Maternal anaemia and the risk of giving birth to a small vulnerable newborn: a cohort analysis of the WOMAN-2 trial in four countries

Maternal anaemia and the risk of giving birth to a small vulnerable newborn: a cohort analysis of the WOMAN-2 trial in four countries | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL This is a preprint and has not been peer reviewed. Data may be preliminary. 23 February 2026 V1 Latest version Share on Maternal anaemia and the risk of giving birth to a small vulnerable newborn: a cohort analysis of the WOMAN-2 trial in four countries Authors : Henry Ochola 0009-0005-0164-3918 [email protected] , Ian Roberts , Emily Webb , Judith Lieber 0000-0002-8514-0381 , Joy Lawn , Hannah Blencowe , Rizwana Chaudhri , … Show All … , Aasia Kayani , Kiran Javaid , Oladapo Olayemi , Folasade Adenike Bello 0000-0002-3337-3335 , Projestine Muganyizi 0000-0002-8362-2408 , Mwansa Lubeya , Bellington Vwalika , Haleema Shakur-Still 0000-0002-6511-109X , Eni Balogun , Danielle Prowse , and Amy Brenner 0000-0003-2017-5994 Show Fewer Authors Info & Affiliations https://doi.org/10.22541/au.177183556.62177322/v1 194 views 76 downloads Contents Abstract Supplementary Material Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract Objective: To investigate the association between maternal haemoglobin concentration and the risk of small vulnerable newborn (SVN) birth. Design: Cohort analysis of data from the World Maternal Antifibrinolytic Trial-2 (WOMAN-2). Setting: Hospitals in Nigeria, Pakistan, Tanzania, and Zambia. Population: Women with moderate or severe anaemia giving birth vaginally between August 2019 and September 2023. Methods: Multivariable logistic regression analysis examining the association between maternal haemoglobin levels and SVN, adjusting for potential confounders. Outcome Measure: We defined SVN as a live- or stillborn baby born preterm (<37 weeks), low birthweight (<2500g), and/or small-for-gestational-age (birthweight <10th percentile of weight specific for sex and gestational age) Results: Among 14444 women, the median haemoglobin level was 85g/L (IQR: 77-91g/L), and the incidence of SVN was 39.5% (5703/14444). A strong inverse relationship was observed between maternal haemoglobin and SVN. Compared to women with haemoglobin 90-99g/L adjusted odds ratios for SVN were: 1.06 (95% CI: 0.97-1.16) for 80-89g/L; 1.32 (95% CI: 1.19-1.46) for 70-79g/L; 1.63 (95% CI: 1.43-1.86) for 60-69g/L; 2.33 (95% CI: 1.83-2.96) for 50-59g/L; and 2.51 (95% CI: 1.85-3.41) for <50g/L. Sensitivity analysis, including multiple pregnancies, yielded similar results. Conclusions: More severe maternal anaemia is associated with increased risk of SVN. These findings emphasise the importance of comprehensive anaemia prevention and management strategies in prenatal care and among women of reproductive age. Supplementary Material File (svn_manuscript_16022026_clean copy.docx) Download 190.05 KB Information & Authors Information Version history V1 Version 1 23 February 2026 Copyright This work is licensed under a Non Exclusive No Reuse License. Keywords fetal medicine haematology: anaemia maternal physiology medical disorders in pregnancy preterm labour: clinical research Authors Affiliations Henry Ochola 0009-0005-0164-3918 [email protected] London School of Hygiene & Tropical Medicine Faculty of Epidemiology and Population Health View all articles by this author Ian Roberts London School of Hygiene & Tropical Medicine Faculty of Epidemiology and Population Health View all articles by this author Emily Webb London School of Hygiene & Tropical Medicine Faculty of Epidemiology and Population Health View all articles by this author Judith Lieber 0000-0002-8514-0381 London School of Hygiene & Tropical Medicine Faculty of Epidemiology and Population Health View all articles by this author Joy Lawn London School of Hygiene & Tropical Medicine Faculty of Epidemiology and Population Health View all articles by this author Hannah Blencowe London School of Hygiene & Tropical Medicine Faculty of Epidemiology and Population Health View all articles by this author Rizwana Chaudhri Shifa Tameer-e-Millat University View all articles by this author Aasia Kayani Shifa Tameer-e-Millat University View all articles by this author Kiran Javaid Shifa Tameer-e-Millat University View all articles by this author Oladapo Olayemi University of Ibadan College of Medicine View all articles by this author Folasade Adenike Bello 0000-0002-3337-3335 University of Ibadan College of Medicine View all articles by this author Projestine Muganyizi 0000-0002-8362-2408 Muhimbili University of Health and Allied Sciences School of Dentistry View all articles by this author Mwansa Lubeya Intercontinental Lusaka View all articles by this author Bellington Vwalika Intercontinental Lusaka View all articles by this author Haleema Shakur-Still 0000-0002-6511-109X London School of Hygiene & Tropical Medicine Faculty of Epidemiology and Population Health View all articles by this author Eni Balogun London School of Hygiene & Tropical Medicine Faculty of Epidemiology and Population Health View all articles by this author Danielle Prowse London School of Hygiene & Tropical Medicine Faculty of Epidemiology and Population Health View all articles by this author Amy Brenner 0000-0003-2017-5994 London School of Hygiene & Tropical Medicine Faculty of Epidemiology and Population Health View all articles by this author Metrics & Citations Metrics Article Usage 194 views 76 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Henry Ochola, Ian Roberts, Emily Webb, et al. Maternal anaemia and the risk of giving birth to a small vulnerable newborn: a cohort analysis of the WOMAN-2 trial in four countries. Authorea . 23 February 2026. DOI: https://doi.org/10.22541/au.177183556.62177322/v1 If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download. For more information or tips please see 'Downloading to a citation manager' in the Help menu . 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