Original Article

Prevalence and risk factor of anemia among pregnant

women admitted in antenatal ward in PBMH
Bhubaneswar, Odisha
Sobhna Pradhan, Tanupama Karna, Debaleena Singha, Piyali Bhatta,
Kalyani Rath, Anasuya Behera
Department of Obstetrics and Gynaecological Nursing, Kalinga Institute of Nursing Sciences, KIIT Deemed to be University,
Bhubaneswar, Odisha, India

A bstract
Background: Anemia is one of the contributing factors for morbidity and mortality during pregnancy in developing country including
India, which eventually leads to fetal and maternal consequences. Growing fetus depends completely on mothers for all its growth
and maturity. Anemia is one of the nutritional deficiency disorders and around 56% of women are suffering from anemia in India.
It is one of the reasons for maternal deaths and fetal complication during pregnancy. Aim: The aim of the study was to assess the
prevalence of anemia and to determine the risk factors of anemia among pregnant women in PBMH hospital, Bhubaneswar, Odisha.
Materials and Methods: A descriptive cross‑sectional study was conducted over a period of 1 month from October 11, 2022, to
November 11, 2022, from the Department of Obstetrics and Gynecology of Pradyumna Bal Memorial Hospital KIMS, Bhubaneswar.
A total sample comprised of 52 pregnant women who were interviewed by using self‑structured questionnaire for data collection and
classification of anemia was performed according to the Indian Council of Medical Research (ICMR) criteria. Results: A total of 52
antenatal mothers were admitted during this study period (October 11, 2022, to November 11, 2022), and all were selected as study
sample. The incidence of anemia among antenatal mother in PBM hospital was found as follows: 17 (33%) mild, 04 (07%) moderate, and
02 (04%) were severe in this present study. The most common indication of anemia among antenatal mother as per the present study
was found to be H/O infection (21%), chronic malaria (15%), hook worm (27%), and birth interval (42%). Conclusion: The study implies
that the prevalence rate of Anemia is high, that is, 44.2%. Spacing between pregnancy and H/O infection plays a significant role in
considering anemia in pregnant women, which eventually affects both maternal and fetal condition.

Keywords: Anemia, antenatal care, pregnant women, prevalence, tertiary care hospital

Introduction individuals worldwide, or 24.8% of the population, and it is

common in pregnancy in about 74% of cases. Data from the
A global health issue, anemia affects both industrialized and National Family Health Survey (NFHS) 4 show that anemia is
underdeveloped nations. Anemia affects over 1.62 billion 50.3% more common in India than in Karnataka. Nearly 50%
of the population is anemic, with rural areas generally bearing a
Address for correspondence: Ms. Sobhna Pradhan, heavier burden than urban ones. Anemia during pregnancy has
Department of Obstetrics and Gynaecological Nursing, Kalinga an impact on the mother’s health, including maternal mortality
Institute of Nursing Sciences, KIIT Deemed to be University,
Bhubaneswar ‑ 751 024, Odisha, India.
and morbidity, as well as the baby’s health, resulting in low
E‑mail: [email protected] birthweight, early delivery, and impaired brain development,
which increases mortality and morbidity.[1]
Received: 27‑03‑2023 Revised: 21‑06‑2023
Accepted: 26‑06‑2023 Published: 21-11-2023 This is an open access journal, and articles are distributed under the terms of the Creative
Commons Attribution‑NonCommercial‑ShareAlike 4.0 License, which allows others to
remix, tweak, and build upon the work non‑commercially, as long as appropriate credit is
Access this article online given and the new creations are licensed under the identical terms.
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How to cite this article: Pradhan S, Karna T, Singha D, Bhatta P, Rath K,

DOI: Behera A. Prevalence and risk factor of anemia among pregnant women
10.4103/jfmpc.jfmpc_558_23 admitted in antenatal ward in PBMH Bhubaneswar, Odisha. J Family Med
Prim Care 2023;12:2875-9.

© 2023 Journal of Family Medicine and Primary Care | Published by Wolters Kluwer ‑ Medknow 2875
 Pradhan, et al.: Anemia in pregnancy

Anemia is one of the highlighted health problems in both Self‑structured tool pertaining to various independent variable
developed and developing countries, affecting both maternal and in sociodemographic profile such as education, family monthly
child health.[2] The World Health Organization (WHO) defines income, number of antenatal visits, intervals of pregnancy,
anemia as a condition in which the hemoglobin concentration and level of Hb. It also encompasses of contributing factors
of a woman during pregnancy is <10 g/dl. Globally, 1.62 billion including H/O malaria, hook worm infection, consumption
people are suffering from anemia, and the prevalence of anemia of iron, and folic acid tablets during present pregnancy.
among pregnant women in Indian is 56% and 47.6% in Odisha.[3,4] Determining the outcome variable level of hemoglobin was
considered through laboratory report. Pregnant mother
Anemia prevalence rates among expectant moms range from 35% with Hb level less than 11 gm/dl was considered as anemic
to 72% in Africa and from 37% to 75% in Asia. It is reasonable further classification of mild, moderate, and severe anemia
to assume that 2–7% of pregnant women have hemoglobin were those recommended by the Indian Council of Medical
levels below 6.5 g/dL. Anemia is the ninth most important factor Research (ICMR), which is defined as follows:
in both women and adolescent girls developing the condition, • Mild anemia: Hb 10.0 mg/dl‑10.9 mg/dl.
according to the World Bank. In India, anemia due to iron • Moderate anemia: Hb 7.0 mg/dl‑10.0 mg/dl.
deficiency affects 80% of pregnant women. In the majority of • Severe anemia: Hb less than 7 mg/dl.
the world, anemia is one of the leading causes of disease and
mortality. Anemia during pregnancy has a negative impact on Data was analyzed by the process of compilation, tabulation,
both the mother and the unborn child’s health; in Africa, anemia and classification and result was expressed in form of frequency
is thought to be a factor in 20% of all maternal deaths.[4,5] and percentage.
• Mild anemia: Hb 10.0 mg/dl‑10.9 mg/dl.
In India, the risk of anemia is higher due to wide range of factors • Moderate anemia: Hb 7.0 mg/dl‑10.0 mg/dl. Severe anemia:
such as insufficient knowledge, low income, and illegal abortion. Hb less than 7 mg/dl.
It is the second leading cause of maternal deaths in India.[6]
Result
Anemia has also been found to be associated with increased
risk of birth asphyxia and low APGAR score less than 7.[7,8] A total of 77 pregnant mothers were admitted during this study
A recent meta‑analysis showed that the risk of maternal period (October 2, 2022, to November 1, 2022) out of which
mortality decreases by 20% due to increase in the hemoglobin 52 pregnant mothers were selected as a study sample. The
concentration by 1 g/dl. Thus, treating anemia is a major health incidence of anemia rates in PBM Hospital was 17 (33%) were
implications in pregnancy and would go a long way in improving mild, 04 (07%) were moderate, and 02 (04%) were severe during
maternal and fetal outcome.[9] the present study period.

The levels of hemoglobin used for the classification of anemia Following are the observations for the variables of the study
in pregnant women as mild, moderate, and severe anemia conducted during the period of January 2021 to August 2021
were those recommended by the Indian Council of Medical is discussed below.
Research (ICMR), which is defined as follows:
Table 1 shows that percentage distribution of women by their
Mild anemia: Hb 10.0 mg/dl–10.9 mg/dl. Moderate anemia: sociodemographic characteristic out of 52 women:
Hb 7.0 mg/dl‑10.0 mg/dl. Severe anemia: Hb less than 7 mg/d.
14 (27%) were in between the 20‑25 yrs of age group, 13 (25%)
Materials and Methods were in between 26 and 30 yrs of age group, 21 (48%) were in
between 31 and 35 yrs of age group, 29 (56%) antenatal women
A descriptive cross‑sectional study was conducted over a period were from rural area, 23 (54%) women were from urban area,
of 1 month from October 2, 2022, to November 1, 2022, from 21 (40%) women were educated, and 31 (60%) women were
the Department of Obstetrics and Gynecology of Pradyumna non educated, 5 (9%) of women family monthly income were
Bal Memorial Hospital KIMS, Bhubaneswar. In considering in between 46094 and 68961/‑, 11 (21%) were in between
the inclusion and exclusion criteria, the pregnant mother 27654‑46089/‑, 25 (49%) were in between 9232‑27648/‑, and
were selected in the study. The study sample was explained 11 (21%) were in the category <9226/‑. 23 (44%) women belong
the purpose of the study and informed regarding potential to nuclear family, 29 (56%) belong to joint family, 15 (28%)
benefit in health, which eventually helped them in making were employed, and 37 (71%) were unemployed. 19 (35%) were
decisions regarding participation in the study. A total sample having no children, 20 (39%) were single child, and 13 (25%)
comprised of 52 pregnant women who were interviewed by were ≥2 no. of children. 18 (35%) were vegetarian, and 34 (65%)
using self‑structured questionnaire for data collection, and were nonvegetarian category of dietary practices. 17 (32%) were
classification of anemia was performed according to Indian primigravida, and 35 (68%) were multigravida. 01 (02%) were
Council of Medical Research (ICMR); among them, 23 mothers nullipara, 23 (44%) were primipara, and 28 (54%) were multipara
were suffering from mild, moderate, and severe anemia. woman.

Journal of Family Medicine and Primary Care 2876 Volume 12 : Issue 11 : November 2023
 Pradhan, et al.: Anemia in pregnancy

Table 1: Sociodemographic variable parameter Table 2: Frequency and percentage distribution on

Frequency Percentage contributing factors of anemia (n=52)
Age 20‑25 years 14 27 Contributing Parameter Frequency Percentage
26‑30 years 13 25 Factor
31‑35 years 25 48 H/O abortion No 31 60
Residence Rural 29 56 Yes 21 40
Urban 23 44 H/O infection Yes 11 21
Mother’s educational level Yes 21 40 No 41 79
No 31 60 H/O chronic Yes 8 15
Socioeconomic status ≥184376 0 0 malaria No 44 85
92191‑184370 0 0 H/O hook worm Yes 14 27
68967‑92185 0 0 No 38 73
46095‑68961 5 9 Menstruation Low 13 26
27654‑46089 11 21 flow Moderate 34 65
9232‑27648 25 49 High 5 9
<9226 11 21 Antenatal visit <4 visit 20 38
Types of family Nuclear 23 44 ≥4 visit 32 62
Joint 29 56 Iron supplement Yes 32 62
Employment status Employed 15 28 No 20 38
Unemployed 37 71 Previous history Yes 17 33
No. of children None 19 35 of anemia No 35 67
1 20 39 Birth Not applicable 17 33
≥2 13 25 interval (year) Yes 13 25
Dietary Practices Veg 18 35 No 22 42
Nonveg 34 65 Body mass Underweight <18.9 7 13
Gravida Primigravid 17 32 index (BMI) Normal weight 19‑24.9 24 46
Multigravid 35 68 Overweight 25‑29.9 21 41
Parity Nullipara 1 2 No. of previous 0 13 25
Primipara 23 44 pregnancies 1 20 39
Multipara 28 54 2‑4 19 36
Hemoglobin level Normal 29 56
Mild 17 33
Table 2 shows the contributing factors leading to anemia in Moderate 4 7
antenatal women, 31 (60%) were not having any H/O abortion, Severe 2 4
21 (40%) were having H/O abortion, 41 (79%) were not having
any H/O infection, 11 (21%) were having history of infection, the health of both the mother and the unborn child and can
08 (15%) were having H/O chronic malaria, 44 (85%) were not have an intergenerational cycle of anemia, malnutrition, etc., as
having any H/O chronic malaria, 14 (27%) were having H/O well as other comorbidities. Anemia is a serious global public
hook worm, 38 (73%) were not having any H/O hook worm health problem that particularly affects pregnant women. The
infection, 13 (26%) had low menstruation flow, 34 (65%) were World Health Organization (WHO) estimates that 1,15,000
moderate, 05 (09%) were high, 20 (38%) attended <4 antenatal maternal deaths globally are attributable to iron‑deficiency
visit, 32 (62%) attended ≥4 antenatal visit, 32 (62%) were taking anemia annually.[10] Fetal complications include prematurity, low
iron supplement, 02 (05%) were not taking iron supplement, birthweight, intrauterine growth restriction, and child mortality.
17 (33%) were having previous H/O anemia, 35 (67%) were
not having previous H/O anemia, 13 (25%) were having birth In India, anemia during pregnancy is a significant public health
interval, 22 (42%) were having no birth interval, 07 (13%) of problem, with 45.7% of pregnant women in urban areas and
mother were underweight <18.9, 24 (46%) were normal weight 52.1% in rural areas having hemoglobin levels <11 g/dl.[3]
and 21 (41%) were overweight, 13 (25%) were having no previous Anemia is the underlying cause or contributing factor for
pregnancies, 20 (39%) were history of single pregnancies, 20‑40% of maternal deaths in India, Odisha reported anemia
19 (36%) were 2‑4 no of previous pregnancies, 29 (56%) were during pregnancy in urban area, which is 46.2% and 47.8% in
having normal Hb level, 17 (33%) were mild, 04 (07%) were rural area.[11,12]
moderate, and 02 (04%) were severe.
According to a survey conducted by the Indian Council of
Discussion Medical Research, more than 50% of children, adolescents, and
expectant mothers are anemic.[13]
Anemia is a well‑known public health issue that primarily
affects developing nations rather than developed nations. Research by Ravishankar Suryanarayana et al. in the Kolar area
Anemia in pregnancy, in particular, has a negative impact on revealed a frequency of 63% among pregnant women. In our

Journal of Family Medicine and Primary Care 2877 Volume 12 : Issue 11 : November 2023
 Pradhan, et al.: Anemia in pregnancy

study, the prevalence of anemia (68.6%) was comparable to Conclusion

that in Kolar.[14]
Anemia is the most common hematological disorder during
According to a study conducted in a rural area of Mysore, pregnancy. Prevalence of anemia in South Asian countries
64.2% of pregnant women had anemia, and there was a strong is among the highest in the world, and National Family and
correlation between anemia and sociodemographic features, Health Survey (NFHS)‑3 reported that 56.4% of pregnant
parity, and age at first pregnancy. Similar results were reported women in India were anemic.[20] It is associated with multiple
in our study, but there was a significant correlation between factors such as poor socioeconomic status, high parity, short
hemoglobin status and the interval between pregnancy and birth interval, poor diet both in quantity and quality, lack of
ICDS service use.[15] health and nutrition awareness, and a high rate of infectious
diseases.[21]
Data of national family health survey of 2, 3, and 4 indicated
that about 50 per cent of pregnant women in India were anemic; National family health survey record reveal that all the efforts
among South Asian countries, India had the highest prevalence made in direction to reduce the anemia prevalence in country are
of anemia. National family health survey 4 of 2018 reported promising but still not able to bring the prevalence below 50%
high rate of anemia during pregnancy in some of the states in in children and women; therefore, efforts need to be improved
India: 62.6% in Jharkhand, 58.3% in Bihar, 51.3% in Gujrat, and continued further.[22]
50.2% in Himachal Pradesh, 47.6% in Odisha, and 44.8% in
Assam, as compared to Kerala, Punjab, Himachal, and Delhi. Our study findings suggest important factor, that is, risk
No substantial or consistent decline was observed in prevalence factors indicating anemia are as follows: 21 (48%) were in
of anemia in pregnant women between NFHS 2, 3, and 4 in any between 31 and 35 yrs of age group, 29 (56%) antenatal
of the states.[16,17] women were from r ural area, 31 (60%) women were
noneducated, 25 (49%) of women’s monthly income were in
Punjab has reported the risk factor for anemia in pregnancy is between 9232 and 27648/‑, 29 (56%) belong to joint family,
directly proportional to parity women had parity >3, spacing 18 (35%) were having ≥2 no. of children, and 28 (54%) were
between two pregnancies. 90.8% anemic and 87.5% women multipara woman.
with spacing between pregnancy <1 year suffered more from
maternal anemia as compared to women with birth interval more Some of the contributing factors are 21 (40%) H/O abortion,
than 3 years, H/O chronic malaria. It is highly recommended 11 (21%) were having history of infection, 08 (15%) were having
that more effective guidelines regarding educating girl child, H/O chronic malaria, 14 (27%) were having H/O hook worm,
spreading effective awareness regarding balanced diet, regular 13 (26%), 20 (38%) attended <4 antenatal visit, 02 (05%) were
antenatal checkups, regular intake of iron–folic acid tab, should not taking iron supplement, 17 (33%) were having previous H/O
start at grassroot levels to get safe motherhood.[18,19] anemia, and 22 (42%) were having no birth interval.

As per the present study conducted in the Department of Implication

Obstetrics and Gynaecology in KIMS, PBMH, Bhubaneswar, was
Prevalence of anemia in pregnancy in KIMS, PBMH,
found out to be 44.23% of women are suffering from anemia
Bhubaneswar, was sound to be high, that is, 44.2%; therefore,
in antenatal women.
few significant recommendations to reduce anemia in pregnancy
from this study are as follows:
The characteristics of variables, that is, risk factors of anemia, are
• Screening program of girls from the adolescent period and
described in terms of the frequency and percentage distribution,
regular antenatal visit
which posturizes that:
• Mass education and awareness campaigns regarding
The major indications for anemia in pregnancy was found out primordial prevention about the counseling on iron‑rich diet
to be 21 (40%) H/O abortion, 11 (21%) were having history and early detection of symptoms of anemia
of infection, 08 (15%) were having H/O chronic malaria, • Free distribution of iron folic acid tablet to the remote and
14 (27%) were having H/O hook worm, 13 (26%) had low hilly area by the government
menstruation flow, 34 (65%) were moderate, 05 (09%) were • Strict vigilance of antenatal mother by Accredited Social
high, 20 (38%) attended <4 antenatal visit, 02 (05%) were not Health Activist worker
taking iron supplement, 17 (33%) were having previous H/O • Implementing this measure will go a long way in solidifying
anemia, 22 (42%) were having no birth interval, 07 (13%) of health outcome of pregnant mother in antenatal, intranatal,
mother were underweight <18.9, 24 (46%) were normal weight and postnatal period, which eventually leads to positive result
and 21 (41%) were overweight, 20 (39%) were having history in fetal outcome.
of single pregnancies, 19 (36%) were having 2‑4 no of previous
pregnancies, 17 (33%) were mild, 04 (07%) were moderate, and Financial support and sponsorship
02 (04%) were severe. Nil.

Journal of Family Medicine and Primary Care 2878 Volume 12 : Issue 11 : November 2023
 Pradhan, et al.: Anemia in pregnancy

Conflicts of interest A systematic review. Int J Environ Res Public Health

2021;18:12799.
There are no conflicts of interest.
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