The association between maternal anemia and preterm birth: A case-control study

  • Zulfiqar Ali Khan Department of Obstetrics and Gynaecology, Swat Medical College, Saidu Sharif Swat, Pakistan
  • Shumaila Khawaja Khail Department of Obstetrics and Gynaecology, Swat Medical College, Saidu Sharif Swat, Pakistan
  • Anina Qureshi Margalla College of Pharmacy, Margalla Institute of Health Sciences, Rawalpindi, Pakistan
  • Palwasha Ahmad Humanities and Social Sciences, Bahria University, Islamabad, Pakistan
Keywords: Pregnancy outcomes, Preterm birth, Neonatal morbidity, Hemoglobin level, Maternal anemia, Prenatal care, Preeclampsia

Abstract

Introduction: Preterm birth (PTB), defined as birth before 37 weeks of gestation, remains a global public health challenge associated with neonatal morbidity and mortality. Maternal anemia, characterized by low hemoglobin levels, is prevalent in many low- and middle-income countries, including Pakistan.

Methodology: A case-control study was conducted at Swat Medical College and Women Hospital Mardan, Pakistan, from June 2022 to June 2023. Medical records of 1000 pregnant women (500 cases of PTB and 500 controls of term births) were reviewed. Maternal anemia, defined as hemoglobin levels below 11 g/dL, was assessed along with demographic variables, pregnancy history, and maternal complications. Logistic regression analysis adjusted for potential confounders was performed to determine the association between maternal anemia and PTB.

Results: Maternal anemia was significantly associated with an increased risk of PTB (adjusted odds ratio [OR] = 2.50; 95% confidence interval [CI]: 1.80-3.50; p < 0.001). Other significant risk factors included previous PTB (adjusted OR = 2.20; 95% CI: 1.50-3.20; p < 0.001), multiparity (adjusted OR = 1.50; 95% CI: 1.10-2.00; p = 0.01), preeclampsia (adjusted OR = 3.00; 95% CI: 2.20-4.20; p<0.001), and gestational diabetes (adjusted OR = 2.00; 95% CI: 1.50-2.70; p<0.001). Demographic factors such as maternal age, education, residence, and pre-pregnancy BMI did not show significant associations with PTB.

Conclusion: Maternal anemia emerges as a significant risk factor for PTB in Pakistan. Early detection and management of anemia during pregnancy are crucial to reducing the burden of PTB and its associated adverse outcomes.

Downloads

Download data is not yet available.

Author Biographies

Anina Qureshi, Margalla College of Pharmacy, Margalla Institute of Health Sciences, Rawalpindi, Pakistan

Senior Lecturer

Palwasha Ahmad, Humanities and Social Sciences, Bahria University, Islamabad, Pakistan

Senior Lecturer

References

Blencowe H, Cousens S, Oestergaard MZ, Chou D, Moller AB, Narwal R, et al. National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. Lancet. 2012; 379(9832):2162-72.

DOI: https://doi.org/10.1016/S0140-6736(12)60820-4

Howson CP, Kinney MV, McDougall L, Lawn JE. Born too soon: preterm birth matters. Reprod Health. 2013; 10(1):1-9.

DOI: https://doi.org/10.1186/1742-4755-10-S1-S1

Chawanpaiboon S, Vogel JP, Moller A-B, Lumbiganon P, Petzold M, Hogan D, et al. Global, regional, and national estimates of levels of preterm birth in 2014: a systematic review and modelling analysis. Lancet Glob Health. 2019; 7(1):e37-e46.

DOI: https://doi.org/10.1016/S2214-109X(18)30451-0

Goldenberg RL, McClure EM. The epidemiology of preterm birth. Preterm birth: prevention and management. 2010; 22-38.

DOI: https://doi.org/10.1016/S0140-6736(08)60074-4

Younes S, Samara M, Al-Jurf R, Nasrallah G, Al-Obaidly S, Salama H, et al. Incidence, risk factors, and outcomes of preterm and early term births: a population-based register study. Int J Environ Res Public Health. 2021; 18(11):5865.

DOI: https://doi.org/10.3390/ijerph18115865

Tucker J, McGuire W. Epidemiology of preterm birth. Br Med J. 2004; 329(7467):675-8.

DOI: https://doi.org/10.1136/bmj.329.7467.675

Heydarpour F, Soltani M, Najafi F, Tabatabaee HR, Etemad K, Hajipour M, et al. Maternal anemia in various trimesters and related pregnancy outcomes: results from a large cohort study in Iran. Iran J Pediatr (Engl Ed). 2019; 29(1).

DOI: https://doi.org/10.5812/ijp.69741

Xiong X, Buekens P, Fraser W, Guo Z. Anemia during pregnancy in a Chinese population. Int J Gynecol Obstet. 2003; 83(2):159-64.

DOI: https://doi.org/10.1016/s0020-7292(03)00214-5

Rahmati S, Delpishe A, Azami M, Ahmadi MRH, Sayehmiri K. Maternal anemia during pregnancy and infant low birth weight: a systematic review and meta-analysis. Int J Reprod Biomed. 2017; 15(3):125.

Marchant T, Schellenberg JA, Nathan R, Abdulla S, Mukasa O, Mshinda H, et al. Anaemia in pregnancy and infant mortality in Tanzania. Trop Med Int Health. 2004; 9(2):262-6.

DOI: https://doi.org/10.1046/j.1365-3156.2003.01178.x

Fowkes FJ, Moore KA, Opi DH, Simpson JA, Langham F, Stanisic DI, et al. Iron deficiency during pregnancy is associated with a reduced risk of adverse birth outcomes in a malaria-endemic area in a longitudinal cohort study. BMC Med. 2018; 16(1):1-10.

DOI: https://doi.org/10.1186/s12916-018-1146-z

Yuan X, Hu H, Zhang M, Long W, Liu J, Jiang J, et al. Iron deficiency in late pregnancy and its associations with birth outcomes in Chinese pregnant women: a retrospective cohort study. Nutr Metab. 2019; 16(1):1-11.

DOI: https://doi.org/10.1186/s12986-019-0360-9

Chang SC, O'Brien KO, Nathanson MS, Mancini J, Witter FR. Hemoglobin concentrations influence birth outcomes in pregnant African-American adolescents. J Nutr. 2003; 133(7):2348-55.

DOI: https://doi.org/10.1093/jn/133.7.2348

World Health Organization. The global prevalence of anaemia in 2011. WHO report. 2011. Available from: https://www.who.int/nutrition/publications/micronutrients/global_prevalence_anaemia_2011/en/.

Abu Hamad K, Abed Y, Abu Hamad B. Risk factors associated with preterm birth in the Gaza Strip: hospital-based case-control study. East Mediterr Health J. 2007; 13(5):1132-41.

DOI: https://doi.org/10.26719/2007.13.5.1132

Torchin H, Ancel P. Epidemiology and risk factors of preterm birth. J Gynecol Obstet Biol Reprod. 2016; 45(10):1213-30.

DOI: https://doi.org/10.1016/j.jgyn.2016.09.013

Svensson AC, Sandin S, Cnattingius S, Reilly M, Pawitan Y, Hultman CM, et al. Maternal effects for preterm birth: a genetic epidemiologic study of 630,000 families. Am J Epidemiol. 2009; 170(11):1365-72.

DOI: https://doi.org/10.1093/aje/kwp328

Cnattingius S, Reilly M, Pawitan Y, Lichtenstein P. Maternal and fetal genetic factors account for most of familial aggregation of preeclampsia: a population-based Swedish cohort study. Am J Med Genet. 2004; 130(4):365-71.

DOI: https://doi.org/10.1002/ajmg.a.30257

Soltani M, Tabatabaee HR, Saeidinejat S, Eslahi M, Yaghoobi H, Mazloumi E, et al. Assessing the risk factors before pregnancy of preterm births in Iran: a population-based case-control study. BMC Pregnancy Childbirth. 2019; 19(1):1-8.

DOI: https://doi.org/10.1186/s12884-019-2183-0

Cobo T, Kacerovsky M, Jacobsson B. Risk factors for spontaneous preterm delivery. Int J Gynecol Obstet. 2020; 150(1):17-23.

DOI: https://doi.org/10.1002/ijgo.13184

Hadley EE, Discacciati A, Costantine MM, Munn MB, Pacheco LD, Saade GR, et al. Maternal obesity is associated with chorioamnionitis and earlier indicated preterm delivery among expectantly managed women with preterm premature rupture of membranes. J Matern Fetal Neonatal Med. 2019; 32(2):271-8.

DOI: https://doi.org/10.1080/14767058.2017.1378329

Winer N, Resche-Rigon M, Morin C, Ville Y, Rozenberg P. Is induced abortion with misoprostol a risk factor for late abortion or preterm delivery in subsequent pregnancies? Eur J Obstet Gynecol Reprod Biol. 2009; 145(1):53-6.

DOI: https://doi.org/10.1016/j.ejogrb.2009.04.028

Moreau C, Kaminski M, Ancel PY, Bouyer J, Escande B, Thiriez G, et al. Previous induced abortions and the risk of very preterm delivery: results of the EPIPAGE study. BJOG. 2005; 112(4):430-7.

DOI: https://doi.org/10.1111/j.1471-0528.2004.00478.x

Raatikainen K, Heiskanen N, Heinonen S. Induced abortion: not an independent risk factor for pregnancy outcome, but a challenge for health counseling. Ann Epidemiol. 2006; 16(8):587-92.

DOI: https://doi.org/10.1016/j.annepidem.2006.01.007

Sureshbabu RP, Aramthottil P, Anil N, Sumathy S, Varughese SA, Sreedevi A, et al. Risk factors associated with preterm delivery in singleton pregnancy in a tertiary care hospital in south India: a case control study. Int J Wom Health. 2021; 13:369.

DOI: https://doi.org/10.2147/IJWH.S282251

Charbonneau KD, Seabrook JA. Adverse birth outcomes associated with types of eating disorders: a review. Can J Diet Pract Res. 2019; 80(3):131-6.

DOI: https://doi.org/10.3148/cjdpr-2018-044

Meis PJ, Klebanoff M, Thom E, Dombrowski MP, Sibai B, Moawad AH, et al. Prevention of recurrent preterm delivery by 17 alpha-hydroxyprogesterone caproate. N Engl J Med. 2003; 348(24):2379-85.

DOI: https://doi.org/10.1056/NEJMoa035140

Published
2024-08-02
How to Cite
1.
Khan Z, Khail S, Qureshi A, Ahmad P. The association between maternal anemia and preterm birth: A case-control study. JSTMU [Internet]. 2Aug.2024 [cited 22Dec.2024];7(1):74-0. Available from: https://j.stmu.edu.pk/ojs/index.php/jstmu/article/view/318