Maternal anaemia appears to be common during the first two trimesters of pregnancy and among Indian and Malay women in Singapore, as reported in a study.
In a retrospective cohort of 1,005 pregnant women receiving antenatal care at Singapore General Hospital, 664 (66.2 percent) had WHO-defined anaemia at any point during pregnancy. [Front Med 2026;doi:10.3389/fmed.2026.1816149]
The prevalence by trimester was highest in the first and second at 36.9 percent and 37 percent, respectively, followed by the third at 23.4 percent. Ethnicity emerged as a strong predictor of maternal anaemia across all trimesters.
The role of ethnicity
The odds of anaemia among Indian women was threefold greater during the first and second trimesters (T1: adjusted odds ratio [aOR], 3.40, 95 percent confidence interval [CI], 1.18–9.90; T2: aOR, 3.50, 95 percent CI, 1.21–10.1) and 14-fold increased during the third trimester (T3: aOR, 14.1, 95 percent CI, 3.38–59.0) relative to Chinese women. The odds of anaemia were also greater among Malays than the Chinese across the three trimesters (T1: aOR, 2.60, 95 percent CI, 1.10–6.20; T2: aOR, 2.70, 95 percent CI, 1.12–6.55; T3: aOR, 7.80, 95 percent CI, 2.10–29.8).
Median levels of haemoglobin across all trimesters were highest in the Chinese (12.3, 11.7, and 12.4 g/dL), followed by Malays (12.1, 10.8, and 11.2 g/dL) and Indians (11.8, 10.4, and 11 g/dL).
The discrepancy in the prevalence of maternal anaemia prevalence in terms of ethnicity is consistent with regional data indicating persistent ethnic disparities in haemoglobin levels, likely influenced by a combination of genetic, dietary, and socioeconomic factors, according to the authors.
As such, management strategies for anaemia in pregnancy must be re-evaluated for local Indian and Malay women, they said. “We propose increased screening and nutritional strategies, including iron supplementation and dietary guidance, in collaboration with dietitians. Enhancing health literacy through patient education on anaemia in pregnancy is also essential.”
Neonatal, maternal outcomes
“Overall complication rates were low in this cohort,” the authors noted.
Neonatal mortality occurred in 0.4 percent of pregnancies, and neonatal morbidity in 0.6 percent. Most of these events were attributed to respiratory distress syndrome, low birth weight, or neonatal jaundice. For maternal complications, antenatal events such as placenta previa and preterm labour occurred in 1 percent of women, while delivery-related complications such as postpartum haemorrhage, cord prolapse, and emergency caesarean delivery were reported in 1.6 percent.
While the neonatal and maternal outcomes were analysed descriptively due to low event rates, incomplete longitudinal haemoglobin data, and the absence of a non-anaemic comparator group, the overall findings “highlight the importance of early and sustained antenatal screening, risk-aware surveillance, and targeted nutritional counselling to reduce preventable maternal and neonatal morbidity,” the authors said.
They also emphasized the need for future prospective studies incorporating iron indices to refine risk stratification and inform personalized antenatal care strategies.