Anaemia in pregnancy in Bangladesh by the WHO 2024 haemoglobin cut-offs: a national biomarker survey and comparison with 2011
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Background
Anaemia in pregnancy is linked to low birthweight, preterm birth and maternal death. Bangladesh has had no publicly documented national haemoglobin survey of pregnant women since 2011, and WHO revised its cut-offs in 2024. We estimated national prevalence under these cut-offs, described haemoglobin across gestation, and compared 2025 with 2011.
Methods
We analysed venous haemoglobin from 1,933 of 2,711 eligible pregnant women in the nationally representative Bangladesh Multiple Indicator Cluster Survey 2025. We reanalysed capillary haemoglobin from 352 pregnant women in the Bangladesh Demographic and Health Survey 2011. Anaemia was haemoglobin below 11.0 g/dL in the first and third trimesters and below 10.5 g/dL in the second. Survey-weighted modified Poisson models estimated prevalence ratios (PR).
Results
In 2025, 53.2% (95% CI 50.6 to 55.8) of pregnant women were anaemic and 22.3% (20.2 to 24.5) had moderate or severe anaemia. A single 11.0 g/dL cut-off gave 60.7%. Prevalence was 42.1% in the first trimester and 67.7% in the third. Mean haemoglobin was lowest in month 6 and only 0.23 g/dL higher in months 8 and 9 than in months 5 and 6. Prevalence was similar across wealth, education and division. It was higher in Hindu women (adjusted PR 1.27, 95% CI 1.12 to 1.45) and slightly higher in urban women (1.13, 1.02 to 1.26). Under identical rules, prevalence was 42.9% (37.1 to 48.8) in 2011 (adjusted PR for 2025, 1.33, 1.15 to 1.54; 1.29, 1.11 to 1.50 with haemoglobin rounded as in 2011). The difference was concentrated in urban women (2.36, 1.62 to 3.42) rather than rural women (1.14, 0.97 to 1.35); the interaction had p<0.001. An assay offset of 0.4 g/dL removed the national difference but not the urban one.
Conclusions
About half of pregnant women in Bangladesh are anaemic, two in three by the third trimester, across all social groups. We found no evidence that anaemia has declined since 2011, and urban women appear to have lost their earlier advantage. Antenatal programmes need universal reach into late pregnancy, and surveys need harmonised haemoglobin methods.
