Re: Rohilla M, Raveendran A, Dhaliwal LK, Chopra S. 2010. Severe anaemia in pregnancy: a tertiary hospital experience from northern India. Journal of Obstetrics and Gynaecology 30:694–696

Dear Sir,

I have read this article with great interest and I have to congratulate the authors for this work, however I have the following comments:

1. Maternal and perinatal outcomes mentioned in this article were those for severe anaemia. It might be of great interest to know if these maternal and perinatal outcomes were compared with the findings of women with mild/moderate anaemia and with women without anaemia.

2. The finding that 17 (17.71%) out of 97 women with severe anaemia had gestational hypertension or pre-eclampsia; two (2.08%) had eclampsia, is of great interest. Perhaps this is the first published observation to highlight the prevalence (which may be high) of pre-eclampsia in severely anaemic women. However, it appears probable that a major factor for severe anaemia in these women was malaria. In the tropics, malaria and anaemia are closely related (Adam et al. 2005). Nothing was mentioned concerning malaria among these women. Previous studies have indicated that malaria increases the risk of hypertensive disorder during pregnancy (Ndao et al. 2009).

3. In the discussion, the authors mentioned that the association of ≥three-fold increase in the incidence of pre-eclampsia in anaemic woman is attributed to maternal vascular dysfunction, which is also implicated in fetal growth restriction (Steer 2000). However, Steer's finding was not concerning anaemia and pre-eclampsia but the ≥three-fold increase in the incidence of pre-eclampsia was in women with high haemoglobin levels, i.e. >12 g/l.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.