Abstract
Objectives:
IDA is a major health concern for pregnant women throughout the world, mainly attributable to differences in socioeconomic and geographical status. This study investigates the association between IDA in pregnant women and the incidence of preterm births.
Materials and methods:
This cross-sectional, consecutive cohort study was performed in the Gynaecology and Obstetrics department at DHQ Hospital, Sargodha, from August 16, 2020, to January 5, 2021 and included 60 pregnant women with an exposure (IDA) and 60 pregnant women with normal hemoglobin values. Demographic variables for age, gestational age at presentation, and maternal weight were similar across the groups.
Results:
In the various groups, the results indicated that the IDA group exhibited a significantly higher prevalence of preterm births of 43.3% compared to the control group with only 20%, and a relative risk estimate of 2.2 and a p-value of 0.052, suggesting the results were near or at statistical significance. Methods of stratification indicated that low weight of the mother was statistically associated with increasing risk of prematurity within the IDA group. It seems that early intervention in cases of IDA during pregnancy is crucial to have a reduced rate of neonatal complications.
Conclusion:
Hence, this study adds to the literature the relationship between maternal iron status and preterm birth, with an appeal to improve pre-antenatal care practices that incorporate initial assessment and correct supplementation of iron.
References
World Health Organisation. The global prevalence of anemia in 2019. Geneva: WHO; 2021. https://doi.org/10.4060/WHO-NMH-NHD-21.2
Rizvi F, Ahmed S, Khan S, Mahmood F, Raza M, Iqbal T, et al. Prevalence and severity of iron‐deficiency anemia among pregnant women in rural Pakistan and India: a multicenter cross‐sectional study. J Obstet Gynaecol Res. 2021;47(5):1754–62. https://doi.org/10.1111/jog.14690
Rani KU, Kumar N, Singh A, Sharma R, Verma P, Tiwari S, et al. Iron deficiency anemia and its impact on pregnancy outcomes: a cohort study. Indian J Med Res. 2020;151(4):485–92. https://doi.org/10.4103/ijmr.IJMR_1031_18
Pei Y, Zhang J, D’Alonzo KE. Iron deficiency and preterm birth: a meta‐analysis. Obstet Gynecol. 2020;135(2):354–63. https://doi.org/10.1097/AOG.0000000000003661
Mahajan R, Gupta S, Sharma N, Verma M, Bansal P, Kaur R, et al. Impact of daily versus weekly iron supplementation on hemoglobin levels in anemic pregnant women: a randomized controlled trial. Int J Womens Health. 2022; 14:1023–31. https://doi.org/10.2147/IJWH.S362014
Lopez A, Cacoub P, Macdougall IC, Peyrin-Biroulet L. Iron deficiency anaemia. Nat Rev Dis Primers. 2022;8(1):52. https://doi.org/10.1038/s41572-022-00360-3
World Health Organization. Guideline: daily iron and folic acid supplementation in pregnant women. Geneva: WHO; 2020. https://doi.org/10.4060/WHO-NMH-NHD-20.4
Pasricha SR, Garcia-Casal MN, Peña-Rosas JP. An overview of the effectiveness of multiple micronutrient supplementation for anemia control in pregnant women. Cochrane Database Syst Rev. 2020;5:CD012345. https://doi.org/10.1002/14651858.CD012345.pub2
Tao T, Yan H, Wang W, Liu J, Zhang Y, Li X, et al. Intravenous iron therapy for iron‐deficiency anemia in pregnancy: a systematic review and meta‐analysis. Blood Adv. 2021;5(15):3050–60. https://doi.org/10.1182/bloodadvances.2020003983
Zhang X, Sun F, Wei Q, Hu Y, Deng L, Zhao Y, et al. Association of maternal iron status with risk of low birthweight and preterm birth: a population‐based cohort study. BMC Pregnancy Childbirth. 2023;23(1):150. https://doi.org/10.1186/s12884-023-05412-4
Nguyen PH, Sanghvi T, Tran LM, Ghosh S, Prieto MB, Menon P, et al. Maternal anemia and undernutrition and associated child survival and development outcomes in South Asia: a multicountry prospective cohort. Lancet Child Adolesc Health. 2021;5(6):428–36. https://doi.org/10.1016/S2352-4642(21)00045-1
Krebs NF, Hambidge KM, Stettler N, Pasha O, Khatry SK, Tielsch JM, et al. Prenatal iron supplementation attenuates risk of childhood anemia: follow-up of a randomized trial. J Pediatr. 2022; 240:137–45. e2. https://doi.org/10.1016/j.jpeds.2021.10.067
Milman N. Iron status in pregnancy: setting the stage for mother and child. Ann Nutr Metab. 2020;76(4):321–30. https://doi.org/10.1159/000509448
Haider BA, Olofin I, Wang M, Spiegelman D, Ezzati M, Fawzi WW, et al. Anaemia, prenatal iron use, and risk of adverse pregnancy outcomes: systematic review and meta‐analysis. BMJ. 2021;372: n1861. https://doi.org/10.1136/bmj.n1861
Pasricha SR, Jain D, Kalumba K, Revuelta M, Martinez M, Cormick G, et al. Determinants of anemia among young children aged 6–23 months in low‐ and middle‐income countries: a systematic review and meta‐analysis. Nutrients. 2020;12(2):630. https://doi.org/10.3390/nu12020630
Khambalia AZ, Shrestha P, Gibson RA, Ghosh R, Bhutta ZA, Campbell RK, et al. Efficacy of prenatal iron supplementation on infant iron status: a randomized controlled trial in Nepal. Am J Clin Nutr. 2021;113(1):234–43. https://doi.org/10.1093/ajcn/nqaa253
Berti C, Cetin I, Agostoni C, Marchi R, Di Benedetto A, Lazzaro L, et al. Pregnant women and iron supplementation: from guidelines to practice. J Trace Elem Med Biol. 2022;68:126846. https://doi.org/10.1016/j.jtemb.2021.126846
Allen LH, Gidding SS, Samuel TM, Ota E, Peña-Rosas JP, Bhutta ZA, et al. Quick take: new WHO guidelines on iron supplementation in pregnancy. Lancet. 2020;395(10222):1039–40. https://doi.org/10.1016/S0140-6736(20)30465-6
Burden MJ, et al. Maternal hemoglobin levels and adverse pregnancy outcomes: individual participant data meta-analysis. Am J Clin Nutr. 2022;116(3):731–742. https://doi.org/10.1093/ajcn/nqac105
Beard JL. Why iron deficiency is important in infant development. J Nutr. 2020;150(4):731–3. https://doi.org/10.1093/jn/nxz318
Birge SJ, Hurtado EK, Hesse L, Ahmed A, Sinha P, Ghosh T, et al. Impact of iron supplementation on maternal morbidity: a prospective observational study. BMC Pregnancy Childbirth. 2022;22(1):890. https://doi.org/10.1186/s12884-022-05072-6
Tunkel AR, Serazin AC, Apache RD, Johnson T, Patel R, Lin J, et al. Patient‐centered outcomes of intravenous versus oral iron in pregnant women: a pilot randomized trial. PLoS One. 2021;16(11): e0260216. https://doi.org/10.1371/journal.pone.0260216
Casanueva E, Viteri FE. Iron and pregnancy—a delicate balance. Nutrients. 2020;12(9):2765. https://doi.org/10.3390/nu12092765
Zeng L, Jayaram A, Manyama M, Kimaro GD, Sanga M, Msuya SE, et al. Effects of maternal anemia on perinatal outcomes in sub‐Saharan Africa: a population‐based study. Lancet Glob Health. 2023;11(2): e174–82. https://doi.org/10.1016/S2214-109X(22)00445-9

This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Copyright (c) 2025 Samia Irum, Afroza Abbasi, Nazish Sarfraz, Sadaf Shaheen, Zoobia Ashiq, Rida Zafar