DOI: https://doi.org/10.

53350/pjmhs20221611304
ORIGINAL ARTICLE

Factors Associated with Maternal Anemia and its Relationship with a Low
Birth Weight of Newborn
SHAHZAD RAUF1, SHAMAYAL MANDOKHEL2, HINA PIRZADA3, REHMAN SHER4, MUNEMA SHAKEEL5, FARHATULLAH6
1
Fellow Neonatology, Agha Khan University Hospital Karachi
2
Associate Professor & Head, Department of Pediatrics Unit 2, Balochistan Institute of Child Health Services, Quetta
3
Assistant Professor, Department of Obstetrics & Gynaecology, AJK Medical College Muzaffarabad Azad Kashmir
4
Medical Officer, Gohar Hospital Totalai District Buner
5,6
Kabir Medical College, Gandhara University, Peshawar
Correspondence to: Dr. Shahzad Rauf, E-mail: rauf_shahzad@yahoo.com, Cell: 0306-8048501

ABSTRACT
Objective: To determine maternal anemia and its relationship with the nutritional status and low birth weight of a newborn.
Study Design: Cross-sectional analytical study.
Place and Duration of Study: Tertiary Care Hospital KPK Peshawar from 1st January 2022 to 30th June 2022.
Methodology: Three hundred and eighty five individuals, aged between 18 to 45 years were enrolled. All patients with
hemoglobin level <11 g/dl, low birth and normal were included. Patients with a history of hypertension and diabetes mellitus
were excluded.
Results: The maternal anemia was found in 39.37% while low birth weight was among 16.62% result was significant (P=0.00).
Mothers taking a balanced diet and milk regularly were reported with normal hemoglobin. Low birth weight was reported in
multigravida 28.3% and 20.25% in primigravida. The multiparous give birth to 29.09% low birth weight and patients taking a gap
of less than 2 years have a low birth weight of a newborn and he results were significant at P=0.043.
Conclusion: The maternal anemia can be a risk factor for the low birth weight of the newborn.
Keywords: Maternal anemia, Nutrition, Newborn, Deficiencies, Low birth weight

INTRODUCTION ingredients of animal origin, which are the primary supply of dietary
A pregnant woman must pay close attention to her health nutrition B12.7 Iron deficiency is the most common dietary cause
throughout this time of rapid transformation to have a healthy baby, of anemia, accounting for approximately 50% of all occurrences
because a growing foetus is entirely dependent on its mother for worldwide and anaemia in pregnancy.Iron deficiency is typically
nutrition, and optimum maternal health depends on adequate caused by low dietary iron consumption and decreased iron
maternal nutrition. Numerous unfavourable maternal and foetal availability due to an overreliance on plant-based diets and iron
outcomes, including gestational diabetes, gestational hypertension, absorption inhibitors such as phytate.8
low birth weight, intrauterine growth limitations, and gestational Multiple physiological changes during pregnancy necessitate
and postnatal death, have been linked to poor maternal nutritional an increase in iron intake.Malaria and hookworm play important
status. 2,3 Approximately 800 pregnant women died of pregnancy- roles in the pathogenesis of anaemia in pregnancy. 9
related problems, and 99% died during childbirth, all of these Consequences of anemia consist of decreased work ability and
fatalities occurring in developing countries, according to a joint danger of mortality for the pregnant female leads to delivery
report from the World Bank, UNICEF, WHO, and the United problems low birth weight and cause less chance of improvement
Nations Population Fund (UNFPA). About 40% of all maternal of infant.Furthermore, mateanaemianthropometry and being
deaths after delivery are linked to anemia, which is a prominent underweight and theobese are risks of pregnancy with
cause of morbidity and mortality in pregnant women. 4 Anemia, negafemale, whichutcomes.In comparison to women of normal
which is defined as a low blood haemoglobin concentration, is still weight, obese pregnant women have a higher risk of foetal
a significant public health concern in many developing nations. 5 macrosomia, a low APGAR score, perinatal death, developing
Anemia is most common among pregnant women and children gestational diabetes, and two cases of increased risk of developing
under the age of five, while it can affect adults at all stages of life. hypertension issues.11 Maternal underweight will exacerbate
Anemia is typically linked to poor health. 6 problems during the IU's life.Since the last ten years, females or
In growing countries, in contrast to developed nations, girls aged 15 to 49 have been prone to obesity and weight
anaemia in pregnancy is extremely prevalent. While the gain.Therefore, the purpose of this study was to evaluate factors
occurrence rates in Africa, Asia, and Latin America vary from 35% related to maternal anaemia and its relationship with low birth
to 75%, much less than 30% of pregnant females in the USA suffer weight.
from tripla anemia. In Pakistan, maternal anemia-related mortality
can reach 194 per 100,000 live births, in contrast to 34 per MATERIALS AND METHODS
100,000 live births in Nigeria. The Safe Motherhood Initiative (SMI) This cross-sectional analytical study was conducted in tertiary care
used to be mounted in 1987 via the United Nations Children's hospitals of Peshawar after the approval of the synopsis from the
Fund and representatives from forty-five international locations to Ethical Board of Gandhara University Peshawar from 1st January
reduce maternal mortality globally by the year 2000. According to 2022 to 30th June 2022. The sample size was 385 non-probability
the findings of recent research on maternal morbidity and mortality convenient sampling was used for the collection of samples from
in Sub-Saharan Africa, anaemia continues to play a significant role patients visiting or admitted in the Gynaecology Department of
in this region's maternal mortality rates.Anemia during pregnancy Hayatabad Medical Complex and Lady Reading Hospital
is caused by a variety of factors, including dietary deficiencies in Peshawar. The age of the patient was from 18 to 45 years
iron, folate, and vitamin B12, as well as external factors such as inclusion criteria were primigravida and multigravida with term
malaria and hookworm.The proportional significance of every one pregnancy age from 18 to 45 years included. Patients with a
of these elements in inflicting anaemia at some stage in pregnancy history of hypertension and diabetes mellitus and unwilling to give
varies notably depending on the region, the time of year, and information were excluded. Different variables were taken like age,
dietary habits. Iron and folate deficits are the most common gravidity, Hb, balanced diet and gap in pregnancy the average
reasons for anaemia in pregnant females in sub-Saharan Africa. birth weight for babies is around 3.5 kg, whereas babies whose
Nutrition B12 deficiency can contribute to anaemia in this region of weight was more than 2500 g were considered normal and weight
the world unknowingly due to the population's reliance on grains as less than 2500 grams were categorized as low birth weight.
an essential meal supply and the restricted consumption of dietary Maternal anemia was defined as hemoglobin levels below 11 g/dL

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 S. Rauf, S. Mandokhel, H. Pirzada et al

The data was import to SPSS-21. The Chi-square test was applied 24-hour recall, the study population's mean dietary diversity score
to assess the association between the outcome variable (newborn) (DDS) was 3.81 and 28.8% of the 379 women attained the
weight) and maternal anemia while for dependent variables ‘t’ test required level of dietary diversity for women. The dietary diversity
was applied. A P<0.05 was considered significant value. score, gestational age and maternal age were the independent
predictors of haemoglobin concentration. Accordingly, respondents
RESULTS with low DDS had a higher likelihood of being anemic than
The maternal hemoglobin was normal in 60% of the females while respondents with high DDS (OR = 1.795, p = 0.022, 95% CI: 1.086
39.37% of the females were anemic with low hemoglobin. The to 2.967).7
weight of the new born was normal in 57.40 % while 16.62 % of The current study showed that 20.77% of females were
the newborn with low birth weight. Females taking no balance diet deficient in iron and other supplements like vitamin C and zinc
and supplements like vitamin C, iron and zinc were 34.4% and while 34.4% were reported anemic by not taking a balanced diet.
24.93% with low birth weight respectively. Low birth weight was Another study in Sub-Saharan Africa, investigated the relative
also found in multigravida 33.5% and in primiparous with contributions of anemia in pregnant women caused by iron, folate,
10.38%.patient with low birth weight having a pregnancy with a and B12 insufficiency. The study included a total of 146 pregnant
gap of 2 to 3 years were 16.62% while patients taking clay and dirt women who visited two prenatal clinics in Gombe, Nigeria. 54% of
got babies with low birth weight (Tables 1-4). the girls were in their third trimester at the time. Blood samples
were purchased to measure the haematocrit, serum iron, total iron-
Table 1: Frequency of maternal anemia and weight of newborns binding capacity, ferritin, folate, nutrition B12 and homocysteine
Variable Normal Anemia  2 value P value levels. In the past, (9.4%) of ladies had malaria. A haemoglobin
Maternal HB 233 (60%) 152 (39.37%) 28.092 0.000 level of less than 105 g/L led to the anaemia classification of forty-
Weight of 321(57.40%) 64(16.62%) 28.092 0.000 four (30%) women.14 This study showed that 39.37% females
newborn reported as anemic with Hb less than normal. The serum ferritin
concentration (10 ng/mL), iron insufficiency used to be the main
Table 2: Balance diet associated with maternal anemia cause of anaemia. Iron deficiency used to be the most common
Balance Diet Normal Anemia  2 value P value
cause of anaemia among pregnant women in northern Nigeria.14 In
Yes 159(41.3%) 37 (9.6%)
9.162 0.002 the present study, iron deficiency anemia was very prominent
No 77(20%) 112 (29.0%)
because of low-balance diet intake and low iron supplements.
Table 3: Different supplements associated with maternal anemia An investigation of the factors influencing low birth weight in
Iron, Vit. C and Normal Anemia  2 value P value the Afghan population was the goal of a study carried out in 2015
zinc supplements showed that low birth weight of less than 2.5 kg. Most of the 15.5%
Yes 181 (47.01%) 62 (16.1%) of infants with low birth weight in the research were female. In the
36.667 0.000
No 46 (11.94%) 96(24.93%) present study, 16.62% of with low birth weight was reported. Other
numerous characteristics, such as maternal education, location or
Table 4: Factors associated with a low birth weight of newborn place of residence, income, and the urban region where low birth
Variable Normal Low birth weight  2 value p-value weight was prevalent, were also taken into account in the study. 15
Gravidity 33(8.57%) 14(4.13%)
Another study done in NWFP-Pakistan on the risk factors for
Primgravida 80(20.77%) 82(21.29%) 6.266 0.044
Multigravida 47(12.20%) 129(33.50%) low birth weight in the public hospitals in Peshawar revealed that,
Primiparous 64(16.62%) 40(10.38%) in addition to gestational age, specific geo-demographic factors
7.823 0.050
Multiparous 169(43.89%) 112(29.09%) (maternal age, consanguinity, and nationality), maternal health
Miscarriage 25(6.49%) 18(4.67%) (anaemia), and pregnancy history (abortion/miscarriage) were
Stillbirth 33(8.57%) 15(3.89%) significantly related to the incidence of LBW seen at the four
Normal vaginal 144(37.40%) 86(22.33%) 8.175 0.043
hospitals surveyed in Peshawar. These findings suggest that
delivery
C section 38(9.87%) 26(6.75%) cultural variables may have a negative impact on the prevalence of
Pregnancy gap 119(30.90%) 43(11.27%) SGA in this region of Pakistan. Low birth weight was discovered in
≥1-2year 3.884 0.043 the current investigation in stillbirth, C-section and miscarriage.
≤ 3 years 159(41.2%) 64(16.62%) Seventeen in the present study 16.62% of babies with fewer than
Non-Food Item 204 105 (27.27%) two years between pregnancies and 9.87% of babies with more
Nil (52.98%)
16.542 0.000 than three years between pregnancies had low birth weights.16
Clay/Dirt 18 (4.67%) 31 (8.05%)
Wall chalk 13 (3.37%) 14 (3.63%) A major factor in newborn survival, health, and development
is low birth weight. There are numerous biological and maternal
risk factors for it. This study's goal is to identify the prevalence of
DISCUSSION low birth weight and its related risk factors. A cross-sectional study
Worldwide, anaemia is a leading cause of morbidity and mortality was conducted at Al-Razi Hospital in Rawalpindi's obstetrics and
in women and children. Intake of these nutrients is crucial gynaecology department, the prevalence of LBW was determined
throughout the critical period of life since deficits in significant
to be 8.9% overall. Male babies (7.9%) had a significantly higher
micronutrients like iron folate, and vitamin B12 before and during likelihood of having LBW than did female babies (9.9%) in the
pregnancy increase the chance of anemia. On the other hand, present study there is no gender.17 In the present study there was
there is little evidence available regarding the dietary intake of food
no discrimination among gender and low birth weight were found in
among pregnant ladies of Ghana, living in rural areas. The females taking low supplements and a balanced diet. Low birth
prevalence of anaemia and inadequate dietary nutrient weight was also found in patients having less than 2-year gap in
consumption by pregnant ladies residing in rural areas, a
pregnancy while multiparous and multigravida was also given birth
comparative cross-sectional study comprised 379 pregnant women to low birth weight.
have 56.5% had anemia.14
In the present study 39.37% of patients visiting the
gynaecology department were reported as anemic while 60% of CONCLUSION
patients with normal Hb levels. Higher prevalence of anemia was Maternal health was very important for the newborn. Factors
found in rural than in urban areas. The majority of survey associated with maternal anaemia can cause the low birth weight
participants consumed insufficient amounts of iron, zinc, folate, of the newborn, and patients with fewer gaps in pregnancy are also
calcium and vitamin A in the present study 20.77% of pregnant at risk for the low birth weight of the newborn.
females were deficient in vitamins, iron and zinc. From the initial

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Factors Associated with Maternal Anemia and its Relationship with a Low Birth Weight of Newborn

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