Anemia in pregnant mothers and the risk of low birth weight: a systematic review and meta-analysis

Document Type : Review Article

Authors

1 M.Sc. of Midwifery, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

2 Professor, Midwifery and Reproductive Health Research Center, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

3 PhD of Reproductive Health, Clinical Research Development Center, Motazedi Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran.

4 M.Sc. student of Midwifery, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

10.22038/ijogi.2024.82324.6190

Abstract

Introduction: A baby's birth weight is one of the indicators of knowing the hygiene and health status of pregnancy period and greatly impacts the occurrence of neonatal complications as well as his health in adulthood. The present study was conducted with aim to evaluate the relationship between anemia in pregnancy and the risk of low birth weight as systematic review and meta-analysis.
Methods: All observational studies published between 2000 and 2024 were searched in Web of Science, Scopus, PubMed, and Google Scholar databases. The keywords based on the MeSh included “Birth weight,” Pregnancy, “Pregnant Women,” and Anemia, combined with the Boolean operators OR and AND. Finally, the articles were reviewed separately by two independent reviewers to assess their quality (Newcastle-Ottawa scale) and extract their main findings. Meta-analysis was performed with Stata software. The heterogeneity of studies was assessed using the I2 index and Cochrane test. The funnel plot method and Begg & Egger tests were used to evaluate publication bias.
Results: Finally, 22 studies with a total sample size of 321,231 people were included in this study. Most of the studies had a high level of methodological quality in terms of quality assessment. The association between pregnancy anemia and low birth weight based on the adjusted odds ratio with the value OR = 1.59 (95%CI: 1.06 to 2.39) showed that in women with anemia pregnancy, the probability of having a low birth weight baby is 1.59 times higher. Publication bias did not affect the results and no influential studies were found in the sensitivity analysis.
Conclusion: If anemia occurs during pregnancy, the likelihood of having a baby with a low birth weight increases. As a result, monitoring mothers from early pregnancy and diagnosing and treating problems can significantly impact the health of both mother and baby and reduce healthcare costs.

Keywords

Main Subjects

References

  1. Jufar AH, Zewde T. Prevalence of anemia among pregnant women attending antenatal care at tikur anbessa specialized hospital, Addis Ababa Ethiopia. J Hematol Thromb Dis 2014; 2(125):2.
  2. Levy A, Fraser D, Katz M, Mazor M, Sheiner E. Maternal anemia during pregnancy is an independent risk factor for low birthweight and preterm delivery. European journal of obstetrics & gynecology and reproductive biology 2005; 122(2):182-6.
  3. Shobeiri F, Begum K, Nazari M. A prospective study of maternal hemoglobin status of Indian women during pregnancy and pregnancy outcome. Nutrition Research 2006; 26(5):209-13.
  4. Anlaakuu P, Anto F. Anaemia in pregnancy and associated factors: a cross sectional study of antenatal attendants at the Sunyani Municipal Hospital, Ghana. BMC research notes 2017; 10:1-8.
  5. Stevens GA, Finucane MM, De-Regil LM, Paciorek CJ, Flaxman SR, Branca F, et al. Global, regional, and national trends in haemoglobin concentration and prevalence of total and severe anaemia in children and pregnant and non-pregnant women for 1995–2011: a systematic analysis of population-representative data. The Lancet Global Health 2013; 1(1):e16-25.
  6. Cunningham FG, Leveno KJ, Bloom SL, Dashe JS, Hoffman BL, Casey BM, et al. Williams Obstetrics. 25nd New York: McGraw-Hill Education; 2018.
  7. Karaoglu L, Pehlivan E, Egri M, Deprem C, Gunes G, Genc MF, et al. The prevalence of nutritional anemia in pregnancy in an east Anatolian province, Turkey. BMC public health 2010; 10:1-12.
  8. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 95: anemia in pregnancy. Obstetrics and Gynecology 2008; 112(1):201-7.
  9. Alem M, Enawgaw B, Gelaw A, Kena T, Seid M, Olkeba Y. Prevalence of anemia and associated risk factors among pregnant women attending antenatal care in Azezo Health Center Gondar town, Northwest Ethiopia. J Interdiscipl Histopathol 2013; 1(3):137-44.
  10. Figueiredo AC, Gomes-Filho IS, Silva RB, Pereira PP, Mata FA, Lyrio AO, et al. Maternal anemia and low birth weight: a systematic review and meta-analysis. Nutrients 2018; 10(5):601.
  11. Rahman MM, Abe SK, Rahman MS, Kanda M, Narita S, Bilano V, et al. Maternal anemia and risk of adverse birth and health outcomes in low-and middle-income countries: systematic review and meta-analysis. The American journal of clinical nutrition 2016; 103(2):495-504.
  12. Sukrat B, Wilasrusmee C, Siribumrungwong B, McEvoy M, Okascharoen C, Attia J, et al. Hemoglobin concentration and pregnancy outcomes: a systematic review and meta‐analysis. BioMed research international 2013; 2013(1):769057.
  13. Afzal Aghai M, Musa Farkhani E, Beygi B, Eftekhari Gol R, Eslami V, Bahrami HR. Maternal Anemia during pregnancy and birth outcomes: a population based cross sectional study Maternal Anemia and birth outcomes. Journal of Sabzevar University of Medical Sciences 2021; 28(1):124-32.
  14. Badi NE, Almoula HA, Idris NI, Hamadalnil Y, Handady SO. Relation Ship of Maternal Haemoglobin Concentration Measured in Labour with Neonatal Outcome among Sudanese Women. Open Journal of Obstetrics and Gynecology 2021; 11(2):131-9.
  15. Sekhavat L, Davar R, Hosseinidezoki S. Relationship between maternal hemoglobin concentration and neonatal birth weight. Hematology 2011; 16(6):373-6.
  16. Ferguson SE, Smith GN, Salenieks ME, Windrim R, Walker MC. Preterm premature rupture of membranes: nutritional and socioeconomic factors. Obstetrics & Gynecology 2002; 100(6):1250-6.
  17. Stangret A, Wnuk A, Szewczyk G, Pyzlak M, Szukiewicz D. Maternal hemoglobin concentration and hematocrit values may affect fetus development by influencing placental angiogenesis. The Journal of Maternal-Fetal & Neonatal Medicine 2017; 30(2):199-204.
  18. Suryanarayana R, Chandrappa M, Santhuram AN, Prathima S, Sheela SR. Prospective study on prevalence of anemia of pregnant women and its outcome: A community based study. Journal of family medicine and primary care 2017; 6(4):739-43.
  19. Çağlayan EK, Küçük Ö, Göçmen AY, Seçkin L, Aktulay A, Üstün YE. Sixth-month perinatal outcomes of anemic pregnancies. Gynecology Obstetrics & Reproductive Medicine 2014; 20(2):68-72.
  20. Rahmati S, Delpishe A, Azami M, Ahmadi MR, Sayehmiri K. Maternal Anemia during pregnancy and infant low birth weight: A systematic review and Meta-analysis. International journal of reproductive biomedicine 2017; 15(3):125.
  21. Mamun AA, O'Callaghan M, Callaway L, Williams G, Najman J, Lawlor DA. Associations of gestational weight gain with offspring body mass index and blood pressure at 21 years of age: evidence from a birth cohort study. Circulation 2009; 119(13):1720-7.
  22. Wells GA, Shea B, O’Connell D, Peterson J, Welch V, Losos M, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses; 2000.
  23. Olivier J, May WL, Bell ML. Relative effect sizes for measures of risk. Communications in statistics-theory and methods 2017; 46(14):6774-81.
  24. Cumpston M, Li T, Page MJ, Chandler J, Welch VA, Higgins JP, et al. Updated guidance for trusted systematic reviews: a new edition of the Cochrane Handbook for Systematic Reviews of Interventions. The Cochrane database of systematic reviews 2019; 2019(10).
  25. Patsopoulos NA, Evangelou E, Ioannidis JP. Sensitivity of between-study heterogeneity in meta-analysis: proposed metrics and empirical evaluation. International journal of epidemiology 2008; 37(5):1148-57.
  26. Elhassan EM, Abbaker AO, Haggaz AD, Abubaker MS, Adam I. Anaemia and low birth weight in Medani, Hospital Sudan. BMC research notes 2010; 3:1-5.
  27. Saberi M, Rahmani S. The relationship between anemia during pregnancy and birth weight. The Iranian Journal of Obstetrics, Gynecology and Infertility 2015; 18(142):6-10.
  28. Pakniat H, Soofizadeh N, Movahed F. Association of the first trimester anemia and fetal birth weight. Journal of Ilam University of Medical Sciences 2018; 26(2):189-97.
  29. Suryanarayana R, Chandrappa M, Santhuram AN, Prathima S, Sheela SR. Prospective study on prevalence of anemia of pregnant women and its outcome: A community based study. Journal of family medicine and primary care 2017; 6(4):739-43.
  30. Ganesh Kumar S, Harsha Kumar HN, Jayaram S, Kotian MS. Determinants of low birth weight: a case control study in a district hospital in Karnataka. The Indian Journal of Pediatrics 2010; 77:87-9.
  31. Ahankari AS, Myles PR, Dixit JV, Tata LJ, Fogarty AW. Risk factors for maternal anaemia and low birth weight in pregnant women living in rural India: a prospective cohort study. Public health 2017; 151:63-73.
  32. Bondevik GT, Lie RT, Ulstein M, Kvåle G. Maternal hematological status and risk of low birth weight and preterm delivery in Nepal. Acta obstetricia et gynecologica Scandinavica 2001; 80(5):402-8.
  33. Ali AA, Rayis DA, Abdallah TM, Elbashir MI, Adam I. Severe anaemia is associated with a higher risk for preeclampsia and poor perinatal outcomes in Kassala hospital, eastern Sudan. BMC research notes 2011; 4:1-5.
  34. Mir MK, Yousaf S, Ilyas A, Tahir S. Maternal anemia is a risk factor for low birth weight babies at term. Pak. J. Med. Health Sci 2016; 10:741-3.
  35. Hämäläinen H, Hakkarainen K, Heinonen S. Anaemia in the first but not in the second or third trimester is a risk factor for low birth weight. Clinical Nutrition 2003; 22(3):271-5.
  36. Kidanto HL, Mogren I, Lindmark G, Massawe S, Nystrom L. Risks for preterm delivery and low birth weight are independently increased by severity of maternal anaemia. S Afr Med J 2009; 99(2):98-102.
  37. Yildiz Y, Özgü E, Unlu SB, Salman B, Eyi EG. The relationship between third trimester maternal hemoglobin and birth weight/length; results from the tertiary center in Turkey. The Journal of Maternal-Fetal & Neonatal Medicine 2014; 27(7):729-32.
  38. Ren A, Wang J, Ye RW, Li S, Liu JM, Li Z. Low first-trimester hemoglobin and low birth weight, preterm birth and small for gestational age newborns. International Journal of Gynecology & Obstetrics 2007; 98(2):124-8.
  39. Bakacak M, Avci F, Ercan O, Köstü B, Serin S, Kiran G, et al. The effect of maternal hemoglobin concentration on fetal birth weight according to trimesters. The Journal of Maternal-Fetal & Neonatal Medicine 2015; 28(17):2106-10.
  40. Lake EA, Olana Fite R. Low birth weight and its associated factors among newborns delivered at wolaita sodo university teaching and referral hospital, southern Ethiopia, 2018. International journal of pediatrics 2019; 2019(1):4628301.
  41. Figueiredo AC, Gomes-Filho IS, Batista JE, Orrico GS, Porto EC, Cruz Pimenta RM, et al. Maternal anemia and birth weight: A prospective cohort study. PloS one 2019; 14(3):e0212817.
  42. Muluneh MW, Mulugeta SS, Belay AT, Moyehodie YA. Determinants of Low Birth Weight Among Newborns at Debre Tabor Referral Hospital, Northwest Ethiopia: A Cross-Sectional Study. SAGE Open Nursing 2023; 9:23779608231167107.
  43. Abeysena C, Jayawardana P, De A. Seneviratne R. Maternal haemoglobin level at booking visit and its effect on adverse pregnancy outcome. Australian and New Zealand Journal of Obstetrics and Gynaecology 2010; 50(5):423-7.
  44. Sayehmiri K, Darvishi Z, Azami M, Qavam S. The prevalence of anemia in first, second and third trimester of pregnancy in Iran: a systematic review and meta-analysis. The Iranian Journal of Obstetrics, Gynecology and Infertility 2015; 18(168):7-15.
  45. Akbari TA, Aghdam A, Najafi NI, Zare R. The relationship between maternal hemoglobin level and birth weight in the 523rd Army Hospital of the Islamic Republic of Iran in Urmia in 2019; (2021):19-23.
  46. Veghari G, Kazemi S, Bemani M, Shabdin M. Hemoglobin concentration level during pregnancy and its association with birth weight. British Journal of Medicine & Medical Research 2015; 8(11):988-992.
  47. Ahankari AS, Myles PR, Dixit JV, Tata LJ, Fogarty AW. Risk factors for maternal anaemia and low birth weight in pregnant women living in rural India: a prospective cohort study. Public health 2017; 151:63-73.
  48. Ren A, Wang J, Ye RW, Li S, Liu JM, Li Z. Low first-trimester hemoglobin and low birth weight, preterm birth and small for gestational age newborns. International Journal of Gynecology & Obstetrics 2007; 98(2):124-8.
  49. Ganesh Kumar S, Harsha Kumar HN, Jayaram S, Kotian MS. Determinants of low birth weight: a case control study in a district hospital in Karnataka. The Indian Journal of Pediatrics 2010; 77:87-9.
  50. Hussein KL, Mogren I, Lindmark G, Massawe S, Nystrom L. The risks for pre-term delivery and low birth weight are independently increased by the severity of maternal anaemia. South African Medical Journal 2009; 99(2):98-102.
  51. Zhou LM, Yang WW, Hua JZ, Deng CQ, Tao X, Stoltzfus RJ. Relation of hemoglobin measured at different times in pregnancy to preterm birth and low birth weight in Shanghai, China. American journal of epidemiology 1998; 148(10):998-1006.
The Iranian Journal of Obstetrics, Gynecology and Infertility
Volume 27, Issue 10
December 2024
Pages 93-121

Files

Share

How to cite

Statistics