Placental Adaptations Under Severe Anemia: Neonatal Outcomes at the Crossroads

Anemia is a major global health problem, particularly in developing countries such as India, due to the greater prevalence of dietary iron deficiency, hemoglobinopathies, macronutrient deficiencies, and infections such as malaria, human immunodeficiency virus (HIV), and hookworm infestation. Anemia-induced hypoxia triggers a range of vascular and structural changes in the placenta, potentially leading to complications for both the mother and the fetus. Studies have shown that placentae from anemic mothers often exhibit hypertrophy, characterized by increased placental weight relative to fetal weight. Placental infarcts and calcifications occur due to inadequate blood flow, leading to areas of necrosis within the placenta. To study these placental alterations and their corresponding correlation with maternal and fetal health, an observational prospective study was conducted at Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, comprising two groups: Group A - severely anemic pregnant females and Group B - nonanemic pregnant females, each consisting of 40 individuals. The placentae from the two groups were first grossly examined and then sent for histopathological examination, and the findings were compared between the two groups. Neonatal outcomes were also correlated with these findings. Our study found significant changes in the placentae of the severely anemic group in terms of an increased incidence of syncytial knots, placental fibrosis, placental calcifications, and villitis, as well as a reduction in placental weight and cord length. Placental fibrosis, calcification, and villitis were associated with adverse fetal outcomes such as preterm delivery and low birth weight. The study concluded that microstructural changes in the placenta due to anemia are a significant contributor to premature and low-birth-weight infants.