Large India study ties severe pregnancy anaemia to stillbirth risk

A study involving nearly 2.2 lakh Indian pregnancies finds moderate and severe maternal anaemia are associated with a significantly higher risk of stillbirth, adding urgency to India's long-running anaemia problem.Anaemia during pregnancy has long been recognised as a threat to the health of both mother and baby. But a large new Indian study adds an important dimension to that concern: maternal anaemia, particularly when moderate or severe, is associated with a higher risk of stillbirth.The study, involving nearly 220,000 pregnant women across 10 cohorts from different parts of India, found that women with haemoglobin levels below 10 g/dL at any point during pregnancy had a greater risk of stillbirth after 28 weeks of gestation compared with women with no or mild anaemia.The risk was highest among women with moderate and severe anaemia.In anaemia, the blood has reduced capacity to carry oxygen, usually because of insufficient haemoglobin or red blood cells. During pregnancy, when the mother's body has to support the growing foetus and placenta, inadequate oxygen delivery can have consequences for maternal and foetal health.The findings, published in The Lancet Regional Health – Southeast Asia, draw on the Indian Council of Medical Research-Stillbirth Pooled India Cohort (ICMR-SPIC), a large pooled dataset bringing together pregnancy cohorts representing different states, communities and urban and rural populations. The significance of the study, carried out by researchers at Oxford University, ICMR, the Indian Institute of Public Health (IIPH) and several other institutes in India and other countries lies not merely in confirming that anaemia and stillbirth are associated, but in showing how the risk varies with the severity of anaemia and the stage of pregnancy, areas where previous Indian evidence has been limited.A LARGE INDIAN DATASETPrevious studies have reported an association between maternal anaemia and stillbirth, but researchers say much of the evidence has come from individual settings or relatively small populations. That makes it difficult to know whether the relationship holds across India's diverse populations and across different degrees of anaemia.The new study attempts to address that gap by pooling individual-level data from 10 pregnancy cohorts. Researchers used several statistical and regression approaches to account for potential confounding factors and arrive at a pooled estimate of the association.The results were striking.Maternal anaemia with haemoglobin below 10 g/dL at any point during pregnancy was associated with increased stillbirth risk after 28 weeks compared with haemoglobin of 10 g/dL or higher.Importantly, the severity of anaemia mattered.Women with moderate and severe anaemia had the highest risk, while mild anaemia generally did not show an increased risk except when it was detected during the second trimester. The timing of stillbirth also appeared to differ: among women with severe anaemia, stillbirth occurred at a median gestational age of 29 weeks, compared with 31 weeks among women with moderate, mild or no anaemia.Lead author and population health researcher at Oxford University, Prerna Gopal, told India Today the findings point to anaemia as a potentially preventable risk factor.“Our study provides evidence that anaemia during pregnancy is associated with an increased risk of stillbirth,” Gopal said, adding that women with moderate and severe anaemia were at the highest risk and that those with severe anaemia were more likely to experience stillbirth earlier in pregnancy.She said the findings underline the importance of timely diagnosis and effective treatment during antenatal care.Researchers also stressed that the study establishes an association, rather than proving that anaemia directly causes stillbirth in every case.WHY INDIA SHOULD WORRYThe findings take on greater importance in a country where both anaemia and stillbirth remain major public-health challenges.According to National Family Health Survey (NFHS)-5, about 57% of women aged 15–49 and 52% of pregnant women in India were anaemic. The scale means that even a modest increase in risk can translate into a substantial population-level burden.The problem is particularly relevant because anaemia is not simply a laboratory abnormality.Apart from stillbirths, the condition is also associated with other adverse pregnancy outcomes, including preterm birth and low birth weight.For mothers, severe anaemia can contribute to fatigue, breathlessness and reduced physiological reserve, while increasing vulnerability to complications such as haemorrhage around childbirth.The country accounted for the world's highest number of stillbirths in 2021, with estimates varying considerably depending on the gestational-age threshold used. Global Burden of Disease (GBD) estimates put the number at about 567,000 at 20 weeks or later and 397,300 at 28 weeks or later.Recent Indian research using NFHS data has also highlighted how much the definition matters. It estimated stillbirth rates of 12.8 per 1,000 births at 28 weeks or later, 16.2 at 24 weeks or later and 22 at 20 weeks or later.The researchers found that anaemia was among several factors associated with stillbirth.This means that the new evidence on anaemia comes at a time when India is already trying to understand and reduce a large, partly hidden burden of foetal deaths.THE POLICY CHALLENGEThe study's most important message may therefore be less about adding another risk factor to a long list and more about identifying one that is measurable, treatable and potentially preventable.In the pooled cohort, around 51% of women had moderate anaemia and 1.3% had severe anaemia. That makes the finding particularly relevant for antenatal care: the women at greatest risk are not an obscure subgroup, but a sizeable proportion of those entering pregnancy care.Gopal said pregnant women should attend antenatal visits regularly, where anaemia screening is a routine component of care. Once detected, she emphasised, treatment needs to continue until the anaemia is resolved rather than stopping prematurely.For policymakers, the findings reinforce the need to ensure that screening translates into treatment and follow-up.India already has the Anaemia Mukt Bharat programme, which has been strengthened through the AMB 2.0 approach, with greater emphasis on a Test, Treat and Track strategy.The government has also issued guidelines for intravenous ferric carboxymaltose use during pregnancy. The broader AMB 2.0 framework seeks to improve diagnosis, treatment, adherence, tracking and management across vulnerable population groups.The challenge, however, is implementation. Iron deficiency is an important contributor to anaemia, but it is not the only one. Nutritional deficiencies, infections, chronic disease and other causes can also contribute. Simply distributing iron tablets is therefore unlikely to be enough for every woman.There is another data-related issue.The latest NFHS-6 fact sheets do not provide anaemia prevalence figures because the government dropped blood-prick testing in this round amid methodological concerns about capillary sampling and instead opted to rely on specialised venous-blood surveys.This makes comparable, nationally representative monitoring of anaemia especially important.- EndsPublished On: Aug 19, 2026 14:42 IST