Assessing Anemia Burden and Multifactorial Contributors Among Pregnant Women in Gujarat: A Cross-Sectional Study Integrating Biochemical, Nutritional, and Geographic Disparities

ASHWINI AGARWAL¹Harsh Bakshi²A.M Kadri²Krupal Joshi^1*Astha Vala²Dholariya Sagar Jayantilal¹Amit Sonagra¹Manisha Upadhyay²Garima Anandani¹gyanendra Singh¹Dr Parth Goswami¹

• ¹All India Institute of Medical Sciences, Rajkot, Rajkot, India
• ²State Health System Resource Centre Gujarat, Gandhinagar, India

Introduction: Anemia remains a critical public health challenge in India, particularly among pregnant women, where its multifactorial etiology is often underappreciated. Despite long-standing supplementation programs, anemia prevalence in Gujarat remains high, necessitating granular, region-specific investigations. Objectives: To assess the prevalence of anemia among pregnant women across ten districts of Gujarat, and to identify key sociodemographic, nutritional, hematological, and biochemical determinants contributing to anemia and its geographic disparities. Methodology: This community-based study included 2,805 pregnant women from diverse settings (tribal/rural/urban). Hematological and biochemical assessments included serum ferritin, iron, C-Reactive Protein (CRP), folate, vitamin B12, prealbumin, and hemoglobinopathy screening. A logistic regression analysis was conducted to determine the independent factors associated with anemia, with the findings presented as adjusted odds ratios (aOR) along with their 95% confidence intervals (CI). Results: Overall anemia prevalence was 64.2%, with mild anemia comprising 82.1% of cases. Tribal women had 2.21-fold higher odds of anemia than urban counterparts (aOR = 2.21, 95% CI: 1.88–2.61, p < 0.001). Anemia was also associated with illiteracy (aOR = 2.16, p < 0.001), underweight status (aOR = 1.58, p < 0.001), and low dietary diversity (aOR = 2.26, p < 0.001). Biochemical assessments revealed absolute iron deficiency in 17.2%, folate deficiency in 15.5%, and vitamin B12 deficiency in 60.3% of anemic women. Elevated CRP levels indicated inflammation in 34.7%. Multivariable binary logistic regression revealed five significant and independent predictors of anemia: reduced red blood cell count (aOR = 0.26; 95% CI: 0.22–0.31), elevated red cell distribution width (RDW-CV) (aOR = 1.39; 95% CI: 1.33–1.46), diminished serum prealbumin (aOR = 0.92; p < 0.001), lower folate levels (aOR = 0.97; p < 0.001), and decreased ferritin concentrations (aOR = 0.99; p < 0.001), each independently contributing to anemia risk. Conclusion: Anemia in Gujarat's pregnant women is highly prevalent and multifactorial, shaped by overlapping nutritional, inflammatory, and social determinants. Region-specific, integrated strategies targeting biochemical deficits and structural inequities are essential for effective anemia mitigation