Moderate to severe anaemia linked with 27 % higher risk of stillbirth in India, study finds

Women in India with moderate-to-severe anaemia at any time during their pregnancy may have a 27 % higher risk of stillbirth after 28 weeks of gestation, according to a study published in The Lancet Regional Health Southeast Asia.

Findings also show stillbirths may tend to occur around the 29th week of gestation among pregnant women with severe anaemia, compared to 31st week of gestation among other women.

Researchers, including those from the UK's University of Oxford, London School of Hygiene and Tropical Medicine and Indian Institute of Public Health Bengaluru, highlighted that anaemia among pregnant mothers is an important and a modifiable risk factor for stillbirth.

Policies aimed at reducing stillbirths should prioritise comprehensive anaemia prevention and treatment strategies among pregnant women, they said.

Anaemia is a blood condition marked by a deficiency of red blood cells or less haemoglobin than normal.

The team looked at the Indian Council of Medical Research (ICMR)-Stillbirth Pooled Indian Cohort Consortium (SPIC) dataset, including a total of 2,14,709 single-foetus pregnancies with known birth outcomes and haemoglobin measurements during gestation period.

About 1,08,982 women (52 %) had moderate to severe anaemia -- haemoglobin (Hb) under 10 grams per decilitre -- overall, a total of 3,595 (1.7 per cent) stillbirths occurred.

"Women with moderate-to-severe anaemia at any time in the pregnancy had a 27% higher risk of stillbirth after 28 weeks of gestation," the authors wrote.

Severe anaemia can three-fold the risk of stillbirth, while moderate anaemia could increase the risk 1.2-fold at any gestational age, compared to women with no or mild anaemia, they said.

They said limited generalisable evidence is available coming from a diverse study setting across varying severity of anaemia and trimesters.

The study leverages a multi-cohort dataset, with the ICMR-SPIC including individual-level data from eight observational studies and two randomised controlled trials conducted across ten states in India.

Evidence from the study strengthens the link between maternal anaemia and stillbirth for India, the authors said.

Interventions to address modifiable causes of anaemia through both treatments or public health approaches at any stage of pregnancy may help reduce the risk of stillbirth, they said.

However, genetic or non-modifiable causes of anaemia might require alternative strategies, the team added.

Maternal anaemia could lead to embryonic anaemia, which may cause oxidative stress in the foetus and result in poor outcomes, or cause cardiovascular defects in the offspring, potentially resulting in stillbirth in some foetuses, the authors said explaining theories for how anaemia can possibly cause stillbirth.

Future research could delineate these mechanisms to inform preventative measures, they said.