Impact of maternal anemia on neonatal outcomes: low birth weight and neonatal anemia in Uganda

Objectives: The Objectives of this study were to determine the prevalence of anemia among women in their third trimester of pregnancy and establish its association with neonatal outcomes at Soroti Regional Referral hospital (SRRH). Material and Methods: This prospective cohort study enrolled 324 women in their third trimester at SRRH (June– August 2025). Data on maternal and neonatal characteristics were collected via structured questionnaires and medical record review. Maternal venous blood and umbilical cord blood were collected at delivery and analyzed for hemoglobin using an automated hematology analyzer. Anemia was defined as hemoglobin <11.0 g/dL for mothers and <13.0 g/dL for neonates. Bivariate and multivariate logistic regression analyses were conducted to determine associations with neonatal outcomes with the level of statistical significance set at ≤ 0.05. Results: The median maternal age was 24 years (interquartile range: 21–28.5). The prevalence of maternal anemia was 32.7% (95% confidence interval [CI]: 27.6–37.9). Maternal anemia was independently associated with low birth weight (LBW) (adjusted odds ratio [AOR] = 2.36, 95% CI: 1.28–4.38, p = 0.006), neonatal anemia (AOR = 6.74, 95% CI: 3.02–15.02, p < 0.001), and cesarean section (AOR = 2.82, 95% CI: 1.63–4.88, p < 0.001), which we conceptualize as an intermediate intervention-related event rather than a direct neonatal outcome. Conclusion: The findings demonstrate a high burden of maternal anemia, with a prevalence of 32.7%, and it is strongly associated with LBW and neonatal anemia. The association with cesarean section suggests that anemia may contribute to intrapartum complications requiring operative intervention. These findings underscore the need for integrated screening, prevention, and management strategies to mitigate perinatal morbidity.