminders, homebased support, and free provision of supplement. Cost benefit analyses also indicate that MMS would be a viable investment for maternal and child health programs. Conclusions: It is possible to reduce the possibility of improvement in maternal and neonatal health outcomes in LMICs with micronutrient supplementation, particularly with MMS. However, tailored interventions, better education, use of data driven approaches are what are needed to overcome the implementation barriers. The long term impacts and the best time and way of delivering the optimal gestational nutrition need to be studied or refined to achieve maternal and child health global targets. Graphical Abstract

Background: Anemia is a common pregnancy disorder with low hemoglobin levels, typically below 11 g/dL in the first and third trimesters or 10.5 g/dL in the second. It can result from malnutrition, blood loss, infections, chronic diseases, and iron and folic acid deficiencies. Affecting 38.2% of pregnant women globally, anemia is linked to adverse maternal and neonatal outcomes, such as preterm delivery, low birth weight, and postpartum hemorrhage. Aim of the study: The aim of this study is to evaluate the impact of maternal anemia on neonatal outcomes. Methods: This prospective observational study, conducted at the Department of Paediatrics, Medical College for Woman and Hospital, Dhaka, Bangladesh, between July 2011 to June 2012, aimed to evaluate the impact of maternal anemia on neonatal outcomes. A total of 130 patients with hemoglobin levels &lt;7 g/dL, gravida ≤3, and singleton pregnancies were included. Exclusion criteria were specific maternal and neonatal conditions. Data on socio-demographics, maternal hemoglobin, and perinatal/neonatal outcomes (prematurity, low birth weight, Apgar scores) were collected via interviews and medical records. Statistical analysis was performed using SPSS, with continuous variables expressed as mean±SD and categorical variables as frequency/percentage. Result: One hundred thirty participants were assessed for socio-demographic characteristics, with the majority (50.77%) in the 25-34 age group. The mean maternal age was 27.19±6.63 years, and 66.15% were multigravida. The mean BMI was 20.92±1.89 kg/m², and the mean hemoglobin level was 7.89±2.82 g/dL, indicating anemia. Preterm labor occurred in 13.08%, and 86.92% experienced term labor. Vaginal delivery occurred in 60%, with 34.62% neonatal ICU admissions. Neonatal complications included meconium-stained liquor (16.15%) and prematurity (13.08%). The mean birth weight was 2760±432.5 grams, with a mean gestational age of 38.1±2.0 weeks. Conclusion: Maternal anemia negatively affects both maternal and neonatal health. It contributes to adverse outcomes for neonates, such as including prematurity, low birth weight, and neonatal anemia, which were also prevalent, with a high rate of NICU admissions. Early detection, timely management, and preventive measures, including iron supplementation, are crucial to reduce these risks and improve maternal and neonatal outcomes.