IMPACT OF MATERNAL HEMOGLOBIN AND SERUM FERRITIN ON BIRTH WEIGHT AND APGAR SCORES IN A TERTIARY CARE HOSPITAL
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Keywords
Maternal anemia; Hemoglobin; Serum ferritin; Birth weight; Apgar score; Neonatal outcomes
Abstract
Background: Maternal anemia remains a major public health problem in developing countries and is associated with adverse neonatal outcomes. Hemoglobin reflects functional iron status, while serum ferritin represents iron stores. Their combined effect on neonatal birth weight and Apgar scores has not been adequately studied in Indian populations.
Objectives: To assess maternal hemoglobin and serum ferritin levels and determine their effect on neonatal birth weight and Apgar scores at 1 and 5 minutes, and to evaluate the association between maternal hemoglobin and selected demographic variables.
Materials and Methods: This prospective observational study was conducted in the Department of Obstetrics and Gynecology, Subbaiah Institute of Medical Sciences and Research centre, Shivamogga, from October 2024 to September 2025. A total of 100 term pregnant women (37–41 weeks gestation) aged 18–30 years with singleton pregnancies were included using convenience sampling. Maternal hemoglobin was estimated by Sahli’s acid hematin method and serum ferritin by chemiluminescence immunoassay (CLIA). Neonatal birth weight was recorded using a digital scale, and Apgar scores were assessed at 1 and 5 minutes. Statistical analysis was performed using EPI INFO version 7, with p <0.05 considered statistically significant.
Results: Maternal anemia was present in 71% of the study population, with moderate anemia being the most common (44%). Mean birth weight was significantly lower in neonates born to anemic mothers (2.77 ± 0.36 kg) compared to non-anemic mothers (3.26 ± 0.30 kg) (p = 0.000001). Apgar scores at both 1 minute (7.28 vs 9.51) and 5 minutes (8.35 vs 9.96) were significantly lower in neonates born to anemic mothers (p = 0.000001). Although 17% of mothers had low serum ferritin levels (<12 ng/ml), serum ferritin did not show a statistically significant association with neonatal birth weight or Apgar scores. Cesarean section rates were significantly higher among anemic mothers (p = 0.03).
Conclusion: Maternal hemoglobin levels have a significant impact on neonatal birth weight and Apgar scores, whereas serum ferritin levels did not show a direct association with immediate neonatal outcomes in this study. Early detection and correction of maternal anemia through effective antenatal care and iron supplementation are essential to improve neonatal outcomes.
References
2. World Health Organization. Worldwide prevalence of anaemia 1993–2005. Geneva: WHO; 2008.
3. Allen LH. Anemia and iron deficiency: effects on pregnancy outcome. Am J Clin Nutr. 2000;71(5 Suppl):1280S-1284S.
4. Kalaivani K. Prevalence & consequences of anaemia in pregnancy. Indian J Med Res. 2009;130(5):627-633.
5. Lone FW, Qureshi RN, Emanuel F. Maternal anaemia and its impact on perinatal outcome. Trop Med Int Health. 2004;9(4):486-490.
6. Sharma JB, Shankar M. Anemia in pregnancy. JIMSA. 2010;23(4):253-260.
7. Kramer MS. Determinants of low birth weight: methodological assessment and meta-analysis. Bull World Health Organ. 1987;65(5):663-737.
8. Bhargava A, Bouis HE, Scrimshaw NS. Dietary intakes and socioeconomic factors are associated with the hemoglobin concentration of Bangladeshi women. J Nutr. 2001;131(3):758-764.
9. Malhotra M, Sharma JB, Batra S, et al. Maternal and perinatal outcome in varying degrees of anemia. Int J Gynaecol Obstet. 2002;79(2):93-100.
10. Kumar KJ, Asha N, Murthy DS, et al. Maternal anemia in various trimesters and its effect on newborn weight and maturity. Int J Prev Med. 2013;4(2):193-199.
11. Rasmussen KM. Is there a causal relationship between iron deficiency or iron-deficiency anemia and weight at birth, length of gestation and perinatal mortality? J Nutr. 2001;131(2S-2):590S-603S.
12. Sifakis S, Pharmakides G. Anemia in pregnancy. Ann N Y Acad Sci. 2000;900:125-136.
13. Lone FW, Qureshi RN, Emanuel F. Maternal anemia and Apgar score. Trop Med Int Health. 2004;9(4):486-490.
14. Worwood M. Indicators of the iron status of populations: ferritin. World Health Organ. 2007;1:35-74.
15. Bothwell TH. Iron requirements in pregnancy and strategies to meet them. Am J Clin Nutr. 2000;72(1 Suppl):257S-264S.
16. Ziaei S, Norrozi M, Faghihzadeh S, et al. A randomised placebo-controlled trial to determine the effect of iron supplementation on pregnancy outcome in pregnant women with haemoglobin ≥13.2 g/dL. BJOG. 2007;114(6):684-688.
17. Scholl TO. Iron status during pregnancy: setting the stage for mother and infant. Am J Clin Nutr. 2005;81(5):1218S-1222S.
18. Preziosi P, Prual A, Galan P, et al. Effect of iron supplementation on the iron status of pregnant women: consequences for newborns. Am J Clin Nutr. 1997;66(5):1178-1182.
19. Dewey KG, Chaparro CM. Session 4: mineral metabolism and body composition iron status of breast-fed infants. Proc Nutr Soc. 2007;66(3):412-422.
20. Lao TT, Tam KF. Maternal serum ferritin and birth weight. Obstet Gynecol. 2000;96(3):395-399.
21. Alka Batar, Anuradha Salvi, Shalini Agarwal, Late Rajorie. Maternl and perinatal out come of pregnancy with severe anemia, IJBAR,2015;6(8):611-616.
22. Malhotra M, Sharma JB, Batra S, Sharma S, Murthy NS, Arora R. Maternal and perinatal out come in varying degrees of anemia. Int J Gynaecol Obstet 2002;79(2):93-100.
23. Ekta Dalal, Jeegar Shah. A comparative study on outcome of neonates born to anemic mothers versus non anemic mothers,Nat L J Med Res.2014;4(4):270- 273.
24. Levy A, Fraser D, Katz M, Mazor M, Sheiner E. Maternal anemia during pregnancy is an independent risk factor for low brth weight and pre term delivery. Eur J Obstet Gynecol Reprod Biol.2005;122(2):182-6.
25. Ahmad MD, Kalsoom U,Sughra U, Hadi U, Imran M. Effect of maternal aemia on birth weight. J Ayub med coll Abottabad 2011;23(1).
26. Soumyamol Francis, Sabitha Nayak. Maternal hemoglobin level and its association with pregnancy out come among mothers.NUJHS;2013;3(3), ISSN 2249-7110.
27. Elise M Laflamme.Maternal Hemoglobin concentration and pregnancy outcome. Mc gill J Med.2011;13(1):47
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Dr Shashikumar N S
Associate Professor, Department of Obstetrics and Gynaecology, Subbaiah Institute of Medical Sciences and Research Centre, Shivamogga, Karnataka.
Dr Chetana Rao N
Assistant Professor, Department of Obstetrics and Gynaecology, Subbaiah Institute of Medical Sciences and Research Centre, Shivamogga, Karnataka.
Dr Soumya B G
Assistant Professor, Department of Obstetrics and Gynaecology, Subbaiah Institute of Medical Sciences and Research Centre, Shivamogga, Karnataka.
