Among pregnant patients with human immunodeficiency virus (HIV) who become anemic, the risk of preterm birth may be twice as high as that of the general population, according to research published in The American Journal of Clinical Nutrition.

Anemia is a common issue during pregnancy, with data suggesting that more than 16% of pregnant people in the United States are anemic. There is, furthermore, evidence of disparities based on race and ethnicity.

Health status is also a predictor of anemia during pregnancy. Patients with HIV, for example, have a higher rate of anemia while pregnant, which may be due to HIV infection or the effects of anti-retroviral medications.

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As medical treatments, such as combination anti-retroviral therapy, improve for patients with HIV, it is essential to evaluate anemia rates and etiology in this patient population. For this study, researchers aimed to determine anemia rates during the third trimester of pregnancy, the relative proportion of anemia cases caused by iron deficiency, and preterm birth rates in anemic patients among pregnant patients with HIV.

Overall, data from 267 patients living with HIV in their third trimester of pregnancy were included. By hemoglobin concentration, 50% of patients were considered anemic, while 20% had moderate to severe anemia and 43.5% had iron-deficiency anemia. The average patient age at delivery was 28.4 years, 67% of patients were Black, 32% of patients had not completed a high school education, and 59% had a household income of less than $10,000 per year.

Analysis showed that patients with anemia tended to be younger, were more likely to be Black, and were more likely to have initiated anti-retroviral medication during the second trimester of pregnancy. Anemic patients were also less likely to have taken iron, B6, and folate supplements as recommended.

In the overall cohort, 16% of patients delivered preterm. Patients with anemia were twice as likely to have a preterm birth (adjusted prevalence ratio, 2.04; 95% CI, 1.12-3.71).

“The elevated prevalence of preterm birth associated with anemia in our cohort highlights the importance of screening and treatment of anemia and/or iron deficiency in pregnant [patients living with] HIV,” the authors wrote. “Nutritional counseling in [patients living with] HIV of childbearing age may be a pathway through which preterm births may be mitigated in this highly susceptible population.”


Jacobson DL, Neri D, Gaskins A, et al. Maternal anemia and preterm birth among women living with HIV in the United States. Am J Clin Nutr. 2021;113(6):1402-1410. doi:10.1093/ajcn/nqaa441