Abstract
Low birth weight and anemia are significant public health challenges in developing countries. This study seeks to evaluate the relationship between hemoglobin levels during the first and second trimesters of pregnancy and the occurrence of low birth weight, while accounting for potential confounding factors. This multi-center cross-sectional study was conducted among all pregnant women with COVID-19 and with no history of receiving the COVID-19 vaccine who delivered in public and private hospitals in three counties, Mahabad, Miandoab, Bukan in Iran, using routinely collected maternity and health data on pregnancies. Hemoglobulin levels were measured during the first (6-10th weeks) and second (24-28th weeks) trimesters of pregnancy, and pregnancy outcomes were recorded in the health information system. Hb levels were categorized into four groups as follows: ≥110 g/L, 100-109 g/L, 90-99 g/L, and < 90 g/L for the first trimester and ≥ 105 g/L, 100-104 g/L, 90-99 g/L, and < 90 g/L for the second trimester. Multivariable logistic regression analysis determined the association between hemoglobin levels during pregnancy and low birth weight. P-values < 0.05 were considered statistically significant. A total of 385 mothers with COVID-19 were included. The mean age of COVID-19 pregnant women was 30.01 ± 6.24 years. After multivariable adjustment, Hb levels < 110 g/L in the first trimester had a significant association with low birth weight [OR, 4.13; (95% CI 2.11-8.10)]. Morevoer, Hb levels < 105 g/L in the second trimester was a significant association with low birth weight [OR:3.91; (95% CI:1.98-7.75)]. Maternal anemia during pregnancy, including first and second trimesters, was a significant association with Low birth weight even after adjusting for common confounders. Effective management and monitoring of anemia in pregnant women, particularly in low- and middle-income countries, are crucial for preventing low birth weight.