A recent extensive study in India has revealed a link between maternal anaemia during pregnancy and a heightened risk of stillbirth. Researchers observed nearly 220,000 pregnant women across ten diverse cohorts within the country. The research indicated that women with haemoglobin levels below 10 gdL at any point during pregnancy faced an increased risk of stillbirth after 28 weeks of gestation compared to their counterparts with no or mild anaemia. Notably, the risk was most pronounced among those with moderate to severe anaemia.

The condition of anaemia, characterized by a reduced capacity of the blood to carry oxygen due to insufficient haemoglobin or red blood cells, poses risks during pregnancy. As the mother’s body supports the developing foetus and placenta, inadequate oxygen delivery can adversely affect both maternal and foetal health. The findings of this study were published in The Lancet Regional Health – Southeast Asia.

The study was conducted by researchers from Oxford University, the Indian Council of Medical Research (ICMR), the Indian Institute of Public Health, and various other institutions across India and abroad. Unlike previous studies which provided limited evidence on the severity of anaemia concerning stillbirth, this research highlighted how the risks differ at various stages of pregnancy.

Analysis of a Large Dataset

Prior studies have attempted to establish a connection between maternal anaemia and stillbirth, yet many relied on small populations or specific settings. This new research aimed to bridge that gap by compiling individual-level data from multiple pregnancy cohorts. Employing various statistical methods, the researchers sought to derive a pooled estimate concerning the relationship between anaemia and stillbirth risk.

The results were noteworthy. Women experiencing maternal anaemia, denoted by haemoglobin levels below 10 gdL, experienced an elevated risk of stillbirth after 28 weeks in comparison to those whose haemoglobin levels were 10 gdL or higher. The severity of anaemia was a crucial factor, with those suffering from moderate to severe anaemia exhibiting the highest risk levels. Conversely, mild anaemia did not typically correlate with an increased risk unless identified during the second trimester.

Additionally, the timing of stillbirths varied based on the severity of anaemia. For women with severe anaemia, stillbirths occurred at a median gestational age of 29 weeks, while those with moderate, mild, or no anaemia experienced stillbirths at a median of 31 weeks.

Public Health Implications for India

The implications of these findings are particularly significant in a country where both anaemia and stillbirth have been prevalent public health concerns. According to the National Family Health Survey (NFHS-5), approximately 57 per cent of women aged 15–49 and 52 per cent of pregnant women are affected by anaemia. This widespread prevalence suggests that even a minor increase in stillbirth risk due to anaemia could have substantial implications for the national health landscape.

In addition to stillbirths, anaemia is associated with other adverse pregnancy outcomes, including preterm birth and low birth weight. For mothers, severe anaemia can lead to fatigue, breathlessness, and increases the risk of complications during childbirth. In 2021, India recorded the world’s highest number of stillbirths, with estimates varying based on gestational age.

While presenting anaemia as an identifiable and treatable risk factor, the study calls for comprehensive antenatal care. Approximately 51 per cent of the women in the study had moderate anaemia, while 1.3 per cent suffered from severe anaemia. This underscores the need for effective screening and treatment of anaemia in pregnant women to potentially reduce stillbirth rates.

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