Prevalence of Anaemia and Associated Factors among Pregnant Women Attending Antenatal Care at Selected Hospitals in Karbala City, Iraq
DOI:
https://doi.org/10.59675/M421Keywords:
Anaemia; pregnancy; prevalence; nutritional factors; socioeconomic status.Abstract
Background: Anaemia during pregnancy remains an important maternal health problem and may occur in association with nutritional, socioeconomic, obstetric, and other health-related factors. This study estimated the prevalence of anaemia and examined clinical, haematological, nutritional, socioeconomic, and obstetric characteristics among pregnant women attending antenatal care in Karbala City, Iraq.
Objective: To estimate the prevalence of anaemia using the prespecified study definition and to describe factors associated with anaemia among pregnant women attending antenatal care at the participating hospitals in Karbala City, Iraq. A secondary retrospective analysis applied the WHO 2024 trimester-specific haemoglobin criteria.
Methods: This cross-sectional observational study included 200 pregnant women attending antenatal clinics at the Maternity and Obstetrics Teaching Hospital and Al-Imam Al-Hassan Teaching Hospital in Karbala City, Iraq, from 10 November 2025 to 20 March 2026. Data were collected using a structured questionnaire, clinical examination, and laboratory assessment. The prespecified study definition of anaemia was haemoglobin <11 g/dL in all trimesters. Categorical variables were analysed using chi-square tests, and continuous variables were compared using independent-samples t-tests or Mann–Whitney U tests according to distribution. Multivariable logistic regression was used to examine factors associated with study-defined anaemia.
Results: Among the 200 participants, 68 (34.0%) met the prespecified study definition of anaemia. In a secondary retrospective reclassification using the WHO 2024 trimester-specific criteria, 47 participants (23.5%) were classified as anaemic. Compared with non-anaemic participants, those classified as anaemic had lower mean haemoglobin, ferritin, RBC count, MCV, MCH, and MCHC and higher RDW. Pallor, fatigue, dizziness, headache, and palpitations were significantly more frequent in the anaemia group (all P < 0.001). Folic acid use (P = 0.006) and red-meat consumption (P = 0.042) differed significantly between groups, whereas iron supplementation did not (P = 0.081). In the multivariable model, low economic status (AOR 2.69, 95% CI 1.31–5.52; P = 0.007) and an iron-poor/irregular nutritional pattern (AOR 2.44, 95% CI 1.17–5.06; P = 0.017) were associated with higher odds of study-defined anaemia, while regular menstrual cycles were associated with lower odds (AOR 0.40, 95% CI 0.21–0.76; P = 0.005).
Conclusion: Study-defined anaemia was present in 34.0% of participants, whereas retrospective application of the WHO 2024 trimester-specific criteria classified 23.5% as anaemic. Low economic status and the study-specific iron-poor/irregular nutritional pattern were associated with higher odds of anaemia, while regular menstrual cycles were inversely associated. Because the study was facility-based, cross-sectional, and based on convenience sampling, the findings describe associations within the participating study population and should not be interpreted as causal or population-wide estimates.
References
1. World Health Organization. Guideline on haemoglobin cutoffs to define anaemia in individuals and populations. Geneva: World Health Organization; 2024. ISBN:9789240088542.
2. James AH. Iron deficiency anaemia in pregnancy. Obstet Gynecol. 2021;138(4):663–674. doi:10.1097/AOG.0000000000004559.
3. World Health Organization. Serum ferritin concentrations for the assessment of iron status in individuals and populations: technical brief. Geneva: World Health Organization; 2020. ISBN:9789240008526.
4. Zeng L, Pei L, Li C, Yan H. Iron deficiency anaemia. In: Khan J, editor. Current Topics in Anaemia. London: IntechOpen; 2017. doi:10.5772/intechopen.69048.
5. Kejela G, Wakgari A, Tesfaye T, Turi E, Adugna M, Alemu N, et al. Prevalence of anaemia and its associated factors among pregnant women attending antenatal care follow-up at Wollega University Referral Hospital, Western Ethiopia. Contracept Reprod Med. 2020;5:26. doi:10.1186/s40834-020-00130-9.
6. Di Renzo GC, Spano F, Giardina I, Brillo E, Clerici G, Roura LC. Iron deficiency anaemia in pregnancy. Womens Health (Lond). 2015;11(6):891–900. doi:10.2217/whe.15.35.
7. Milman N. Oral iron prophylaxis in pregnancy: not too little and not too much! J Pregnancy. 2012;2012:514345. doi:10.1155/2012/514345.
8. Goonewardene M, Shehata M, Hamad A. Anaemia in pregnancy. Best Pract Res Clin Obstet Gynaecol. 2012;26(1):3–24. doi:10.1016/j.bpobgyn.2011.10.010.
9. Cantor AG, Bougatsos C, Dana T, Blazina I, McDonagh M. Routine iron supplementation and screening for iron deficiency anaemia in pregnancy: a systematic review for the US Preventive Services Task Force. Ann Intern Med. 2015;162(8):566–576. doi:10.7326/M14-2932.
10. Mawani M, Ali SA, Bano G, Ali SA. Iron deficiency anaemia among women of reproductive age, an important public health problem: situation analysis. Reprod Syst Sex Disord. 2016;5(3):187. doi:10.4172/2161-038X.1000187.
11. Suega K, Dharmayuda TG, Sutarga IM, Bakta IM. Iron-deficiency anaemia in pregnant women in Bali, Indonesia: a profile of risk factors and epidemiology. Southeast Asian J Trop Med Public Health. 2002;33(3):604–607.
12. Hussain AMA, Kadhem QI, Hussain NA. Prevalence of anaemia in a sample of pregnant women in Babylon Governorate, Iraq. Rev Latinoam Hipertens. 2020;15(4):275–279. doi:10.5281/zenodo.4442769.
13. Zhang J, Li Q, Song Y, Fang L, Huang L, Sun Y. Nutritional factors for anaemia in pregnancy: a systematic review with meta-analysis. Front Public Health. 2022;10:1041136. doi:10.3389/fpubh.2022.1041136.
14. Chandra S, Tripathi AK, Mishra S, Amzarul M, Vaish AK. Physiological changes in haematological parameters during pregnancy. Indian J Hematol Blood Transfus. 2012;28(3):144–146. doi:10.1007/s12288-012-0175-6.
15. de Haas S, Ghossein-Doha C, van Kuijk SMJ, van Drongelen J, Spaanderman MEA. Physiological adaptation of maternal plasma volume during pregnancy: a systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2017;49(2):177–187. doi:10.1002/uog.17360.
16. Wang R, Xu S, Hao X, Jin X, Pan D, Xia H, et al. Anaemia during pregnancy and adverse pregnancy outcomes: a systematic review and meta-analysis of cohort studies. Front Glob Womens Health. 2025;6:1502585. doi:10.3389/fgwh.2025.1502585.
17. Jung J, Rahman MM, Rahman MS, Swe KT, Islam MR, Rahman MO, et al. Effects of haemoglobin levels during pregnancy on adverse maternal and infant outcomes: a systematic review and meta-analysis. Ann N Y Acad Sci. 2019;1450(1):69–82. doi:10.1111/nyas.14112.
18. Rahman MM, Abe SK, Rahman MS, Kanda M, Narita S, Bilano V, et al. Maternal anaemia and risk of adverse birth and health outcomes in low- and middle-income countries: systematic review and meta-analysis. Am J Clin Nutr. 2016;103(2):495–504. doi:10.3945/ajcn.115.107896.
19. Daru J, Allotey J, Peña-Rosas JP, Khan KS. Serum ferritin thresholds for the diagnosis of iron deficiency in pregnancy: a systematic review. Transfus Med. 2017;27(3):167–174. doi:10.1111/tme.12408.
20. Chibanda Y, Brookes M, Churchill D, Al-Hassi H. The ferritin, hepcidin and cytokines link in the diagnoses of iron deficiency anaemia during pregnancy: a review. Int J Mol Sci. 2023;24(17):13323. doi:10.3390/ijms241713323.
21. O’Toole F, Sheane R, Reynaud N, McAuliffe FM, Walsh JM. Screening and treatment of iron deficiency anaemia in pregnancy: a review and appraisal of current international guidelines. Int J Gynaecol Obstet. 2024;166(1):214–227. doi:10.1002/ijgo.15270.
22. Mintsopoulos V, Tannenbaum E, Malinowski AK, Shehata N, Walker M. Identification and treatment of iron-deficiency anaemia in pregnancy and postpartum: a systematic review and quality appraisal of guidelines using AGREE II. Int J Gynaecol Obstet. 2024;164(2):460–475. doi:10.1002/ijgo.14978.
23. Cantor AG, Holmes R, Bougatsos C, Atchison C, DeLoughery T, Chou R. Screening and supplementation for iron deficiency and iron deficiency anaemia during pregnancy: updated evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2024;332(11):914–928. doi:10.1001/jama.2024.13546.
24. Peña-Rosas JP, De-Regil LM, Garcia-Casal MN, Dowswell T. Daily oral iron supplementation during pregnancy. Cochrane Database Syst Rev. 2015;(7):CD004736. doi:10.1002/14651858.CD004736.pub5.
25. Skolmowska D, Głąbska D, Kołota A, Guzek D. Effectiveness of dietary interventions in prevention and treatment of iron-deficiency anaemia in pregnant women: a systematic review of randomized controlled trials. Nutrients. 2022;14(15):3023. doi:10.3390/nu14153023.
26. Seid A, Fufa DD, Weldeyohannes M, Tadesse Z, Fenta SL, Bitew ZW, et al. Inadequate dietary diversity during pregnancy increases the risk of maternal anaemia and low birth weight in Africa: a systematic review and meta-analysis. Food Sci Nutr. 2023;11(7):3706–3717. doi:10.1002/fsn3.3388.
27. Zhao G, Xu G, Zhou M, Jiang Y, Richards B, Clark KM, et al. Prenatal iron supplementation reduces maternal anaemia, iron deficiency, and iron deficiency anaemia in a randomized clinical trial in rural China, but iron deficiency remains widespread in mothers and neonates. J Nutr. 2015;145(8):1916–1923. doi:10.3945/jn.114.208678.
28. Lett C. Iron deficiency and iron deficiency anaemia in pregnancy: a narrative review for Canadian obstetrical practice. J Obstet Gynaecol Can. 2026;48(8):103369. doi:10.1016/j.jogc.2026.103369.
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Academic International Journal of Medical Sciences
This work is licensed under a Creative Commons Attribution 4.0 International License.
