Maternal anemia is associated with adverse obstetric, neonatal and placental outcomes in Mbarara, Uganda

Abstract

Objective: Maternal anemia is a significant risk factor for maternal morbidity and mortality, affecting 42% of pregnant women globally. In addition to increased risk of death from peripartum hemorrhage, anemic pregnant women are at increased risk of preterm birth, intrauterine growth restriction and stillbirth. The World Health Organization defines moderate and severe anemia in pregnancy as hemoglobin (Hb) < 10 g/dl and Hb < 7 g/dl, respectively. We aimed to characterize the effect of moderate and severe maternal anemia on obstetric, neonatal and placental outcomes in a resource-limited setting. Study design: Prospective cohort of 352 pregnant women delivering at a tertiary Ugandan referral hospital serving a mixed urbanagrarian population. 176 (50%) women were living with HIV and taking antiretroviral therapy. Anemia was diagnosed in labor using point-of-care Hb estimation via peripheral venipuncture. Placentas were collected at birth for gross and histologic examination. Obstetric and neonatal outcomes were determined through chart review and questionnaires. Categorical variables were analyzed using Chi squared and Fisher’s exact tests. Results: Moderate or severe anemia (Hb< 10 g/dl) was present in 17/352 (5%) of women. The mean Hb was 8.5 g/dl in the anemic group, and 12.9 g/dl in the non-anemic group. The only demographic difference between groups was a higher proportion of married in the non-anemic group. More anemic women were HIVinfected, 14/17 (82%) vs 162/335 (48%) in the non-anemic group (P¼0.006). There were no differences in obstetric outcomes. There were more blood transfusions in the anemic group (12% vs 2%, P¼0.04) and more neonatal deaths (12% vs 3%, P¼0.01). Placental thickness was lower in the anemia group (1.4 cm vs 1.7 cm, P¼0.04). Placental weights and histologic findings did not differ between groups. Conclusion: Moderate to severe anemia is associated with increased risk of maternal blood transfusion, neonatal death and decreased placental thickness in Uganda. Future studies should investigate whether treating maternal anemia decreases risk of adverse outcomes.