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Bangladesh Journal of Medical Science Vol. 18 No. 01 January’19

Original article:Foetal outcome in pregnant women with anaemia

Neerja Singal1, Bal Krishan Taneja2, Geetanjali Setia3, Kiran Kumar Singal4,

Abstract:Background: AnaemiainpregnancyisoneofthemostimportantandcommonpublichealthproblemsnotonlyinIndiabutalsoinmostoftheSouthEastAsiancountries.Anaemiaisthemostcommonnutritionaldeficiencydisorderintheworld.Thereispredominanceofirondeficiencyanaemia (nutritional anaemia). In pregnancy, it is one of the leading causes responsible foradverse foetal outcome. Objective:TofindoutthesituationandcausesofanaemiainpregnantwomenatMMIMSRduringthestudyperiodwithspecialreferencetotheseverityofthediseaseand tofindout foetaloutcome inpregnantwomenwithanaemia.Methods: ThestudywasconductedinDepartmentofObstetricsandGynaecology,MMIMSR,Mullana,Ambala(India).Thestudywascarriedoutbetweentheperiodofoctober2012toSeptember2014.Atotalof200casesofmoderateandsevereanaemiawereincludedinthestudyonthebasisofsimplerandomsamplingmethodand200casesofnonanaemicsubjectswereincludedtoserveascontrolsfortheanaemicgroup,duringthestudyperiod.Hbgm/dlwastakenascriteriafordecidinganaemiacasesandalso toclassify themaccording to theseverity.Caseswereclassifiedaccording toWHOcriteria.Results:Outof200casesof anaemia,70%weremoderatelyanaemic (Hb7–9.9gm/dl)and30%wereseverlyanaemic(Hb<7gm/dl).Microcytichypochromictypeofanaemia(82.5%)wasmoreprevalentsuggestingnutritionalinadequaciesascauseofanaemia.Adversefoetaloutcomeintheformofpretermbirth(17%),stillbirth(3.5%),lowbirthweightbabies(27.5%),neonatalmorbidity(23.3%)wasmoreintheanaemicgroupthannonanaemiccontrols. Conclusion: Anaemia in pregnancy has adverse foetal outcome in the form ofdecreasedbirthweight,increasedperinatalmorbidityandmortality.Keywords: Anemia;Pregnancy;Microcytichypochromic;foetaloutcome

Correspondence to: GeetanjaliSetia,Ex.Resident,,DepartmentofObs.&Gynae,M.M.InsttituteofMedi-calSciences&Resarch,Mullana(Ambala),IndiaE-mail:drkiranksingal@yahoo.co.in

1. NeerjaSingal,Professor,DepartmentofObs.&Gynae*.2. BalKrishanTaneja,Ex.Professor,DepartmentofObs.&Gynae#.3. GeetanjaliSetia,Ex.Resident,,DepartmentofObs.&Gynae#.4. KiranKumarSingal,Professor,DepartmentofMedicine*

M.M.MedicalCollege&Hospital,Kumarhatti,Solan(H.P.)India M.M.InsttituteofMedicalSciences&Resarch,Mullana(Ambala),India.

Bangladesh Journal of Medical Science Vol. 18 No. 01 January’19. Page : 63-72DOI: https://doi.org/10.3329/bjms.v18i1.39551

IntroductionAnaemiainpregnancyisoneofthemostimportantandcommonpublichealthproblemsnotonlyinIndiabut also in most of the South East Asian countries. About16%to40%ofmaternaldeathsoccurduetoanaemia. Anaemia also increases maternal morbidity significantly.Mostofthepregnantpatientspresentingtooutpatientdepartment have iron deficiency anaemia. Alongwith physiological causes, social causes are alsoresponsibleforanaemiaduringpregnancylikeearlyage at marriage, teenage pregnancy, ill spacing

betweentwopregnanciesandpoorsupplementationofiron,malnutrition,endemicdiseaseslikemalariaand worm infestations. Standards laid by WHOsuggest haemoglobin below 11 gm/dl as anaemia.According to standards laid down, incidence ofanaemiaduringpregnancyinIndiarangesfrom65%to75%.1

Theprevalenceofanaemiaallovertheworldis51%andisashighas87.5%amongstpregnantwomeninIndia.2Anaemia,themostpreventablecausethatcanimproveperinatalhealth.

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AimTostudyoutcomeofpregnancyincasesofModerateand Severe Anaemia.ObjectivesAnaemiainpregnancyisoneofthemostimportantandcommonpublichealthproblemsnotonlyinIndiabut also in most of the South East Asian countries.Anaemiaisthemostcommonnutritionaldeficiencydisorder in the world. WHO has estimated thatprevalence of anaemia in pregnant women is 14percentindevelopedand51percentindevelopingcountriesand65-75percentinIndia.1The high prevalence of anaemia is recognized tobe contributory to under nutrition of the foetus and infant mortality. Adverseeffectsofanaemiaonthefoetus1. Foetalgrowthrestriction(FGR).2. Pretermbirth.3. Intrauterinefoetaldeathsduetosevereplacental

insufficiency. The incidence of still birth andpreterm births have been found to decrease ifiron therapy has been administered before 30weeksofgestation.

4. Longtermeffects:Studieshaveshownthatsevereanaemia in the mother may result in behavioural abnormalities in children and reduced cognitive skillsandimpairedschoolinglater.This issaidto be due to deficiency of chemical mediatorsin the foetal brain as a result of maternal iron deficiency.

Inviewofhighprevalenceofanaemiainpregnancyanditsseriousadverseconsequencesonbothmotherand baby, prevention andmanagement of anaemiahas become a very high priority in obstetric andpublichealthpractice.So,presentstudywascarriedouttoobservetheeffectsofanaemiaonfoetaloutcomeanditsprevalence. Material and methodsThepresentstudywasconducted inDepartmentofObstetrics and Gynaecology, MMIMSR, Mullana, Ambala. The study was carried out between theperiodsofOctober2012toSeptember2014.Theobjectivesofthestudywerea)To find out the situation and causes of anaemiain pregnant women atMMIMSR during the studyperiodwith special reference to the severity of thedisease.b)Tofindouttheperinataloutcome.Inclusion criteria •Atotalof200casesofmoderateandsevereanaemiawere included in the study on the basis of simple

random sampling method and 200 cases of nonanaemicsubjectswereincludedtoserveascontrolsfortheanaemicgroup,duringthestudyperiod.• Hbgm/dl was taken as criteria for deciding

anaemia cases and also to classify them according to the severity.

• Hbgm/dl was taken as criteria for decidinganaemia cases and also to classify them according to the severity.

Antenatal women with moderate anaemia (Hb-7-9.9gm/dl)Antenatalwomenwithsevereanaemia(Hb<7gm/dl).Antenatalwomenwithmoderateandsevereanaemiaotherwisehavingnoothermedicalproblem.Exclusion criteria Antenatalwomenwithnoanaemia(Hb≥11gm/dl)Antenatal women with mild anaemia (Hb-10-10.9gm/dl)Antenatalcaseswithotherassociateddiseaseswereexcluded.Cases of bad obstetric history for any other reason.MethodsAll study subjectswere studied in full detailswithreferencetoage,presentpregnancydetailsregardingthe number of antenatal visits, ill health, chronic infection or infestation any time during pregnancywere studied. Mode of delivery, intrapartum andpostpartumcomplicationswerestudied.Detailed neonatal examination and neonatal complicationswerenoted.Womenwereinvestigatedfor:-1. Completehaemogram.2. UrineRoutineExaminationandMicroscopy:3. StoolRoutineExaminationandMicroscopy:4. Peripheral Blood Smear for evidence malarial

parasite.5. Serumironandserumtotalironbindingcapacity

toknowtheironstores.6. SerumIron/Folate/HaemoglobinElectrophoresis

(whenrequired)7. AnyOtherInvestigationsasandwhenrequired.OnlyHbwasdoneinthecontrolgroup.Ethical Clearance: This research proposal wasacceptedbytheEthicsCommitteeofM.M.InstituteofMedicalSciences&Resarch,Mullana(Ambala),India.ResultsThestudy subjects were divided into two groups.200cases of moderate and severe anaemia200nonanaemic controls

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Table-1: Distribution of study subjects according to age

Age (years)Cases Controls

N=200 % N=200 %

≤19Yrs. 31 15.5 28 14

20-29Yrs. 158 79 164 82

> 30Yrs. 11 5.5 8 4

Total 200 100 200 100CC=0.061, P=0.691 (NS)Table - 2: Distribution of cases according to the severity of anaemia

Severity of anaemia

No. of cases (N=200) %

Moderate 140 70Severe 60 30Total 200 100

It is observed that out of 200 anaemia cases 70%were moderately anaemic and 30% were severelyanaemic.

Table - 3: Symptom analysis of anaemic cases and control group

SymptomsCases Controls

N = 200 % N = 200 %

Asymptomatic 30 15 194 97

Weakness / Fatiguability

150 75 0 0

Dyspnoea/Palpitations

74 37 0 0

Pedal Edema 40 20 6 3

LossofAppetite 56 28 0 0

Malaria 3 1.5 0 0

Visualblackouts 3 1.5 0 0

Fever 3 1.5 0 0

UTI 3 1.5 0 0

TB 3 1.5 0 0p<0.001(HS)85%of anaemicwomen had symptoms suggestiveofanaemia.Thecommonsymptomswereweakness/fatiguabilityin75%,dyspnoea/palpitationsin37%andpedaledemain20%ofanaemiccases.97% of the control group were asymptomaticand only 3% had pedal edema due to associatedgestationalhypertension.Table - 4: Relationship of grade of anaemia with different mean blood parametersBlood parameters(Mean value)

Moderate(N = 140)

Severe(N = 60)

PCV (%) 27.0 19.2

MCV (fl) 76.0 61.8

MCH (pg) 22.37 17.91

MCHC (%) 27.4 25.1

S. Iron (mg/dl) 59.74 60.15

S.TIBC (mg/dl) 447.44 477.20

ThistableshowsthatmeanPCVwas27.0%inthemoderate anaemic group and 19.2% in theseverelyanaemicgroup.

The meanMCV was 76.0fl in the moderatelyanaemic and 61.8fl in the severely anaemicgroup.

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ThemeanMCHwas22.37pginthemoderatelyanaemic and 17.91pg in the severely anaemicgroup.

ThemeanMCHCwas27.4%inthemoderatelyanaemic and 25.1% in the severely anaemicgroup.

ThisshowsthatMCV,MCHandMCHCareallreducedinirondeficiencyanaemia,whichisthecommonesttypeofanaemiainpregnancy.

The mean S. Iron was 59.74 mg/dl in themoderately anaemic and 60.15 mg/dl in theseverelyanaemicgroup.

The mean S. TIBC was 447.44 mg/dl in themoderately anaemic and 477.20 mg/dl in theseverelyanaemicgroup.

This shows that as the iron stores decrease in irondeficiencyanaemia,serumtotalironbindingcapacityincreases.

Table – 5: Type of anaemia in cases based on peripheral smear

Type of blood picture Frequency %

Microcytichypochromic 165 82.5

Dimorphic 35 17.5

Total 200 100

Maximum cases had microcytic hypochromicanaemiaaccountingfor82.5%ofcases.

Dimorphic anaemiawaspresent in thebalance17.5%ofthecases.

Table – 6: Table showing the foetal outcome in the study subjects

Foetal outcome

Cases (N=200) Controls (N=200)

No. of cases % No. of cases %

Alive 193 96.5 200 100

Still born 7 3.5 0 0

Total 200 100 200 100CC=0.185; P = 0.008 (HS)

Table–7: Table showing the neonatal complications in the study subjects

ComplicationCases (N=200) Controls (N=200)

No. of cases % No. of cases %

Preterm birth 34 17 8 4

IUGR 15 7.5 10 5

Still birth 7 3.5 0 0

ENND 1 0.5 2 1

Congenital anomaly

1 0.5 0 0

CC=0.208; P = 0.059 (NS) ENND–Early Neonatal Death

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17%ofthebabiesinanaemicgroupwerepretermasagainstonly4%inthecontrolgroup.

7.5%ofbabiesinanaemicgroupand5%inthecontrolgrouphadIUGR.

3.5%of thebabieswere still born in anaemicgroup.

0.5%ofbabiesinanaemicgroupand1%inthecontrolgrouphadearlyneonataldeath.

Onebaby in theanaemicgrouphadcongenitalanomaly(Anencephaly).

Table–8: Distribution of birth weight in the babies of study subjects

Birth Weight

(Kg)

Cases (N=200) Controls

Moderate Severe Total % N=200 %

<1 0 1 1 0.5 2 1

1-1.49 9 4 13 6.5 2 1

1.5-2.49 22 19 41 20.5 30 15

2.5-3.49 95 36 131 65.5 142 71

>3.5 14 0 14 7 24 12

Total 140 60 200 100 200 100CC=0.249; P =0.010 (HS)It is evident from the above table that the incidence oflowbirthweightbabies(<2.5kg)ismore-27.5%inanaemicwomenasagainst17%innonanaemicwomen.

Table – 9: Table showing analysis of Apgar score at 1 min

Apgarscoreat1 min.

Cases(N*=193) Controls

Moderate Severe Total % N=200 %

Normal 117 39 156 80.8 190 95MildAsphyxia

(5-7)13 11 24 12.4

4 2

Moderate asphyxia(3-4)

3 2 5 2.6 21

Severe asphyxia(0-2)

2 6 8 4.24 2

Total 135 58 193 100 200 100 CC=0.307; P<0.001 (HS)N* = Number of babies born live in the cases.

95% of babies in the non anaemic group hadnormalApgarscoreatbirthandonly5%hadbirthasphyxiawhile19.2%ofbabiesintheanaemicgroupshowedevidenceofbirthasphyxia–12.4%mildlyasphyxiated,2.6%moderatelyasphyxiatedand4.2%severelyasphyxiated.Thus,anaemiainpregnancyisassociatedwithlowerApgarscoreatbirth.Table – 10: Table showing NICU admissions in the babies

Cases Controls

N*= 193 % N = 200 %

No admission 138 71.5 180 90

Admission to NICU

55 28.5 2010

Total 193 100 200 100

CC=0.318;P< 0.001(HS)N* = Number of babies born live in the cases28.5% of babies in the anaemic group had NICUadmissionsasagainstonly10%inthecontrolgroup.

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Table – 11: Table showing the neonatal morbidity in the study subjects

Cases (N* = 193) Controls (N = 200)

No. of cases % No. of cases %

RDS 14 7.3 4 2

Jaundice 2 1 4 2

Pulmonary hypoplasia 2 1 0 0

HMD 3 1.6 0 0

MAS 24 12.4 2 1

Total 45 23.3 10 5CC=0.248; P=0.013 (HS)N*= Number of babies born live in the cases

Theabove table shows thatneonatalmorbiditywas23.3%intheanaemicgroupasagainstonly5%inthecontrolgroup.

Themajor causes of neonatalmorbidity in theanaemic group were Meuconium AspirationSyndrome (MAS) and Respiratory DistressSyndrome (RDS).

Thus, anaemia in pregnancy leads to increase inneonatal morbidity.

Table – 12: Table showing perinatal mortality in the study subjects

Perinatal mortality

Cases (N =200) Controls (N=200)No. of cases

% No. of cases

%

Normal 192 96 198 99

Still birth 7 3.5 0 0

ENND 1 0.5 2 1

Total 200 100 200 100CC=0.189; P=0.024 (S)

Theoverallperinatalmortalitywas4%intheanaemicgroupand1%inthecontrolgroup.Thus,anaemiainpregnancyisassociatedwithpoorperinataloutcome.DiscussionMajority of study subjects in the present studybelonged to the age group of 20-29 years, 79% incases and 82% in the controls group (table no-1). This is comparable to the study conducted byKhandait DW et al (2001)15; inwhich 70% of thecasesbelongedto20-29yearsagegroup. Studies conducted by Malhotra P et al5 andSanhaHetal6alsoconcludedsimilarresults.Inthepresentstudy,85%of anaemicwomen had symptoms suggestiveofanaemia.ThecommonsymptomswereWeakness/ Fatiguebility in 75%, Dyspnoea / Palpitations in37%, Loss of Appetite in 28% and Pedal Edemain 20% cases. Malaria, fever, UTI, TB and visualblackoutswerepresentin1.5%cases.(tableno-3)Sharma JB4studied thatanaemicpatientscomplainof weakness, exhaustion and lassitude, indigestionandlossofappetite.Palpitation,dyspnoea,giddiness,edema and rarely anasarca and even congestive cardiac failure can occur in severe cases.In the present study, (table no-4) the mean PCV,MCV,MCH,MCHC and S. Iron and S.TIBC arecomparablethattothatstudiedbyAgarwalV.24InthepresentstudymeanPCVwas27%inmoderate

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anaemiaand19.2%insevereanaemia.InthestudyconductedbyAgarwalV,meanPCVwas21.6%inmoderateand14.9%insevereanaemia.

Blood parameters (Mean value)

Moderate(N = 140)

Severe(N = 60)

PCV(%) 27.0 19.2

MCV(fl) 76.0 61.8

MCH(pg) 22.37 17.91

MCHC(%) 27.4 25.1

S. Iron (mg/dl) 59.74 60.15

S.TIBC(mg/dl) 447.44 477.20InthepresentstudymeanMCVwas76flinmoderateand61.8flinsevereanaemia.MeanMCVwas83.5flinmoderateand75.3flinsevereanaemiainstudybyAgarwalV. In the present study meanMCH was 22.37pg inmoderate and 17.91pg in severe anaemia. MeanMCHwas26.2pginmoderateand22.6pginsevereanaemiainstudyconductedbyAgarwalV.In the present study mean MCHC was 27.4% inmoderate and 25.1% in severe anaemia. This iscomparable tostudybyAgarwalV, inwhichmeanMCHCwas26.4%inmoderateand24.4%insevereanaemia. In the present studymean S.Ironwas 59.74mg/dlinmoderateand60.15mg/dl insevereanaemia. InthestudyconductedbyAgarwalV,meanS.Ironwas54.2mg/dl inmoderate and 28.19mg/dl in severeanaemia.Inthepresentstudy,meanS.TIBCwas447.44mg/dlinmoderateand477.20mg/dlinsevereanaemia(table no-12). In the study by Agarwal V, meanS.TIBCwas320.62mg/dl inmoderate and419.34mg/dl in severe anaemia. Thus,ironstoresdecreaseinirondeficiencyanaemiaandserumtotalironbindingcapacityincreases.Peripheralsmearexaminationtellsusaboutthetypeofanaemiaandisimportantinthemanagement.Thepresent study correlates with study conducted byAwastietal.25In the present study majority, 82.5% of subjectshad microcytic hypochromic anaemia (table no-5)as compared to 17.5% subjects having dimorphicanaemia.This is comparable to study conducted byAwasthietal,inwhich22%subjectshaddimorphicanaemia and 66.57% had microcytic hypochromicanaemia. AwanMMetal8alsofoundthat76%ofthecaseshad

microcytichypochromicanaemia.Similarly, in the study conducted by Rao P Srinivasa et al7, it was concluded that, anaemia in 1sttrimesterofpregnancywasendemicandmicrocytic,hypochromicanaemiaismostcommon.Thereisahighincidenceofadversefoetaloutcomein the form of preterm birth, IUGR, stillbirths,early neonatal deaths in anaemic group comparedtocontrols.Thecauseofearlyneonataldeathswaspretermbirthandrespiratorydistress in thepresentstudy. In thepresent study,17%of thebabies inanaemicsubjects were preterm as against only 4% in thecontrolgroup.7.5%ofbabiesinanaemicgroupand5% in the control group had IUGR, 3.5 % of thebabies were still born in anaemic group. 0.5% ofbabiesinanaemicgroupand1%inthecontrolgrouphad early neonatal death. (table no-7)ThesefindingsarecomparablewiththeobservationsofAwasthiAetal25,Preterm9.5%,andIUD6.5%. Similarly, Ali AA et al18concludedthattherewere3.3%stillbirthsinanaemicgroup.SifakisSetal9studiedthatanaemiawithhaemoglobinlevels less than 6 gm/dl was associated with poorpregnancy outcome. Prematurity, spontaneousabortions, lowbirthweight,and foetaldeathswerecomplicationsofseverematernalanaemia.Similarly, Sarin AR10 also concluded that maternal anaemiawasassociatedwithpoorfoetaloutcome.Sangeeta VB et al19 concluded that there was 1.7timesincreasedriskofprematurebirthamongcases,2 times increased risk of IUGR among cases, 1.8timesincreasedriskofIUDamongcases.LoneFWetal22concludedthattherewasa3.7and4 timesgreater riskof intrauterinefoetaldeathandpreterm delivery and among the anaemic womenthanthenon-anaemicwomen.Inthepresentstudy,thattheincidenceoflowbirthweight babies (< 2.5 kg) was 27.5% in anaemicsubjects (table no-8) as against 17% in the nonanaemic subjects. This is comparable to the studyconductedbyToshinaV11,where29.6%babieshadlowbirthweightinanemiccases.Similarly, in the study conducted by Meda N et al21, incidenceoflowbirthweight(<2.5kg)was21%. Sarin AR10,ElGuindiWetal12 and Geelhoed Det al13 also concluded that maternal anaemia leads to higherincidenceoflowbirthweightbabies.Ali AA et al14concludedthat,theriskofLBWwas2.5timeshigherinwomenwithmild/moderateanaemiaand8.0timeshigherinwomenwithsevereanaemia.

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BondevikGTetal16studiedthatsevereanaemiawasassociatedwithasignificantlyincreasedriskoflowbirthweight. Sangeeta VB et al19 concluded that therewas 2.8timesincreasedriskoflowbirthweightamongcases.BakhtiarUJ et al20 found that the riskof lowbirthweight was 1.8 times more in anaemic mothers.Therewas 2.2 times increased risk of intra uterinefoetal death in anaemic mothers.Inthepresentstudy,19.2%ofbabiesintheanaemicgroup (table no-9) showed evidence of birthasphyxia(12.4%ofbabiesweremildlyasphyxiated,2.6% moderately asphyxiated and 4.2% severelyasphyxiated)ascomparedto5%babieshavingbirthasphyxiainthenonanaemiccontrols.Thesefindingsarecomparable to thestudyconductedbyAgarwalP83,where incidenceofbirth asphyxiawas21% inbabies of anaemic women as compared to 3% inbabiesofnonanaemicsubjects.Bondevik GT et al16 studied that the risk of lowApgar scorewas significantly increased in womenwithsevereanaemiainthefirsttrimester.Sangeeta VB et al19 concluded that there was 1.6timesincreasedriskofbirthasphyxiaamongcases.BakhtiarUJ et al20 found that neonates of anaemic women had 1.7 times increased risk of lowApgarscore at one minute. Similarly,LoneFWetal22 concluded that neonates of anaemicwomenhad1.8 times increased riskoflowApgarscoresat1minute.Themajorcausesofneonatalmorbidityintheanaemicgroup were Meuconium aspiration syndrome andRespiratorydistresssyndrome.Inthepresentstudy,neonatalmorbiditywas23.3%in the anaemic group (table no-11) as against only5%inthecontrolgroup.Thisiscomparabletostudydone byAgarwal P23, inwhich neonatalmorbiditywas21% in anaemic subjects as compared to14%in the non anaemic subjects. Thus, anaemia inpregnancyleadstoincreaseinneonatalmorbidity.Rohilla M et al17 in their study concluded that Foetal distresswasseenin26%oftheanaemiccaes.The overall perinatal mortality was 4% in theanaemicgroup(tableno-12)and1%in thecontrolgroup.Thus,anaemiainpregnancyisassociatedwithpoorperinataloutcome.Thisiscomparabletostudyby Rohilla M et al17,whichconcludedthatperinatalmortalitywas4.16%inanaemiccases.Similar resultswere also seen in study carried outby Sarin AR10 with 7.9% perinatal deaths in theanaemicsubjects.

SummaryInthepresentstudy,amongvariouscausesofanaemia,90%werenutritionalinorigin.Irondeficiencywasthecommonestnutritionalanaemiafollowedbyfolicaciddeficiency.Anaemia in pregnancywas found to be associatedwithadverseperinataloutcomelikelowbirthweightbabies and increased maternal morbidity, neonatal morbidity and mortality.Anaemiawasresponsibleforadversefoetaloutcomein the form of low birth weight babies and intrauterinegrowth restriction.Maternal irondeficiencyinpregnancyreducesfoetalironstores,puttingthematriskforlongtermcognitiveandneurodevelopmentimpairmentsintheneonate.ThepresentstudywasconductedinDepartmentofObstetrics and Gynaecology, MMIMSR, Mullana, Ambala. The study was carried out between theperiodofoctober2012 toSeptember2014.A totalof200casesofmoderateandsevereanaemiawereincludedinthestudyonthebasisofsimplerandomsampling method and 200 cases of non anaemicsubjectswere included to serve as controls for theanaemicgroup,duringthestudyperiod.Cases were classified into mild (10 – 10.9gm/dl),moderate (7 – 9.9gm/dl) and severe ( < 7gm/dl)anaemiaaccordingtoWHOCriteriaMajorityofstudysubjectswereintheagegroupof20-29years–79%incasesand82%incontrols.Thisisnotstatisticallysignificant.85%oftheanaemicwomenhadsymptomssuggestiveof anaemia. The common symptoms were easyfatiguabilityfollowedbydyspnoeaandpalpitations,lossofappetiteandpedaledema.Thisisstatisticallyhighlysignificant.Outof200casesofanaemia,70%weremoderatelyanaemicand30%wereseverlyanaemic.ThemeanPCV,MCV,MCH,MCHCandRBCcountare all reduced in anaemia patients indicating thatirondeficiencyisthecommonesttypeofanaemiainpregnancy.The mean S. Iron was 59.74 mg/dl in moderateanaemia and 60.15 mg/dl in the severely anaemicgroup. The mean S.TIBC was 447.44 mg/dl inmoderateanaemiaand477.20mg/dlintheseverelyanaemic group. This shows that as iron storesdecreaseinirondeficiencyanaemia,serumtotalironbindingcapacityincreases.Microcytichypochromicanaemiawasthecommonesttypeofanaemia(82.5%).The neonatalmorbiditywas 23.3% in the anaemicgroupand5%inthecontrolgroupwithmeconeum

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aspiration as the leading cause.This is statisticallyhighlysignificant.Theperinatalmortalitywas4%inthecasesand1%inthecontrolgroup.Therefore, efforts need to be directed not only tocorrectanaemiabuttopreventanaemiaintheentirewomenfolkofthecountry.Proper antenatal care is the basic requirement forprevention,earlydetectionandtreatmentofanaemia.AdequateIronandfolicacidsupplementationduringpregnancy in iron deficient mothers improves ironstatusduringpregnancyandpostpartumperiod,thusprovidingsomeprotectionagainstirondeficiencyinthe subsequent pregnancy. Ensuring maternal ironsufficiencyduringgestationisthemostcosteffectivemethodof preventing perinatal iron deficiency andrelated morbidities.ConclusionFrom the present study under discussion, it isconcluded that anaemic antenatal cases sufferingfrom moderate and severe anaemia carried adverse

effects on foetal outcome in the formof decreasedbirth weight, increased perinatal morbidity andmortality. Acknowledgement:The authors thank the patients for their consent toparticipateinthestudyandwishtoacknowledgeforevery the support fromM.M. Institute ofMedicalSciences & Resarch, Mullana (Ambala), India forsupportingtoconductthestudy.Conflict of interest: None declared. Source of funding: NILAuthor contribution: Datagatheringandideaownerofthisstudy:NeerjaSingalStudydesign:NeerjaSingal,BalKrishanTanejaDatagathering:BalKrishanTaneja,GeetanjaliSetiaWritingandsubmittingmanuscript:NeerjaSingal,Kiran Kumar SingalEditingandapprovaloffinaldraft:NeerjaSingal,BalKrishanTaneja

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