Anaemia is one of the most common medical conditions complicating pregnancy, particularly in low- and middle-income countries, and remains a major contributor to maternal morbidity and mortality worldwide. It is defined by the World Health Organization (WHO) as a haemoglobin concentration of less than 11 g/dL in pregnant women, and is most often due to iron deficiency, although other nutritional deficiencies, infections, and genetic disorders may also contribute [1]. Globally, approximately 40% of pregnant women are estimated to be anaemic, with the highest burden reported in South Asia and sub-Saharan Africa [2,3].

During pregnancy, physiological changes such as plasma volume expansion lead to haemodilution, making women more vulnerable to iron deficiency and other micronutrient deficiencies [4]. Anaemia in pregnancy has been linked to a range of adverse maternal and perinatal outcomes, including preterm delivery, low birth weight, intrauterine growth restriction, and increased risk of maternal mortality [5–7]. Furthermore, the condition can impair physical performance, reduce immunity, and contribute to postpartum depression [8,9].

In India, despite various national health programs promoting iron and folic acid supplementation, the prevalence of anaemia among pregnant women remains unacceptably high. Socioeconomic status, dietary patterns, poor adherence to supplementation, and inadequate antenatal care have been identified as major determinants [2,3]. Regular screening through antenatal clinics provides an important opportunity for early diagnosis and management, thereby reducing maternal and neonatal complications [4,5].

Given the continuing high prevalence and the associated health risks, there is a need to generate updated local data from tertiary care centres to guide targeted interventions. The present study aims to assess the prevalence of anaemia among pregnant women attending antenatal clinics in a tertiary care hospital and to explore its association with demographic and obstetric variables.

Study Population

The study included pregnant women attending the antenatal outpatient department during the study period.

Sample Size and Sampling Technique

A total of 450 pregnant women were enrolled using a consecutive sampling method until the required sample size was achieved. The sample size was calculated based on an expected prevalence of anaemia of 55%, a confidence level of 95%, and a margin of error of 5%.

Inclusion Criteria

• Pregnant women aged 18–40 years
• All trimesters of pregnancy
• Willing to provide informed consent

Exclusion Criteria

• Women with known haematological disorders (e.g., thalassemia, sickle cell anaemia)
• Those with acute or chronic infections at the time of enrolment
• Women who had received a blood transfusion in the preceding 3 months

Data Collection

Sociodemographic data (age, education, socioeconomic status), obstetric history (parity, trimester), and dietary habits were recorded using a structured proforma.

Laboratory Investigations

Venous blood samples (2 mL) were collected under aseptic precautions and analysed for haemoglobin concentration using an automated hematology analyser. Anaemia was classified as per WHO guidelines:

• Mild: 10–10.9 g/dL
• Moderate: 7–9.9 g/dL
• Severe: <7 g/dL

Statistical Analysis

Data were entered into Microsoft Excel and analysed using SPSS version 26.0 (IBM Corp., Armonk, NY, USA). Continuous variables were expressed as mean ± standard deviation (SD), while categorical variables were expressed as frequencies and percentages. The Chi-square test was used to assess associations between anaemia and categorical variables. A p-value <0.05 was considered statistically significant.

A total of 450 pregnant women were included in the study. The mean age of participants was 26.4 ± 4.8 years, with the majority belonging to the age group 21–30 years (68.2%). Most women were from lower socioeconomic status (56.4%) and multiparous (58.9%).

Prevalence and Severity of Anaemia

The overall prevalence of anaemia was 58.4% (n=263). Of these, mild anaemia was observed in 111 women (42.2%), moderate anaemia in 125 women (47.5%), and severe anaemia in 27 women (10.3%) (Table 1).

Table 1. Distribution of pregnant women according to severity of anaemia (n = 450)

Anaemia and Trimester of Pregnancy

A higher prevalence of anaemia was noted among women in the third trimester (68.1%) compared to the first (45.3%) and second trimesters (53.4%), which was statistically significant (p=0.002) (Table 2).

Table 2. Association between trimester of pregnancy and prevalence of anaemia

*Chi-square test; * statistically significant

Anaemia and Socioeconomic Status

Women from lower socioeconomic status had a significantly higher prevalence (72.4%) compared to those from middle (55.6%) and upper socioeconomic groups (38.9%) (p<0.001) (Table 3).

Table 3. Association between socioeconomic status and prevalence of anaemia

*Chi-square test; * statistically significant

Anaemia and Parity

Anaemia prevalence was higher among multiparous women (64.8%) compared to primigravidae (50.9%), and the difference was statistically significant (p=0.015) (Table 4).

Table 4. Association between parity and prevalence of anaemia

*Chi-square test; * statistically significant

In summary, anaemia was more prevalent in the third trimester, among multiparous women, and in those from lower socioeconomic backgrounds (Tables 1–4).

The present study found that more than half of the pregnant women attending the antenatal clinic were anaemic, with an overall prevalence of 58.4%. This is consistent with the National Family Health Survey (NFHS-5) report, which documented a prevalence of around 52% among pregnant women in India [1]. The high burden of anaemia in this population reflects both nutritional deficiencies and socio-economic disparities, despite ongoing supplementation programs.

In our study, the majority of anaemic women had moderate anaemia, similar to findings from a study in Uttar Pradesh, where 46% of pregnant women were moderately anaemic [2]. Mild anaemia was also common, suggesting that early detection during antenatal visits could allow for prompt intervention and prevent progression to severe forms. Severe anaemia, though less frequent (10.3%), remains clinically significant given its association with adverse maternal and fetal outcomes, including increased risk of postpartum haemorrhage and perinatal mortality [3,4].

Trimester-wise distribution showed a significantly higher prevalence in the third trimester (68.1%), which may be attributed to increased iron requirements for fetal growth and haemodilution during late pregnancy [5,6]. Similar trends have been reported in studies from Nepal and Bangladesh, where anaemia prevalence rose progressively across trimesters [7,8]. These findings underscore the importance of early antenatal registration and continuous iron supplementation.

Socioeconomic status was strongly associated with anaemia, with the highest prevalence among women from lower-income households (72.4%). This relationship has been documented in multiple studies, where poor dietary diversity, limited access to healthcare, and higher rates of infection contribute to anaemia in disadvantaged groups [9,10]. The role of education and awareness is also critical, as maternal literacy influences dietary practices and adherence to supplementation [11].

Multiparity was significantly associated with higher anaemia prevalence (64.8% in multiparous vs. 50.9% in primigravidae). Repeated pregnancies without adequate spacing may deplete maternal iron stores, a finding consistent with reports from Ethiopia and Pakistan [12,13]. This highlights the need for family planning counselling and nutritional rehabilitation between pregnancies.

The persistence of high anaemia rates despite national supplementation programs raises concerns about compliance, bioavailability of iron preparations, and the influence of cultural dietary habits [14,15]. Strategies to improve coverage must include community-level nutrition education, regular screening, and management of underlying causes such as hookworm infection and malaria where endemic.

Overall, the study findings align with existing literature, reaffirming that anaemia in pregnancy is a multifactorial problem requiring a comprehensive approach that integrates nutrition, infection control, and reproductive health interventions. Strengthening antenatal care services, with a focus on high-risk groups such as women in late pregnancy, from low socioeconomic status, and with higher parity, is essential to reduce the burden of anaemia and improve maternal-fetal outcomes.

Anaemia remains highly prevalent among pregnant women attending antenatal clinics, particularly in the third trimester, in those with multiple pregnancies, and among women from lower socioeconomic backgrounds. Strengthening early screening, ensuring compliance with iron supplementation, promoting balanced nutrition, and addressing socio-economic disparities are essential to reduce the burden and improve maternal and neonatal outcomes.

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