Effects of Maternal Anemia on Placental Ratio Among Women Admitted for Delivery in Tertiary Care Hospital

Madiha Sabir; Rohana Salam; Khushal Khan; Zamrud Zehri; Sania Ali; Hira; Sana Ullah Kakar

doi:10.70749/ijbr.v3i3.932

Authors

Madiha Sabir Department of Gynecology, Sandeman Provincial Hospital, Quetta, Balochistan, Pakistan.
Rohana Salam Department of Gynecology, Sandeman Provincial Hospital, Quetta, Balochistan, Pakistan.
Khushal Khan Department of Surgery, Sandeman Provincial Hospital, Quetta, Balochistan, Pakistan.
Zamrud Zehri Department of Gynecology, Sandeman Provincial Hospital, Quetta, Balochistan, Pakistan.
Sania Ali Department of Gynecology, Sandeman Provincial Hospital, Quetta, Balochistan, Pakistan.
Hira Department of Gynecology, Sandeman Provincial Hospital, Quetta, Balochistan, Pakistan.
Sana Ullah Kakar Balochistan Institute of Psychiatry and Behavioural Sciences (BIPBS), Quetta, Balochistan, Pakistan.

DOI:

https://doi.org/10.70749/ijbr.v3i3.932

Keywords:

Maternal Anemia, Placental Ratio, Pregnancy Complications, Placental Weight, Hemoglobin Levels.

Abstract

Background: Maternal anemia, a common pregnancy complication, affects fetal development and placental function. The placental ratio, a key indicator of placental efficiency, is influenced by maternal hemoglobin levels. Objective: This study aims to assess the impact of maternal anemia on placental ratio among women admitted for delivery in a tertiary care hospital. Methodology: A total of 120 pregnant women were categorized into anemic (n=60) and non-anemic (n=60) groups. Placental weight, birth weight, and placental-to-birth weight ratio were analyzed. Results and Discussion: This study analyzed 120 pregnant women, divided into anemic (n = 60) and non-anemic (n = 60) groups based on hemoglobin levels. The anemic group had significantly lower hemoglobin (8.7 ± 1.2 g/dL) than the non-anemic group (12.4 ± 0.9 g/dL). Anemic mothers had larger placental weight (680 ± 120 g) and placental ratio (0.23 ± 0.04) compared to non-anemic mothers (560 ± 100 g; 0.17 ± 0.03). Despite placental hypertrophy, birth weight was lower in the anemic group (2950 ± 420 g vs. 3300 ± 350 g). Neonates of anemic mothers had higher NICU admissions (30% vs. 12%), low Apgar scores, and preterm births. Findings highlight the need for early anemia management to improve neonatal outcomes. Conclusion: Maternal anemia significantly impacts placental ratio, birth weight, and neonatal outcomes. This study suggests that placental hypertrophy compensates for reduced oxygen availability, yet fetal growth remains compromised. Anemic mothers had lower birth weights and higher preterm deliveries, NICU admissions, and low Apgar scores. Early diagnosis, iron supplementation, and enhanced prenatal care are essential to improving maternal and neonatal health outcomes globally.

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References

1. Addo, O. Y., Yu, E. X., Williams, A. M., Young, M. F., Sharma, A. J., Mei, Z., Kassebaum, N. J., Jefferds, M. E., & Suchdev, P. S. (2021). Evaluation of hemoglobin cutoff levels to define anemia among healthy individuals. JAMA Network Open, 4(8), e2119123. https://doi.org/10.1001/jamanetworkopen.2021.19123

2. Alem, A. Z., Efendi, F., McKenna, L., Felipe-Dimog, E. B., Chilot, D., Tonapa, S. I., Susanti, I. A., & Zainuri, A. (2023). Prevalence and factors associated with anemia in women of reproductive age across low- and middle-income countries based on national data. Scientific Reports, 13(1). https://doi.org/10.1038/s41598-023-46739-z

3. Aparicio, E., Jardí, C., Bedmar, C., Pallejà, M., Basora, J., & Arija, V. (2020). Nutrient intake during pregnancy and post-partum: Eclipses study. Nutrients, 12(5), 1325. https://doi.org/10.3390/nu12051325

4. Balarajan, Y., Ramakrishnan, U., Özaltin, E., Shankar, A. H., & Subramanian, S. (2011). Anaemia in low-income and middle-income countries. The Lancet, 378(9809), 2123-2135. https://doi.org/10.1016/s0140-6736(10)62304-5

5. Burton, G. J., & Fowden, A. L. (2015). The placenta: A multifaceted, transient organ. Philosophical Transactions of the Royal Society B: Biological Sciences, 370(1663), 20140066. https://doi.org/10.1098/rstb.2014.0066

6. Elstrott, B., Khan, L., Olson, S., Raghunathan, V., DeLoughery, T., & Shatzel, J. J. (2019). The role of iron repletion in adult iron deficiency anemia and other diseases. European Journal of Haematology, 104(3), 153-161. https://doi.org/10.1111/ejh.13345

7. Larsen, S., Bjelland, E. K., Haavaldsen, C., & Eskild, A. (2016). Placental weight in pregnancies with high or low hemoglobin concentrations. European journal of Obstetrics & Gynecology and reproductive biology, 206, 48-52. https://doi.org/10.1016/j.ejogrb.2016.08.039

8. Fowden, A., Coan, P., Angiolini, E., Burton, G., & Constancia, M. (2011). Imprinted genes and the epigenetic regulation of placental phenotype. Progress in Biophysics and Molecular Biology, 106(1), 281-288. https://doi.org/10.1016/j.pbiomolbio.2010.11.005

9. GODFREY, K. M., REDMAN, C. W., BARKER, D. J., & OSMOND, C. (1991). The effect of maternal anaemia and iron deficiency on the ratio of fetal weight to placental weight. BJOG: An International Journal of Obstetrics & Gynaecology, 98(9), 886-891. https://doi.org/10.1111/j.1471-0528.1991.tb13510.x

10. GODFREY, K. M., REDMAN, C. W., BARKER, D. J., & OSMOND, C. (1991). The effect of maternal anaemia and iron deficiency on the ratio of fetal weight to placental weight. BJOG: An International Journal of Obstetrics & Gynaecology, 98(9), 886-891. https://doi.org/10.1111/j.1471-0528.1991.tb13510.x

11. Hytten, F. (1985). Blood volume changes in normal pregnancy. Clinics in Haematology, 14(3), 601-612. https://doi.org/10.1016/s0308-2261(21)00496-

12. Jones, H., Powell, T., & Jansson, T. (2007). Regulation of placental nutrient transport – A review. Placenta, 28(8-9), 763-774. https://doi.org/10.1016/j.placenta.2007.05.002

13. Jouanne, M., Oddoux, S., Noël, A., & Voisin-Chiret, A. S. (2021). Nutrient requirements during pregnancy and lactation. Nutrients, 13(2), 692. https://doi.org/10.3390/nu13020692

14. Kazma, J. M., Van den Anker, J., Allegaert, K., Dallmann, A., & Ahmadzia, H. K. (2020). Anatomical and physiological alterations of pregnancy. Journal of Pharmacokinetics and Pharmacodynamics, 47(4), 271-285. https://doi.org/10.1007/s10928-020-09677-1

15. Khatun, S., Shah, D. K., Shrestha, N., & Yadav, A. K. (2022). Ratio of placenta to birth weight in anemic and non-anemic mothers. Journal of Nobel Medical College, 11(1), 61-66. https://doi.org/10.3126/jonmc.v11i1.46065

16. Kingdom, J., & Kaufmann, P. (1997). Oxygen and placental villous development: Origins of fetal hypoxia. Placenta, 18(8), 613-621. https://doi.org/10.1016/s0143-4004(97)90000-x

17. Lao, T., & Wong, W. (1997). Placental ratio—its relationship with mild maternal anaemia. Placenta, 18(7), 593-596. https://doi.org/10.1016/0143-4004(77)90015-7

18. Zhao, B., Sun, M., Wu, T., Li, J., Shi, H., & Wei, Y. (2024). The association between maternal anemia and neonatal anemia: a systematic review and meta-analysis. BMC pregnancy and childbirth, 24(1), 677. https://doi.org/10.1186/s12884-024-06832-1

19. Qiao, Y., Di, J., Yin, L., Huang, A., Zhao, W., Hu, H., & Chen, S. (2024). Prevalence and influencing factors of anemia among pregnant women across first, second and third trimesters of pregnancy in monitoring areas, from 2016 to 2020: A population-based multi-center cohort study. BMC Public Health, 24(1). https://doi.org/10.1186/s12889-024-18610-x

20. Rahman, M. M., Abe, S. K., Rahman, M. S., Kanda, M., Narita, S., Bilano, V., Ota, E., Gilmour, S., & Shibuya, K. (2016). Maternal anemia and risk of adverse birth and health outcomes in low- and middle-income countries: Systematic review and meta-analysis. The American Journal of Clinical Nutrition, 103(2), 495-504. https://doi.org/10.3945/ajcn.115.107896

21. Stevens, G. A., Paciorek, C. J., Flores-Urrutia, M. C., Borghi, E., Namaste, S., Wirth, J. P., Suchdev, P. S., Ezzati, M., Rohner, F., Flaxman, S. R., & Rogers, L. M. (2022). National, regional, and global estimates of anaemia by severity in women and children for 2000–19: A pooled analysis of population-representative data. The Lancet Global Health, 10(5), e627-e639. https://doi.org/10.1016/s2214-109x(22)00084-5

22. Xiong, X., Buekens, P., Alexander, S., Demianczuk, N., & Wollast, E. (2000). Anemia during pregnancy and birth outcome: A meta-analysis. American Journal of Perinatology, 17(03), 137-146. https://doi.org/10.1055/s-2000-9508