Anemia in Pregnancy: Incidence, Risk Factors, and Outcomes

In Saudi Arabia, the reported prevalence of anemia in pregnancy varies considerably, reflecting differences in sociodemographic characteristics and nutritional status across study populations.

This study aimed to (i) determine the prevalence of anemia at the first antenatal visit; (ii) assess prevalence across pregnancy trimesters; (iii) identify risk factors, including compliance with iron and multivitamin supplementation; and (iv) evaluate maternal and neonatal outcomes associated with anemia.

We conducted a prospective cohort study at the antenatal clinic of King Khalid University Hospital, Riyadh, Saudi Arabia, between January 2020 and December 2022. Pregnant women attending their first antenatal visit were consecutively recruited and followed throughout pregnancy. Hemoglobin (Hb) was measured in each trimester, and anemia was defined according to the World Health Organization (WHO) criteria. Outcomes included postpartum hemorrhage (PPH, transfusion, preterm birth, low birth weight (LBW), and neonatal intensive care unit (NICU) admission. Notably, Hb data were available for 220 women (21.9%) in the first trimester, primarily due to late booking. This limitation was acknowledged to ensure transparency regarding potential selection bias.

A total of 1003 women were included. The prevalence of anemia increased with gestational age: 26 women (11.8%) at the first visit, 105 women (14.4%) in the second trimester, and 289 women (28.8%) in the third trimester. Advancing gestational age was an independent predictor of anemia (adjusted OR 1.03, 95% CI 1.01-1.05, p = 0.007). Anemia was significantly associated with PPH (18 women (6.3%) vs. 23 women (3.6%), p = 0.047), but not with LBW or NICU admission. Iron supplementation increased progressively during pregnancy, but postpartum continuation was significantly lower among anemic women compared with non-anemic women (195 (67.5%) vs. 528 (83.4%), p = 0.035).

Anemia in pregnancy is common among Saudi women and is associated with maternal complications and suboptimal adherence to supplementation. Early screening, strategies to improve compliance, and culturally tailored nutritional counseling are essential to reduce risks.