J Ayub Med Coll Abbottabad 2011;23(1)

ORIGINAL ARTICLE

EFFECT OF MATERNAL ANAEMIA ON BIRTH WEIGHT

Muhammad Owais Ahmad, Umay Kalsoom*, Ume Sughra*, Usman Hadi**,
Muhammad Imran
Departments of Physiology, *Community Medicine, Foundation University Medical College, Rawalpindi, **Health Services Academy,
Islamabad, Fauji Foundation Hospital, Rawalpindi

Background: Anaemia is a common medical problem in pregnancy. The extent up to which,

maternal anaemia effects maternal and neonatal health is still uncertain. Maternal anaemia is
commonly considered a risk factor for low birth weight (LBW) babies. Some studies have
demonstrated a strong association between low haemoglobin before delivery and LBW babies.
However, others have not found a significant association. Therefore, there is insufficient information
to assess the overall adverse impact of anaemia during pregnancy. The aim of this study was to
determine whether maternal anaemia would affect the birth weight of the baby and compare this with
that of non-anaemic mothers. It was a cross-sectional comparative study carried out at the maternity
ward of Fauji Foundation Hospital, Rawalpindi. Methods: One hundred subjects divided into two
groups each containing 50 subjects on the basis of consecutive non probability sampling were
included in the study. Group-A included 50 Anaemic pregnant women and Group-B 50 non-anaemic
pregnant women. Information was collected by direct interviewing method through a precoded
structured questionnaire. The Hb level and birth weights were taken from the labour room record.
Results: The mean age of the mothers in anaemic group was found to be older than the non anaemic
group, i.e., (29.44 versus 27.98), though the difference was statistically non significant. The number
of low birth weight infants (64%) was statistically very highly significantly more (p<0.001) in the
anaemic group of mothers than the non anaemic group (10%). Conclusion: The results of this study
show an association of maternal anaemia in pregnancy with increased risk of LBW babies.
Keywords: Maternal anaemia, Perinatal outcome, Low birth weight.

INTRODUCTION
Anaemia in pregnancy is a common problem and 50%
pregnant women in developing countries are suffering
from anaemia; 20% of the maternal deaths are directly or
indirectly related to anaemia. According to WHO criteria
Haemoglobin concentration of less than 11 gm/dl and
haematocrit of <033 is declared as anaemia in
pregnancy.1 Anaemia is a critical health concern because
it effects growth and development of neonates.
Prevalence of anaemia in developing countries is 56%, it
is even higher in the Central Asia, reported as being 80%
in India.2 Anaemia causes maternal morbidity and
mortality, and also affects the perinatal outcome, it can
also cause maternal infections, post partum haemorrhage
and pre-eclampsia. Pregnant anaemic mothers often
complain of body aches and easy fatigability.
In Pakistan common causes of anaemia are
poor economic conditions, illiteracy, lack of health
seeking behaviour, repeated pregnancies, gender bias and
worm infestation. Previous studies in Pakistan shows
iron deficiency as the main factor responsible for
anaemia in pregnancy.3 Anaemia is a common problem
in pregnant women especially in developing countries
like Pakistan, ranging from 8% to 33%, and increases the
risk of LBW and IUGR.4
Low birth weight is a major determinant of
mortality, morbidity and disability in infancy and

childhood and has a long term impact on health

outcomes in adult life.
Across the world, neonatal mortality is 20 times
more likely for low birth weight (LBW) babies
compared to heavier babies (2.5 kg).5 It is also
established as an important risk factor for neonatal
morbidity.6,7 The cohort of LBW (birth weight <2.5 Kg)
babies is likely to reflect two effects, namely a short
gestational age (preterm births) and small for gestational
age (SGA).
A strong relationship was found between
maternal anaemia and low birth weight babies.8 The
findings were in agreement with other studies of
anaemic pregnant women carried out in Pakistan9 and
Syria10. Women can develop iron deficiency anaemia
from the loss of blood during menstruation and from
repeated pregnancies; it can also be caused by a lack of
iron in the diet. During pregnancy, women may develop
anaemia because the growing foetus may draw upon the
mothers iron for the development of RBCs and other
tissues.11
There is variation in the data from different
studies about the association of maternal anaemia on
adverse pregnancy outcomes and there is insufficient
information to asses the overall adverse impact of
anaemia during pregnancy. The aim of the study was to
determine whether maternal anaemia would affect the
birth weight of the baby and compare this with that of
non-anaemic mothers.

http://www.ayubmed.edu.pk/JAMC/23-1/Owais.pdf

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J Ayub Med Coll Abbottabad 2011;23(1)

MATERIALS AND METHODS

This was a comparative cross-sectional study,
comparing the effect of maternal anaemia on birth
weight of the baby with that of non-anaemic mothers.
This study took place at the Maternity ward of Fauji
Foundation Hospital, Rawalpindi and was carried out
from May 2009 to October 2009. Sample size was 100
divided into two groups each containing 50 subjects.
Group-A included 50 anaemic pregnant women and
Group-B 50 non-anaemic pregnant women. Sampling
technique was consecutive non-probability. Inclusion
criteria was all pregnant women 16 years and older and
a singleton pregnancy with a complete medical record.
In Group A pregnant women having haemoglobin levels
<11 g/dl in labour and in Group-B pregnant women
having haemoglobin levels 11 g/dl in labour were
included in this study. All women with a past history of
preterm delivery, obstetrical complications or any
medical illness, except anaemia, were excluded from the
study in order to control for the confounding factors. As
preterm delivery can recur in the next pregnancy, a past
history of preterm delivery can cause preterm delivery,
rather than anaemia.
The questionnaire for this study consists of
demographic and socioeconomic profile, education
level, antenatal history, obstetric history and birth
weights of the babies.
Information was collected by direct
interviewing method through a pre-coded structured
questionnaire. Every subject was approached personally,
briefed about the purpose of study, taken into
confidence and reassured about the confidentiality of
their information. Verbal informed consent was taken
before the start of study, each question was explained in
Urdu or in the language they understood and
questionnaire was filled on the spot so as to get unbiased
remarks. The Hb level and birth weights were taken
from the labour room record.
Data was analysed using SPSS-12. Descriptive
statistics were used to calculate means and standard
deviations for numerical data. These were compared
using t-test at a confidence level of 95%. Frequencies
were calculated for categorical data. These were
compared using 2 test, and p<0.05 was statistically
significant.

RESULTS
The results are summarised in Figure-1 and Table-1.
Figure-1 shows simple bar chart of the anaemic and nonanaemic mothers in different ages. When the ages of the
mothers in both the groups were compared, the mean age
of the anaemic group was found to be older than the nonanaemic group, (29.44 versus 27.98). However, the
difference between the two groups was statistically nonsignificant (p=0.146). The age for the anaemic mothers

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ranged between 18 and 38 years, and age of non-anaemic

mothers ranged between 20 and 40 years.
Table-1 shows that whether the infant had low
birth weight at birth in anaemic and non anaemic
mothers. The difference between the two groups was
found to be statistically very highly significant
(p<0.001) in our study, as 64% of mothers delivered a
low birth weight baby in the anaemic group as against
10% in the non anaemic group.
30

25

20

15

10

A, Anemic

Group

B, Non-Anemic

Figure-1: Mean ages of the mothers in anaemic

and non-anaemic groups
Table-1: Low and normal birth weight babies of
the anaemic and non-anaemic mothers
Group
A: Anaemic (n=50)
B: Non-Anaemic (n=50)
p-Value

Underweight
Normal
32 (64%)
18 (36%)
5 (10%)
45 (90%)
0.001*
*Significant

DISCUSSION
Anaemia in pregnancy is an important public health
problem worldwide. WHO estimates that more than half
of pregnant women in the World have a haemoglobin
level indicative of anaemia (<11.0 g/dl), the prevalence
may however be as high as 56 to 61% in developing
countries.4
As it is estimated that about 7.3 million
perinatal deaths occur annually in the world, most of
these in developing countries especially Asia12, one
could assume many of these could be prevented by
correcting maternal anaemia. Prematurity and birth
anoxia are the main causes of perinatal deaths in
Pakistan. In the studied population, prematurity was the
leading cause of perinatal death but less frequent than in
other hospitals in Pakistan13, indicating poor
resuscitation facilities and neonatal care in the country.
Severe anaemia (<8 g/dl) is associated with birth weight
values that are 200400 g lower than in women with
higher (>10 g/dl) haemoglobin values, but these
researchers generally have not excluded other factors
that might also have contributed to both LBW and the
severity of anaemia.14
Low birth weight, i.e., <2.5 Kg is widely used
as an indicator of newborn health. The association of
LBW has been studied with a variety of factors relates
to geo-demographics, maternal health and pregnancy

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J Ayub Med Coll Abbottabad 2011;23(1)

history in various studies. Anaemia which is a common

problem in pregnant women in developing countries like
Pakistan increases the incidence of low birth weight.
Badshah et al15 in their study found that the
predicted incidence figures for low birth weight babies
show an increase among the Tribal areas of Pakistan in
anaemic mothers, with a highly significant difference
(p<0.01) in the incidence of low birth weight babies
among the anaemic mothers compared to non anaemic
mothers. Their study showed that anaemic mothers are
at increased risk of small for gestational age infants
compared to non anaemic mothers. The results of a
study in Ahmedabad, India by Mavalankar et al16, were
also consistent with Badshah et al15, with reference to
the effect of maternal anaemia on low birth weight.
Lone et al11 in a multivariate analysis of their
study population showed that the risk of low birth
weight babies in the anaemic population was 1.9 times
higher (95% CI= 1.03.4).
Jones et al17 also found an increased incidence
of low birth weight babies in anaemic mothers, however
the difference from the non anaemic group in their study
was non significant (p=0.11).
The results of our study were also consistent
with the above mentioned studies, showing that the
majority of anaemic mothers gave birth to low birth
weight babies, with a very highly significant difference
(p<0.001) from the non anaemic group.
The management and control of anaemia in
pregnancy is enhanced by the availability of local
prevalence statistics, which is however not adequately
provided in Pakistan.

CONCLUSION
The results show the association of maternal anaemia in
pregnancy with increased risk of LBW babies. Our
study also shows that anaemia in pregnancy is still a
major health problem. The improvements achieved in
the developed world may largely be due to more
effective diagnosis and treatment.

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Address for Correspondence:

Dr. Muhammad Owais Ahmad, Associate Professor of Physiology, Kabir Medical College, Canal Road,
University Town Peshawar, Pakistan. Cell: +92-300-5172892
Email: drmowais@hotmail.com

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