Impact of iron deficiency gestational anaemia on neonatal cardiac structure, function, and electrophysiology: a comparative cross-sectional study

Background : Iron deficiency gestational Anaemia (IDGA) is common worldwide, particularly in low- and middle-income countries. Although adverse maternal and perinatal outcomes are well described, their influence on neonatal cardiac structure and function is incompletely understood. Methods: This comparative cross-sectional study included 150 term neonates (≥37 weeks of gestation) evaluated at 72 hours of life. 75 neonates were born to mothers with iron-deficiency anaemia (Hb 7.0- 9.9 g/dL with low ferritin) and 75 to non-anaemic mothers (Hb ≥11 g/dL). All neonates underwent echocardiography and 12-lead electrocardiography. Group comparisons were performed using independent t-tests. Multivariable linear regression was used to adjust for gestational age, birth weight, sex, and mode of delivery. Results: Neonates of anaemic mothers showed significantly larger left ventricular internal dimensions in diastole (LVIDd: 1.86 cm vs. 1.52 cm, p <0.001) and systole (LVIDs: 1.31 cm vs. 0.97 cm, p <0.001), with reduced fractional shortening (34.80% vs. 39.67%, p < 0.001). The ejection fraction was modestly lower in the anaemic group (66.42% vs. 69.33%, p = 0.046). Electrocardiography demonstrated shorter PR intervals and P-wave duration, with mild QTc prolongation. After adjustment, maternal anaemia remained an independent predictor of ventricular enlargement and reduced systolic function. Conclusion : Iron-deficiency gestational anaemia was associated with early alterations in neonatal cardiac structure, systolic function, and electrical conduction, consistent with adaptive cardiovascular remodelling in response to intrauterine hypoxia.