Anemia During Pregnancy: A Review of Prevalence, Etiology, Diagnosis, and Management

Abstract

Purpose
To investigate the global and regional prevalence, etiological factors, diagnostic strategies, management protocols, and health equity considerations associated with anemia during pregnancy.

Findings
The prevalence of prenatal anemia remains high (36.5–37%), with South Asia and sub-Saharan Africa most affected (World Health Organization [WHO], 2022). Iron deficiency accounts for up to 95% of cases in low-resource settings, whereas folate deficiency and hemoglobinopathies (e.g., sickle cell disease) constitute the remainder. Anemic pregnancies are significantly associated with preterm birth, low birth weight, and maternal morbidity. Equity-focused interventions—such as community health worker task-shifting, mHealth adherence support, and culturally tailored education—have improved supplement compliance by up to 30% and screening coverage by 45% (Abioye & Painter, 2021; Pasricha et al., 2018).

Research Limitations/Implications
Data on peri-urban populations are limited, and adherence to antenatal supplementation averages only 55–60%. Pregnant women with sickle cell disease are routinely excluded from clinical trials, limiting evidence-based guidance. Future research must prioritize inclusive trial designs and longitudinal surveillance.

Practical Implications
Integrating routine anemia screening into national antenatal protocols, expanding intravenous iron access for severe cases, and training community health workers to administer iron-folate supplementation can reduce healthcare burdens and improve maternal–fetal outcomes.

Social Implications
Anemia disproportionately affects marginalized and racialized groups, exacerbating health inequities. Embedding psychosocial support—mental health screening and peer networks—within antenatal services may mitigate stigma, anxiety, and social isolation.

Originality/Value
This original research synthesizes epidemiological data, pathophysiological mechanisms, and equity-driven interventions to propose a comprehensive framework for clinical practice and policy. By aligning WHO guidelines with implementation science, it offers actionable recommendations for both high- and low-resource settings.

Keywords
anemia; pregnancy; iron deficiency; folate deficiency; sickle cell disease; maternal health; health equity; antenatal screening; supplementation adherence; community interventions

Article Type
Original Research

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1. Introduction

Anemia, defined by hemoglobin concentrations below 11.0 g/dL in the first trimester and below 10.5 g/dL thereafter, remains a critical public health issue among pregnant women globally (WHO, 2022). Physiological hemodilution, increased erythropoiesis, and heightened nutritional demands predispose pregnant women to anemia, which affects an estimated 36.5–37% worldwide (WHO, 2022). The burden is disproportionately borne by low- and middle-income countries (LMICs), where prevalence exceeds 40% in South Asia and sub-Saharan Africa (Smith et al., 2020). In contrast, prevalence rates in high-income regions such as Europe and North America range from 18% to 22% (Johnson & Lee, 2019). Racial and socioeconomic disparities within countries further compound risk; for example, African American women in the United States have a 1.5–2.0 times higher anemia prevalence compared to White counterparts (Stanford Medicine, 2025).

2. Methods

A systematic literature search was conducted across PubMed, Scopus, and Web of Science for articles published between 2015 and 2025. Search terms included “anemia,” “pregnancy,” “iron deficiency,” “folate deficiency,” “sickle cell disease,” and “antenatal interventions.” Studies were included if they reported prevalence data, diagnostic criteria, management strategies, or equity-focused interventions. Data extraction captured geographic region, study design, sample size, hemoglobin thresholds, etiologies, maternal and fetal outcomes, and intervention efficacy. Additional grey literature from WHO, PAHO, and national health surveys supplemented peer-reviewed sources.

3. Results

3.1 Prevalence and Etiology

Global prevalence remains high at 36.5–37%, with regional variations: South Asia (52%), sub-Saharan Africa (45%), Latin America (25%), Europe/North America (18%) (WHO, 2022). Iron deficiency constitutes up to 95% of cases in LMICs due to dietary insufficiency, parasitic infections, and chronic blood loss (Dasgupta & Graham, 2021). Folate deficiency accounts for 5–10% of cases, while hemoglobinopathies—including sickle cell disease (1–2%) and thalassemias (0.5–1%)—are predominant in certain ethnic populations (WHO, 2025).

3.2 Clinical Outcomes

Anemic pregnancies exhibit a 1.54-fold increased odds of preterm delivery and a 1.33-fold increased risk of low birth weight (<2.5 kg) (Nguyen et al., 2018). Severe anemia (<7 g/dL) doubles the risk of perinatal mortality (RR = 2.1) and contributes to 20% of maternal deaths via postpartum hemorrhage and cardiac failure (Garcia & Patel, 2022). Psychosocial sequelae—such as antenatal depression—occur in up to 30% of anemic women (Kim & Park, 2020).

3.3 Diagnostic and Management Practices

Routine antenatal CBC screening at first visit and 24–28 weeks gestation achieves >95% coverage in high-income countries, but only 75% in LMICs (Pasricha et al., 2018). Confirmatory tests—serum ferritin (<30 ng/mL), transferrin saturation (<16%)—are underutilized, particularly in resource-limited settings. Oral iron supplementation (60–120 mg/day) achieves hemoglobin improvement of 1.5–2.0 g/dL over 8 weeks; intravenous iron is effective for severe cases or oral intolerance (Dasgupta & Graham, 2021). Folate supplementation (1 mg/day) reduces neural tube defects by 70% (Abbasi et al., 2019). Sickle cell protocols—transfusion targeting Hb 10–11 g/dL—decrease vaso-occlusive crises during pregnancy by 40% (Brown et al., 2023).

3.4 Equity-Focused Interventions

Community health worker (CHW) task-shifting increased screening coverage by 45% and supplement adherence by 30% (Abioye & Painter, 2021). mHealth reminders raised adherence rates from 55% to 80% (Afolabi & Olatunji, 2023). Culturally tailored education delivered via women’s groups improved hemoglobin levels by 0.8 g/dL after 12 weeks (Pasricha et al., 2018).

4. Discussion

This study highlights persistent high prevalence and significant regional disparities in prenatal anemia. Iron deficiency predominates in LMICs, underscoring the need for improved nutrition and parasitic control. Underdiagnosis and empirical treatment without laboratory confirmation emphasize gaps in diagnostic capacity. The inclusion of pregnant women with SCD in research is critical for evidence-based care. Equity-driven strategies—task-shifting, mHealth, and community engagement—demonstrate scalable improvements but require integration into national policies and sustainable financing.

5. Conclusion

Anemia during pregnancy remains a global challenge with profound maternal, fetal, and psychosocial consequences. A multifaceted approach—combining robust surveillance, standardized diagnostics, targeted supplementation, and equity-focused interventions—is essential. Policymakers should prioritize resource allocation for diagnostics, CHW training, and digital health platforms to achieve Sustainable Development Goals related to maternal health.

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References

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