Maternal anaemia and risk of adverse obstetric and neonatal outcomes in South Asian countries: A systematic review and meta-analysis

BACKGROUND: The occurrence of maternal anaemia is common in South Asian countries which increase the risk of adverse maternal obstetric and birth outcomes. This may adversely affect the achievement of the Sustainable Development Goals’ (SDG) targets of reducing maternal and under-five deaths by 2030. OBJECTIVES: To summarize the evidence on the association of maternal anaemia with adverse birth and maternal obstetric outcomes. METHODS: We adopted the PRISMA consensus statement. PubMed, CINAHL and Web of Science databases were searched on February 20, 2020. A total of 38 studies was included, of which 25 articles were included in the quantitative synthesis and meta-analysis. RESULTS: Maternal anaemia was associated with a significantly higher risk of low birth weight (OR, 1.90; 95% CI, 1.06-2.60, p ​< ​0.05), preterm birth (OR, 1.96; 95% CI, 1.20-2.41, p ​< ​0.05) and perinatal mortality (OR, 2.90; 1.97-3.78, p ​< ​0.05). Non-significant associations were seen with neonatal mortality (OR, 1.80; 95% CI, 0.90-27.77, p ​= ​0.7), miscarriage (OR, 1.68; 95% CI, 0.48-3.20, p ​= ​0.08), preeclampsia (OR, 2.66; 95% CI, 0.61-11.52, p ​= ​0.6) and caesarean delivery (OR, 1.18; 95% CI, 0.36-2.80, p ​= ​0.07). CONCLUSION: Maternal anaemia increases the risk of low birth weight, preterm birth and perinatal mortality. Improving maternal nutritional status and iron supplementation during pregnancy are important for reducing these adverse outcomes.