Understanding Anemia and Predictors of Adverse Maternal and Neonatal Outcomes: A Multicenter Prospective Cohort Study in Southern Ethiopia.

OBJECTIVE

To assess the adverse maternal and neonatal outcomes of anemia among pregnant women in primary hospitals in Southern Ethiopia.

METHODS

This institution-based prospective cohort study was conducted from March 1 to October 30, 2022, in three primary hospitals in the Hadiya zone of Southern Ethiopia. Participants were categorized into exposed (Hb < 11 g/dL) and non-exposed (Hb ≥ 11 g/dL) groups based on hemoglobin levels measured before delivery. Baseline characteristics were comparable between groups. Maternal and neonatal complications were considered as outcomes. Data were analyzed using STATA version 15. Descriptive statistics summarized baseline characteristics, and Chi-square tests assessed associations. Generalized linear models with a log link calculated adjusted relative risks (aRRs) with 95% CIs. Statistical significance was set at P < 0.05. Multivariable models adjusted for confounders, and sensitivity analyses evaluated robustness using multiple imputations for missing data.

RESULTS

A total of 490 participants were enrolled in the study, with 245 in each of the exposed and non-exposed groups. Due to loss to follow-up, 220 participants in the exposed group and 239 in the non-exposed group were assessed for outcomes. Prolonged labor (adjusted RR (aRR) = 3.235; 95% CI: 1.658, 6.312; P = 0.003) and postpartum hemorrhage (aRR = 2.901; 95% CI: 1.202, 7.910; P = 0.045) were identified as adverse maternal pregnancy outcomes of anemia. We observed low birth weight (aRR = 3.020; 95% CI: 1.233, 6.010; P = 0.002) and respiratory distress syndrome (aRR = 4.820; 95% CI: 2.901, 9.012; P = 0.001) as neonatal complications. Furthermore, having no previous history of anemia reduced the risk of prolonged labor (aRR = 0.078; 95% CI: 0.033, 0.188; P = 0.015) and low birth weight (aRR = 0.480; 95% CI: 0.370, 0.592; P = 0.001).

CONCLUSION

Mothers who have experienced maternal anemia in the past or present face serious consequences for both themselves and their children. Preventing anemia should thus start before conception and continue through pregnancy.