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Abstract
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.
- body mass index
- anemia
- pregnancy
- neonatal deaths
- malnutrition
- stillbirth
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Footnotes
Contributors AP conceived and designed the study and developed the initial data collection tools; AP and AAP wrote the first draft of the manuscript, which PLH, PKD, YVP and SG subsequently revised. AP and AAP developed the analysis plan outline and AAP carried out the data analyses. AP, PLH, PKD, YVP and SG contributed to data analysis through review, interpretation and cross-checking figures and tables. All authors read, revised, and approved the final manuscript.
Funding This study was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the US National Institutes of Health. (Grant Reference Nos. U01HD058322 and U01HD078439).
Competing interests None declared.
Patient consent Not required.
Ethics approval The study in Nagpur, India, has been reviewed and approved by the Institutional Review Board of the Lata Medical Research Foundation (RPC#22A) and the Partners Human Research Committee/IRB in Boston, Massachusetts (H-35430).
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement A deidentified minimal dataset that underlies the findings and conclusions described in the manuscript can be shared upon request by the editors to verify the reported study findings. All authors hereby declare that individual participant data in any form is not a part of this publication.