Anaemia among Antenatal Women: Determinants and Pregnancy Outcomes from a Prospective Hospital-Based Cohort Study

Background:Anaemia in pregnancy remains a major public health challenge in low- and middle-income countries and is associated with adverse maternal and neonatal outcomes. Despite routine antenatal interventions such as iron–folic acid supplementation and nutritional counselling, the burden of anaemia among pregnant women continues to be high. Prospective evidence capturing prevalence, incidence, determinants, and pregnancy outcomes under routine clinical care remains limited. Objectives:The study aimed to determine the prevalence and incidence of anaemia among antenatal women, analyse socio-demographic, nutritional, and clinical determinants, evaluate the association between maternal anaemia and pregnancy outcomes, and assess the utilisation and effectiveness of existing antenatal anaemia prevention and management interventions .Methods:A hospital-based prospective cohort study was conducted over six months among 300 pregnant women attending antenatal care services at a tertiary care hospital. Haemoglobin levels were measured at enrolment and during follow-up using an automated haematology analyser. Anaemia was classified according to standard criteria. Data on sociodemographic characteristics, dietary intake, supplement use, and antenatal care practices were collected using a structured case record form. Pregnancy outcomes were recorded, and utilisation of preventive interventions was assessed. Statistical analysis included descriptive statistics, logistic regression, and Kaplan–Meier survival analysis. Results:The overall prevalence of anaemia was 66.7%, with mild, moderate, and severe anaemia accounting for 30.0%, 26.7%, and 10.0%, respectively. The cumulative incidence of new-onset anaemia during pregnancy was 12.78%, with a higher incidence observed during the second trimester. Younger maternal age, short inter-pregnancy interval, vegetarian diet, irregular iron–folic acid intake, and infection history were significant determinants of anaemia (p < 0.05). Iron deficiency anaemia was the most common.subtype. Increasing anaemia severity was significantly associated with adverse maternal and neonatal outcomes, including postpartum haemorrhage, blood transfusion requirement, low birth weight, and NICU admission (p < 0.001). Regular utilisation of antenatal interventions was associated with improved haemoglobin levels and reduced anaemia severity Conclusion:Anaemia remains highly prevalent among antenatal women and is associated with significant adverse pregnancy outcomes. Strengthening early screening, improving adherence to antenatal interventions, and enhancing clinical pharmacy involvement may substantially reduce anaemia-related morbidity.