Maternal anemia and underweight as determinants of pregnancy outcomes: cohort study in eastern rural Maharashtra, India

BMJ Open. 2018 Aug 8;8(8):e021623. doi: 10.1136/bmjopen-2018-021623.


Objectives: To study the trend in the prevalence of anaemia and low BMI among pregnant women from Eastern Maharashtra and evaluate if low BMI and anaemia affect pregnancy outcomes.

Design: Prospective observational cohort study.

Setting: Catchment areas of 20 rural primary health centres in four eastern districts of Maharashtra State, India.

Participants: 72 750 women from the Nagpur site of Maternal and Newborn Health Registry of NIH's Global Network, enrolled from 2009 to 2016.

Main outcome measures: Mode of delivery, pregnancy related complications at delivery, stillbirths, neonatal deaths and low birth weight (LBW) in babies.

Results: Over 90% of the women included in the study were anaemic and over a third were underweight (BMI <18 kg/m2) and with both conditions. Mild anaemia at any time during delivery significantly increased the risk (Risk ratio; 95% confidence interval (RR;(95% CI)) of stillbirth (1.3 (1.1-1.6)), neonatal deaths (1.3 (1-1.6)) and LBW babies (1.1 (1-1.2)). The risks became even more significant and increased further with moderate/severe anaemia any time during pregnancy for stillbirth (1.4 (1.2-1.8)), neonatal deaths (1.7 (1.3-2.1)) and LBW babies (1.3 (1.2-1.4)).,. Underweight at anytime during pregnancy increased the risk of neonatal deaths (1.1 (1-1.3)) and LBW babies (1.2;(1.2-1.3)).The risk of having stillbirths (1.5;(1.2-1.8)), neonatal deaths (1.7;(1.3-2.3)) and LBW babies (1.5;(1.4-1.6)) was highest when - the anaemia and underweight co-existed in the included women. Obesity/overweight during pregnancy increased the risk of maternal complications at delivery (1.6;(1.5-1.7)) and of caesarean section (1.5;(1.4-1.6)) and reduced the risk of LBW babies 0.8 (0.8-0.9)).

Conclusion: Maternal anaemia is associated with enhanced risk of stillbirth, neonatal deaths and LBW. The risks increased if anaemia and underweight were present simultaneously.

Trial registration number: NCT01073475.

Keywords: anemia; body mass index; malnutrition; neonatal deaths; pregnancy; stillbirth.

Publication types

  • Observational Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Anemia / complications*
  • Anemia / epidemiology
  • Female
  • Humans
  • India / epidemiology
  • Infant
  • Infant Mortality
  • Infant, Low Birth Weight
  • Infant, Newborn
  • Malnutrition / complications
  • Pregnancy
  • Pregnancy Complications / epidemiology*
  • Pregnancy Complications, Hematologic / epidemiology*
  • Pregnancy Outcome / epidemiology*
  • Prospective Studies
  • Rural Population / statistics & numerical data
  • Stillbirth / epidemiology
  • Thinness / complications*
  • Young Adult

Associated data