Abstract
Background: Maternal anemia is a major public health problem in Pakistan, with estimated prevalence of 50–75% among pregnant women. Despite its recognized clinical significance, evidence on the specific magnitude of its association with adverse fetal outcomes in urban Pakistani settings remains limited. Methods: A hospital-based cross-sectional study was conducted in Lahore, Pakistan. One hundred (100) pregnant women were enrolled from a specialized gynecology unit. Anemia was defined as hemoglobin (Hb) <11.0 g/dL. Fetal outcomes preterm birth (<37 weeks gestation) and low birth weight (LBW; <2.5 kg) and maternal complications were assessed. Chi-square tests, Spearman rank correlations, binary logistic regression, and multiple linear regression were performed using SPSS v27. Results: Anemia prevalence was 65% (mean Hb = 10.18 g/dL). All 42 preterm births (100%) occurred exclusively in anemic women (χ² = 38.992, p < .001; Cramer's V = .624). Similarly, all 52 LBW cases (100%) were confined to the anemic group (χ² = 58.333, p < .001; Cramer's V = .764). Hemoglobin was positively correlated with birth weight (rs = .651, p < .001) and gestational age (rs = .575, p < .001). Anemia status was the strongest predictor of birth weight (β = .749, p < .001; R² = .639). No significant association was found between anemia and maternal complications (p = .928). Conclusion: Maternal anemia demonstrates a powerful, near-exclusive association with preterm birth and low birth weight in this Lahore cohort. These findings underline the urgent need for universal antenatal hemoglobin screening, iron supplementation, and nutritional counselling as cornerstones of maternal care in Pakistan