# Prevalence and risk factors for anaemia during pregnancy in Sylhet district of Bangladesh: a cohort study

## TL;DR

This study found high rates of anemia in pregnant women in rural Bangladesh, especially in the third trimester, and identified risk factors like poor nutrition and lack of iron supplements.

## Contribution

The study provides new insights into anemia risk factors during pregnancy in rural Bangladesh using a large cohort and longitudinal data.

## Key findings

- At baseline, 38% of pregnant women were anemic, with 14% having moderate to severe anemia.
- Women with mild or moderate to severe anemia at baseline had significantly higher risks of moderate to severe anemia in the third trimester.
- Iron supplementation and drinking tubewell water were associated with lower risks of moderate to severe anemia.

## Abstract

Anaemia during pregnancy poses a major public health problem globally, with reported prevalences ranging from approximately 5.2% to 65.7%. A significant portion of this burden is borne by low- and middle-income countries. We aimed to determine the prevalence of anaemia during pregnancy and identify the factors associated with anaemia in the third trimester of pregnancy in a cohort of women in the rural Sylhet district, Bangladesh.

We enrolled 3000 pregnant women between 8 and 19 weeks of gestational age (GA). Trained community health workers collected data on their sociodemographic, obstetric, nutritional, dietary, anthropometric, and household characteristics. Blood samples were collected at baseline (<20 weeks of gestation) and at a follow-up visit between 24–36 weeks of GA to measure haemoglobin (Hb) concentrations. We classified them according to their anaemia status into no anaemia (Hb ≥11g/dl), mild (10 to <11 g/dl), and moderate to severe (<10g/dl) groups. We then used unadjusted and adjusted multinomial logistic regression models to calculate the relative risk ratios (RRR) and 95% confidence intervals (CIs) of potential risk factors for mild or moderate to severe anaemia in the third trimester of pregnancy.

Of the 2679 women tested at enrolment, 1010 (38%) were anaemic, 634 (24%) had mild anaemia, and 376 (14%) had moderate to severe anaemia. At the third-trimester follow-up, 1950 (79%) of 2473 women were anaemic; 739 (30%) had mild anaemia, and 1211 (49%) had moderate to severe anaemia. Women with baseline mild anaemia had about a five-fold higher risk (RRR = 4.84; 95% CI = 3.64–6.46) and those with moderate to severe anaemia about an 11-fold higher risk (RRR = 10.78; 95% CI = 6.69–17.35) of having moderate to severe anaemia in the third trimester. Iron supplementation during pregnancy (RRR = 0.75; 95% CI = 0.60–0.93) and drinking tubewell water (RRR = 0.76; 95% CI = 0.60–0.96) were significantly associated with a lower risk of moderate to severe anaemia in the third trimester.

We documented a high rate of anaemia in our sample, particularly during the third trimester of pregnancy, underscoring an urgent need for interventions to improve maternal and child health outcomes, such as improved nutrition education, expanded access to and adherence with iron supplementation, and enhanced antenatal care.