Introduction

Anemia in pregnancy is defined by WHO as a hemoglobin concentration below 11.0 g/dL [1]. It remains a major public health problem worldwide. According to the WHO, the global prevalence of anemia among pregnant women was 35.5% in 2023, with a substantially higher burden in low- and middle-income countries than in high-income countries [2]. It is associated with adverse maternal and fetal outcomes, including preterm birth, low birth weight, increased susceptibility to infections, and maternal mortality [3]. A review by Mangla and Singla reported that the prevalence of anemia exceeded 20% in nearly 80% of countries worldwide, while remaining below 20% in most industrialized nations [4]. Iron deficiency accounts for more than half of all anemia cases and remains the leading nutritional cause of anemia during pregnancy [5].

The South-East Asian region bears a disproportionately high burden of maternal anemia, with a reported prevalence of 48.7% [6]. According to the National Family Health Survey (NFHS)-4, 50.3% of pregnant women in India and 46.1% in Delhi were anemic [7]. The NFHS-5 reported a prevalence of 52.2% among pregnant women in India and 42.2% in Delhi, indicating only a modest decline over time [8]. However, rural-specific estimates for anemia among pregnant women in Delhi are not available.

The burden of anemia across all three trimesters of pregnancy is influenced by multiple sociodemographic and obstetric factors [9]. India belongs to high anemia-prevalent areas where ≥40% of menstruating adult women and adolescent girls are anemic. India ranked 170th among 180 countries for anemia among females during the Global Nutrition Survey, 2016 [10].

Anemia during pregnancy is a multifactorial condition influenced by nutritional, socioeconomic, obstetric, and infectious factors [11]. Balcha et al. reported that low family income, multiparity, short interpregnancy gap, not taking iron and folate, and poor knowledge of anemia are major contributors to anemia among pregnant women [12]. Brooker et al. highlighted the role of parasitic infestations, particularly hookworm infection, in the development of iron deficiency anemia and demonstrated the effectiveness of preventive interventions such as iron supplementation and deworming [13]. Ghosh-Jerath et al. identified poverty, illiteracy, migration, and high parity as important determinants of inadequate antenatal care utilization [14]. Ramesh et al. observed a significantly higher prevalence of anemia among multigravida women than primigravida women [15]. Similarly, Tomar et al. reported that low socioeconomic status, short birth spacing, and inadequate iron-folic acid (IFA) tablet consumption were significantly associated with anemia during pregnancy [16]. These findings indicate that maternal anemia is shaped by a complex interaction of nutritional, socioeconomic, obstetric, and health-service-related factors.

Although several studies have examined anemia among pregnant women in different parts of India, evidence from rural areas of Delhi remains limited. Local data on the prevalence and factors associated with anemia are essential for planning targeted interventions and strengthening antenatal care services. Therefore, the present study was undertaken to determine the prevalence of anemia and identify sociodemographic, nutritional, menstrual, obstetric, and history of worm infestation factors associated with anemia among pregnant women attending the antenatal clinic of the Rural Health Training Centre (RHTC), Barwala, Delhi.