(PTFS11-07-25) Maternal Hemoglobin Concentrations and Their Associations With Obstetric and Nutritional Factors During Pregnancy and Postpartum: Findings From Uttar Pradesh, India

Objectives: Maternal anemia remains a public health concern, especially in low-resource settings. This study explored hemoglobin concentrations (Hb) during pregnancy and postpartum, examining their associations with obstetric characteristics, iron-folic acid (IFA) supplementation, and maternal nutritional factors among women in Uttar Pradesh, India.

Methods: A prospective cohort study was conducted among 475 pregnant women across three time points: early pregnancy (5–21 weeks), late pregnancy (27–39 weeks), and postpartum (within 42 days of birth). Socio-demographic characteristics, obstetric factors, IFA supplementation, body mass index, dietary diversity, and Hb concentrations were measured and multivariable linear regression was performed to assess their associations with Hb at each stage. Path analysis evaluated direct and indirect paths influencing postpartum Hb.

Results: Mean Hb declined from early (10.5 g/dL) to late pregnancy (9.7 g/dL) and improved postpartum (10.4 g/dL). IFA supplementation in second and third trimesters was associated with higher Hb during late pregnancy (β= 0.012, p< 0.0001) and postpartum (β= 0.004, p< 0.0001), respectively. Body mass index ≥25 was associated with higher Hb during early pregnancy (β = 0.474, p = 0.006), but this association reversed postpartum (β= -0.360, p= 0.032). Women delivering in health facilities had higher postpartum Hb (β = 0.739, p=0.013). Late pregnancy Hb was predicted by early pregnancy Hb (β= 0.378, p < 0.0001), and postpartum Hb was predicted by late pregnancy Hb (β = 0.506, p < 0.0001). Path analysis highlighted that dietary diversity and IFA supplementation were indirectly associated with postpartum Hb through late pregnancy Hb. Similarly, ANC visits were indirectly associated with late pregnancy and postpartum Hb through improved IFA intake and Hb at earlier stages of pregnancy.

Conclusions: Support for maternal health during pregnancy such as ANC visits, improved dietary diversity, IFA supplementation, and facility-based deliveries had a combined direct and indirect association with higher maternal Hb, with mediation by Hb at earlier stages of pregnancy on later stage of pregnancy and postpartum Hb. Continuity of care during pregnancy is important to address maternal anemia effectively.

Funding Sources: Bill and Melinda Gates Foundation, through Alive & Thrive