According to the World Health Organization (WHO), approximately 40% of pregnant women suffer from gestational anemia, most commonly caused by iron deficiency (ID). Gestational iron deficiency anemia (IDA) has been associated with pregnancy and delivery complications, as well as adverse neonatal outcomes. Our goal was to assess how gestational IDA affects maternal and neonatal outcomes in Finland. Comparison of intravenous iron substitution to orally administered iron was also one target of our study. In addition, we aimed to assess whether gestational anemia increases the risk of maternal psychological distress and shortens the duration of breastfeeding.

In a Clinical Birth Cohort with 11 669 pregnancies delivered at Turku University Hospital, Turku, Finland, between 2016 and 2018, 215 pregnant women had anemia with hemoglobin (Hb) levels <100 g/l. Moderate or severe gestational anemia was associated with prematurity, fetal growth restriction, maternal postpartum infections, and longer postpartum hospital stay. While intravenous iron corrected Hb values more effectively, no differences in maternal and neonatal outcomes were detected.

The associations between anemia and maternal psychological distress as well as breastfeeding were explored using a prospectively collected FinnBrain Birth Cohort with 1 273 pregnant women, who delivered during 2011–2015. Maternal Hb <110 g/l did not increase the risk of maternal psychological distress during pregnancy or postpartum. However, Hb <100 g/l was associated with anxiety symptoms in late pregnancy. Additionally, anemia in the third trimester did not shorten the duration of breastfeeding, and women with gestational anemia achieved the nationally recommended goal of exclusive breastfeeding as often as non-anemic women.

Even in a high-standard maternity care setting, gestational anemia is associated with an increased risk of clinically significant adverse maternal and neonatal outcomes. However, maternal antenatal anemia does not increase the risk of psychological distress or shorten breastfeeding duration. Adequate treatment should be available to pregnant women to prevent adverse maternal and neonatal outcomes.