Background: Preterm birth remains a major contributor to neonatal morbidity and mortality worldwide. Emerging evidence suggests that elevated maternal serum ferritin during pregnancy, reflecting inflammatory activation rather than iron sufficiency, may be associated with preterm delivery. This study aimed to evaluate the association between mid-pregnancy serum ferritin levels and subsequent preterm birth among anemic pregnant women.
Methods: A prospective observational study was conducted over one year at a tertiary-care teaching hospital in West Bengal, India. A total of 100 anemic pregnant women (hemoglobin <11 g/dL) with singleton pregnancies were enrolled between 20 and 28 weeks of gestation and followed until delivery. Serum ferritin was measured at enrollment. Preterm birth was defined as delivery before 37 completed weeks of gestation. Comparisons between term and preterm groups were performed using appropriate statistical tests, and the discriminatory performance of ferritin was evaluated using receiver operating characteristic (ROC) analysis.
Results: Preterm birth occurred in 25.0% (25/100) of participants (95% CI: 17.5%-34.3%). Median serum ferritin levels were significantly higher among women who delivered preterm (74.6 ng/mL, IQR 62.1-96.8) compared with those delivering at term (41.1 ng/mL, IQR 30.5-56.2; p <0.001). Using a ferritin cut-off of ?70 ng/mL, preterm birth occurred in 53.6% of women compared with 13.9% among those with lower ferritin levels, corresponding to an unadjusted odds ratio of 7.15 (95% CI: 2.63-19.42). Serum ferritin demonstrated moderate discriminatory ability for predicting preterm birth, with an AUC of 0.76.
Conclusion: Among anemic pregnant women, elevated mid-pregnancy serum ferritin levels were strongly associated with an increased risk of preterm birth. These findings support the role of serum ferritin as a clinically relevant marker reflecting inflammatory processes linked to preterm delivery and suggest its potential utility in antenatal risk stratification in anemic populations.
International Journal of Clinical Obstetrics and Gynaecology
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