Maternal anemia is associated with adverse maternal and neonatal outcomes in Mbarara, Uganda

Abstract

Purpose

Maternal anemia is a significant risk factor for maternal morbidity and mortality, increasing risk of preterm birth, intrauterine growth restriction, stillbirth, and death. Moderate and severe anemia in pregnancy is defined as hemoglobin (Hb) <10 g/dl and Hb < 7 g/dl, respectively. We aimed to characterize the association of maternal anemia with maternal, neonatal, and placental outcomes in a resource-limited setting.

Methods

Data were collected from a prospective cohort of 352 pregnant women at a tertiary academic Ugandan hospital. One hundred and seventy-six (50%) of women were living with HIV. Hemoglobin was measured in labor, and placentas were collected postpartum. Maternal outcomes included mode of delivery, hemorrhage, blood transfusion, intensive care unit admission, and maternal mortality. Neonatal outcomes included gestational age at delivery, birthweight, stillbirth, and neonatal mortality. Placental descriptors included weight and thickness. Categorical variables were analyzed using Chi-squared and Fisher’s exact tests.

Results

Hemoglobin < 10 g/dl, was present in 17/352 (5%) of women. Significantly more women with moderate or severe anemia were HIV-infected: 14/17 (82%) versus 162/335 (48%) (p = .006). Blood transfusions (2/17, 12% versus 5/335, 2%, p = .04) and neonatal deaths (2/17, 12% versus 9/335, 3%, p = .01) were more common in the anemia group. Placental thickness was lower in the anemia group (1.4 cm versus 1.7 cm, p = .04).

Conclusions

Moderate and severe anemia was associated with maternal HIV infection, maternal blood transfusion, neonatal death, and decreased placental thickness. The overall rate of moderate and severe anemia among this cohort was lower than previously reported.

Keywords:

• Anemia
• blood transfusion
• global health
• maternal morbidity
• neonatal morbidity
• placental pathology

Author contributions

PK Edelson: project development, data analysis, manuscript writing, and manuscript editing; D Cao: data collection and management, data analysis, and manuscript editing; KE James: data analysis and manuscript editing; J Ngonzi: project development and manuscript editing; DJ Roberts: project development, data analysis, and manuscript editing; LM Bebell: project development, data analysis, and manuscript editing; AA Boatin: project development, data analysis, and manuscript editing.

Disclosure statement

All authors report no conflicts of interest.

Additional information

Funding

Adeline A. Boatin is supported by the career development awards from the Eunice Kennedy Schriver National Institute of Child Health and Human Development (K23 HD097300-01) and Massachusetts General Hospital Executive Committee on Research through the Center for Diversity and Inclusion. Lisa M. Bebell is supported by a career development award from the National Institute of Allergy and Infectious Diseases (K23 AI138856) and the American Society of Tropical Medicine and Hygiene Burroughs Wellcome Fellowship.