Prevalence of Anaemia and Associated Factors among Pregnant Women Attending Antenatal Care at Selected Hospitals in Karbala City, Iraq

Abstract

Background: Anaemia during pregnancy remains an important maternal health problem and may occur in association with nutritional, socioeconomic, obstetric, and other health-related factors. This study estimated the prevalence of anaemia and examined clinical, haematological, nutritional, socioeconomic, and obstetric characteristics among pregnant women attending antenatal care in Karbala City, Iraq. Objective: To estimate the prevalence of anaemia using the prespecified study definition and to describe factors associated with anaemia among pregnant women attending antenatal care at the participating hospitals in Karbala City, Iraq. A secondary retrospective analysis applied the WHO 2024 trimester-specific haemoglobin criteria. Methods: This cross-sectional observational study included 200 pregnant women attending antenatal clinics at the Maternity and Obstetrics Teaching Hospital and Al-Imam Al-Hassan Teaching Hospital in Karbala City, Iraq, from 10 November 2025 to 20 March 2026. Data were collected using a structured questionnaire, clinical examination, and laboratory assessment. The prespecified study definition of anaemia was haemoglobin <11 g/dL in all trimesters. Categorical variables were analysed using chi-square tests, and continuous variables were compared using independent-samples t-tests or Mann–Whitney U tests according to distribution. Multivariable logistic regression was used to examine factors associated with study-defined anaemia. Results: Among the 200 participants, 68 (34.0%) met the prespecified study definition of anaemia. In a secondary retrospective reclassification using the WHO 2024 trimester-specific criteria, 47 participants (23.5%) were classified as anaemic. Compared with non-anaemic participants, those classified as anaemic had lower mean haemoglobin, ferritin, RBC count, MCV, MCH, and MCHC and higher RDW. Pallor, fatigue, dizziness, headache, and palpitations were significantly more frequent in the anaemia group (all P < 0.001). Folic acid use (P = 0.006) and red-meat consumption (P = 0.042) differed significantly between groups, whereas iron supplementation did not (P = 0.081). In the multivariable model, low economic status (AOR 2.69, 95% CI 1.31–5.52; P = 0.007) and an iron-poor/irregular nutritional pattern (AOR 2.44, 95% CI 1.17–5.06; P = 0.017) were associated with higher odds of study-defined anaemia, while regular menstrual cycles were associated with lower odds (AOR 0.40, 95% CI 0.21–0.76; P = 0.005). Conclusion: Study-defined anaemia was present in 34.0% of participants, whereas retrospective application of the WHO 2024 trimester-specific criteria classified 23.5% as anaemic. Low economic status and the study-specific iron-poor/irregular nutritional pattern were associated with higher odds of anaemia, while regular menstrual cycles were inversely associated. Because the study was facility-based, cross-sectional, and based on convenience sampling, the findings describe associations within the participating study population and should not be interpreted as causal or population-wide estimates.