Postpartum anemia and maternal wellbeing: A cohort analysis of the WOMAN-2 trial

Objective: We examined the association between postpartum anemia and maternal wellbeing in women who gave birth with anemia. Methods: We conducted a cohort analysis using secondary data from the WOMAN-2 trial. Between August 2019 and September 2023, women with moderate or severe anemia who were giving birth vaginally were recruited from hospitals in Nigeria, Pakistan, Tanzania, and Zambia. Our exposure was postpartum anemia (hemoglobin concentration <70, 70–99, or ≥100 g/L: severe, mild/moderate, and no postpartum anemia, respectively). Our primary outcome was physical capacity (6-min walk test). Our secondary outcomes were patient-reported vigor, fatigue (general, physical, emotional, mental), overall fatigue, other anemia symptoms, breastfeeding difficulties, expected difficulties with usual activities, breathlessness, illness, and pain. Hemoglobin was measured at 24-h after birth or discharge and outcomes were measured at discharge or 42 days postpartum, whichever happened first. We assessed the association between postpartum anemia and maternal wellbeing with multivariable regression models. Results: Among 15 068 participants, 11% had severe, 75% had mild/moderate, and 14% had no postpartum anemia. After adjusting for potential confounders, each 10 g/L increase in hemoglobin was associated with 2.99 (95% confidence interval [CI]: 2.12–3.86) more meters walked in 6 min. Compared to mild/moderate postpartum anemia, severe anemia was associated with expected difficulties doing usual activities (adjusted odds ratio [aOR] =1.48, 95% CI: 1.14–1.91) and other adverse wellbeing outcomes. No postpartum anemia was associated with less illness (aOR = 0.58, 95% CI: 0.35–0.96) and some adverse wellbeing outcomes. Conclusion: Low postpartum hemoglobin was associated with worse wellbeing of new mothers. Our results support recommendations to prevent and treat low postpartum hemoglobin.