Maternal and fetal outcome after severe anemia in pregnancy in rural Ghana.

BACKGROUND: Anemia in pregnancy contributes to poor outcome for mother and child in low-income countries. This study analyzes adverse maternal and fetal outcome after severe anemia in pregnancy in rural Ghana.

METHODS: A cohort study in two (sub)district hospitals, including 157 pregnant women exposed to severe anemia (Hb < 8.0 g/dl) and 152 nonexposed pregnant women (Hb > or = 10.9 g/dl), matched for age and parity strata. Adverse outcomes analyzed were postpartum hemorrhage, need for blood transfusion, maternal mortality, low birth-weight, and perinatal mortality.

RESULTS: Compared to nonexposed women, exposed women had an increased risk of maternal death (5/157 versus 0/152). Fetal outcome did not significantly differ between the study groups, although perinatal mortality was increased with exposure to Hb < 7.0 g/dl (OR 3.1; 95% CI 1.0-9.4), and low birth-weight was increased with exposure to Hb < 6.0 g/dl (OR 2.5; 95% CI 1.2-5.4). Overall fetal outcome was significantly better when hemoglobin prior to childbirth was at least 8.0 g/dl (OR 3.9; 95% CI 1.6-9.6), body mass index at least 20 kg/m2 (OR 2.8; 95% CI 1.5-5.3), and number of antenatal visits at least 4 (OR 2.0; 95%CI 1.1-3.7).

CONCLUSIONS: Severe anemia in pregnancy results in relatively poor maternal and fetal outcome. Apparently maternal risks increase prior to fetal risks. In order to improve maternal and fetal outcome, it is recommended that district hospitals in low-income countries make prevention, early diagnosis, and treatment of severe anemia in pregnancy a priority.