Effect of maternal blood transfusion versus maternal parenteral iron therapy on fetal vascular adaptation: an observational study in a tertiary care hospital in North India

Background: Maternal anemia, particularly with haemoglobin levels below 7g/dl, is associated with significant fetal hemodynamic adaptations that may impact perinatal outcomes. This study aimed to evaluate the effects of maternal anemia on fetal doppler indices and assess changes after treatment with blood transfusion versus parenteral iron therapy. Methods: A prospective study was conducted over a period of 12 months at GMC Srinagar, including 80 pregnant women (32-36 weeks gestation) with severe anemia (Hb<7g/dl). Participants were divided into two groups: Group 1 (blood transfusion) and Group 2 (parenteral iron therapy). Hematological parameters and fetal doppler indices (umbilical artery resistive index [UA RI] and middle cerebral artery resistive index [MCA RI]) were measured at admission, two weeks, and four weeks post-treatment. Statistical analysis was performed using SPSS Version 20.0. Results: At baseline, Group 1 had significantly lower hemoglobin (5.69±0.54g/dl) than Group 2 (6.46±0.29g/dl, p<0.001). Post-treatment, Hb levels improved to 8.18±0.33g/dl (Group 1) and 8.05±0.22g/dl (Group 2, p=0.116), with a greater increase in Group 1 (2.48±0.77g/dl vs. 1.59±0.18g/dl, p<0.001). Doppler indices showed a significant reduction in UA RI and an increase in MCA RI in both groups (p<0.001). Conclusions: Both blood transfusion and parenteral iron therapy effectively improved maternal hematological status and fetal doppler parameters. However, blood transfusion led to a faster correction of anemia. Regular doppler monitoring allows for timely assessment of fetal adaptation and intervention, improving perinatal outcomes.