Evaluation of the Association Between Maternal Anemia, Oral Mucosal Changes, and Adverse Birth Outcomes Among Pregnant Women

Introduction: Maternal anemia remains a major public health concern associated with adverse maternal and neonatal outcomes worldwide. Oral mucosal changes are also commonly observed in anemic individuals and may reflect the systemic severity of nutritional and hematological deficiencies. This study aimed to evaluate the association between maternal anemia, oral mucosal changes, and adverse birth outcomes among pregnant women. Materials and methods: This prospective observational cohort study was conducted among 174 pregnant women attending antenatal clinics at Desh Bhagat Dental College and Hospital (Mandi Gobindgarh, PB, IND) in association with the Department of Obstetrics and Gynecology of the affiliated teaching hospital. Hemoglobin (Hb) levels were estimated during the first trimester using an automated hematology analyzer, and comprehensive oral examinations were performed to assess oral mucosal changes associated with anemia. Participants were followed until delivery, and birth outcomes, including low birth weight, preterm birth, and stillbirth, were recorded. Statistical analysis was performed using an independent t-test, chi-square test, relative risk analysis, and multivariable logistic regression. Statistical significance was set at p < 0.05. Results: Among the 174 enrolled women, 72 (41.4%) were anemic, and 102 (58.6%) were non-anemic. Mild anemia was observed in 31 (17.8%), moderate anemia in 34 (19.5%), and severe anemia in seven (4.0%) participants. Oral mucosal changes were significantly more prevalent among anemic women than among non-anemic women (p < 0.001). Low birth weight was significantly higher among women with anemia (p < 0.001), while preterm birth occurred in 24 (33.3%) anemic women compared with 14 (13.7%) non-anemic women (p = 0.002). Stillbirth was observed in seven (9.7%) anemic participants and two (2.0%) non-anemic participants (p = 0.016). Oral mucosal changes were independently associated with low birth weight, whereas maternal anemia remained an independent predictor of low birth weight. Conclusion: Maternal anemia was significantly associated with oral mucosal changes and adverse birth outcomes, particularly low birth weight, preterm birth, and stillbirth. Increasing anemia severity demonstrated a dose-dependent relationship with worsening oral and neonatal outcomes. Early antenatal hematological and oral screening, along with timely nutritional intervention and appropriate management of anemia, may help improve maternal and neonatal health outcomes.