Predictive Factors for Small Head Circumference Among Pregnant Women with Third-Trimester Anemia

Maternal anemia during pregnancy may adversely affect fetal growth, including neonatal head circumference (HC). This retrospective cohort study aimed to identify predictors of small HC among infants born to women with third-trimester anemia. Secondary data were obtained from the HosXP electronic medical database and delivery records of pregnant women who delivered between October 2020 and September 2023. A total of 934 women met the eligibility criteria and were included in the analysis. Maternal characteristics were summarized using descriptive statistics. Associations between maternal factors and neonatal HC were examined using the Chi-square test, Fisher’s exact test or Mann–Whitney U test, and independent predictors were identified using binary logistic regression analysis. The mean neonatal HC was 32.76 ± 1.50 cm, and 43.90% of infants were classified as having a small HC. Gravidity, pre-pregnancy body mass index (BMI), and gestational weight gain (GWG) were significantly associated with neonatal HC. Multivariable analysis revealed that women with two pregnancies (aOR = 0.51, 95% CI: 0.352–0.734) and those with three or more pregnancies (aOR = 0.54, 95% CI: 0.373–0.773) had lower odds of delivering infants with small HC than primigravida women. Pre-pregnancy overweight or obesity was associated with lower odds of small HC (aOR = 0.59, 95% CI: 0.426–0.805), whereas inadequate GWG increased the likelihood of this outcome (aOR = 1.38, 95% CI: 1.010–1.894). Maternal gravidity, pre-pregnancy BMI, and GWG may influence neonatal HC. These findings may support nurses in identifying women at risk, monitoring GWG, and providing targeted nutritional counseling during antenatal care.