Anaemia during pregnancy linked to higher stillbirth risk India: Study

Zenana Desk

New Delhi, September 17, 2026: Anaemia during pregnancy is often discussed as a nutritional problem that leaves a woman tired, weak or short of breath. But new research from India suggests that its consequences during pregnancy may extend much further.

A large analysis of more than 214,000 singleton pregnancies across 10 Indian states has found that moderate to severe maternal anaemia was associated with a higher risk of stillbirth after 28 weeks of pregnancy. The risk was substantially higher among women with severe anaemia.

The study, published in The Lancet Regional Health – Southeast Asia, analysed data collected through the ICMR-SPIC consortium, bringing together information from eight observational studies and two randomised controlled trials. Most of the participating cohorts recruited women between 2010 and 2023.

The findings put a familiar problem in a different light: a condition that is common during pregnancy may also be an important, potentially preventable risk factor for stillbirth.

What did the researchers find?

Of the women included in the analysis, 108,982 — about 52% — had moderate to severe anaemia, defined by a haemoglobin level below 10 grams per decilitre.

There were 3,595 stillbirths in the study population.

After analysing the data, researchers found that women who had moderate to severe anaemia at any point during pregnancy had a 27% higher risk of stillbirth after 28 weeks compared with women who had no or only mild anaemia.

The severity of anaemia mattered.

Women with severe anaemia, defined as haemoglobin below 7 g/dL, had more than three times the risk of stillbirth compared with women with no or mild anaemia. The reported risk ratio was 3.12.

For moderate anaemia, the risk ratio was 1.20.

The researchers also found a difference in the timing of stillbirth. Among women with severe anaemia, stillbirths occurred around the 29th week of pregnancy, compared with around the 31st week among women with no or mild anaemia.

Why does anaemia matter during pregnancy?

Anaemia means that the blood does not have enough haemoglobin to carry oxygen efficiently.

During pregnancy, a woman’s body has increased demands as blood volume expands and the placenta and developing fetus require oxygen and nutrients.

Severe anaemia can therefore become a serious medical problem.

The new study does not suggest that every pregnant woman with anaemia will experience complications or that anaemia alone determines the outcome of a pregnancy. Rather, the researchers found a population-level association between the severity of maternal anaemia and stillbirth risk.

That distinction is important.

The study shows an increased risk; it does not mean that anaemia inevitably leads to stillbirth.

India already has a major anaemia burden

The significance of the findings becomes clearer against India’s wider anaemia problem.

The researchers note that anaemia affects nearly half of pregnant women in India, while the country accounted for an estimated 17.3% of the global stillbirth burden in 2019.

That makes anaemia more than an individual pregnancy concern.

It becomes a public-health question.

If a common and potentially modifiable condition is associated with an increased risk of stillbirth, then identifying and treating anaemia before and during pregnancy could form part of efforts to improve pregnancy outcomes.

The problem may begin before pregnancy

Pregnancy does not necessarily start with a woman in perfect nutritional health.

A woman may enter pregnancy already anaemic, particularly if she has experienced years of heavy menstrual bleeding, inadequate dietary iron, repeated pregnancies, nutritional deficiencies or other medical conditions.

This makes pre-pregnancy health important.

A woman who begins pregnancy with low haemoglobin may have less room to absorb the additional demands placed on her body during pregnancy.

For this reason, the study’s implications go beyond antenatal check-ups. They also raise questions about women’s health before conception, particularly among adolescents and women of reproductive age.

Why one blood test can matter

Anaemia can sometimes be dismissed because symptoms may appear ordinary.

Tiredness can be attributed to pregnancy itself. Weakness may be considered normal. Breathlessness may be overlooked.

But haemoglobin testing can identify anaemia even when symptoms are not dramatic.

The new findings reinforce why screening during pregnancy matters — particularly when anaemia is moderate or severe.

They also highlight the importance of following up after a woman is diagnosed rather than treating the blood-test result as a routine finding.

Not all anaemia is simply about iron

Iron deficiency is a major contributor to anaemia, but it is not the only possible cause.

Anaemia can also be linked to folate or vitamin B12 deficiency, infections, inherited blood disorders and chronic diseases, among other conditions.

That means simply telling every anaemic woman to take iron may not address the underlying cause.

The appropriate treatment depends on why the anaemia is present and how severe it is.

For pregnant women, that assessment becomes particularly important because both maternal and fetal health are involved.

A preventable risk factor?

The researchers describe maternal anaemia as an important and potentially modifiable risk factor for stillbirth and argue that efforts to reduce stillbirth should include comprehensive strategies to prevent and treat anaemia during pregnancy.

That does not mean every stillbirth can be prevented by correcting anaemia.

Stillbirth has many possible causes, including complications involving the placenta, fetal growth, infections, hypertension and other maternal or fetal conditions.

But the study adds to evidence that maternal anaemia deserves more attention as part of pregnancy care.

And the scale of the Indian data makes the finding difficult to ignore.

The bigger question for women’s health

For years, anaemia has been measured in terms of haemoglobin numbers, iron tablets and nutrition programmes.

But behind every blood test is a woman entering pregnancy with a particular health history — and sometimes with health problems that have been present long before she becomes pregnant.

The new research suggests that addressing anaemia cannot begin only when a woman is visibly unwell during pregnancy.

It may need to begin much earlier: with better nutrition, menstrual-health care, screening, diagnosis and treatment for women and girls before they ever become pregnant.

Because protecting a pregnancy may sometimes begin long before the pregnancy itself.

The study was a secondary analysis of the ICMR-SPIC consortium dataset. It found an association between maternal anaemia and stillbirth risk; it does not establish that anaemia alone causes stillbirth.