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Observational Study
. 2025 Apr 26;25(1):506.
doi: 10.1186/s12884-025-07626-9.

Impact of maternal anemia during pregnancy on neonatal metabolic profiles: evidence from the Beijing Birth Cohort Study

Shunan Wang  1 , Wei Zheng  2 , Jinqi Zhao  1 , Lulu Li  1 , Yue Tang  1 , Lifei Gong  1 , Lijin Gu  1 , Guanghui Li #  3 , Yuanyuan Kong #  4
Affiliations
Observational Study

Impact of maternal anemia during pregnancy on neonatal metabolic profiles: evidence from the Beijing Birth Cohort Study

Shunan Wang et al. BMC Pregnancy Childbirth. .

Abstract

Background: Anemia during pregnancy is associated with various adverse neonatal outcomes. However, the association between maternal anemia during pregnancy and newborn metabolic profiles remains unclear. This study aimed to investigate whether anemia during pregnancy is associated with alterations in neonatal metabolic profiles.

Methods: This prospective observational cohort study included 12,116 pregnant women, with or without gestational anemia, recruited through the Beijing Birth Cohort Study (ChiCTR2200058395), along with their neonates born between July 2021 and October 2022 in Beijing, China.

Results: Among the 12,116 participants, 576 pregnant women were diagnosed with anemia (Anemia group), while 11,540 did not have anemia (Control group). The rates of metabolic profile abnormalities were significantly higher in the Anemia group compared to the Control group (P < 0.05): 20.83% vs. 16.1% for the overall metabolic profile, 11.9% vs. 9.25% for amino acid profiles, and 11.11% vs. 8.04% for acylcarnitine profiles. Individual metabolic indicators showed significant differences: alanine and arginine levels significantly decreased, while tyrosine levels significantly increased in the Anemia group. Notably, most acylcarnitines indicators (C0, C2, C4DC + C5-OH, C5DC + C6-OH, C6, C6DC, C10, C10:1, C12, C12:1, C14, C14:1, C14:2, C16, C16:1, C16:1-OH, C18, and C18:1) were significantly reduced in the Anemia group, except for C5, which was elevated. Pathway analysis revealed that these alterations were associated with beta-oxidation of very long-chain fatty acids, oxidation of branched-chain fatty acids, mitochondrial beta-oxidation of long-chain saturated fatty acids, and fatty acid metabolism. All of these pathways were related to fatty acid oxidation. Sensitive analyses in normal birth weight (NBW) and term infants (TI) confirmed these findings and demonstrated their robustness. In addition, in NBW infants and TIs, citrulline and arginine were significantly decreased, which were associated with aspartate metabolism and the urea cycle.

Conclusions: Maternal anemia during pregnancy is significantly associated with alterations in neonatal metabolic profiles, particularly in fatty acid beta-oxidation and related pathways. These findings highlight the potential metabolic consequences of gestational anemia and provide insights into its role in adverse neonatal outcomes and abnormal newborn screening results.

Keywords: Acylcarnitines; Amino acids; Anemia during pregnancy; Fatty acid oxidation; Metabolism; Newborn metabolic profiles.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study adhered to the principles of the Declaration of Helsinki and was approved by the Ethics Committee of Beijing Obstetrics and Gynecology Hospital, Capital Medical University (2018-ky−009−01). The participants or their legal guardians provided their written informed consent to participate in this study. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Study Flowchart
Fig. 2
Fig. 2
Incidence of Neonatal Metabolic Profile Abnormalities. A. The incidence of tandem mass spectrometry abnormalities: Anemia group VS Control group, 20.83%(n = 120) VS 16.1%(n = 1858), χ2 =8.9960, P < 0.05;.B. The incidence of amino acid (AA) profile abnormalities: Anemia group VS Control group, 11.98%(n = 69) VS 9.25%(n = 1068), χ2 =4.7886, P < 0.05; C. The incidence of acylcarnitine (AC) profile abnormalities: Anemia group VS Control group, 11.11%(64) VS 8.04%(928), χ2 = 6.8763, P < 0.05;
Fig. 3
Fig. 3
Correlation between anemia during pregnancy and neonatal metabolic indicators. Spearman rank correlation was used to assess correlations between anemia during pregnancy and neonatal metabolic indicators. The P < 0.05 was considered to be statistically significant. Red round dots indicate a significant positive correlation, green square dots indicate a significant negative correlation and gray triangular dots indicate no significant correlation
Fig. 4
Fig. 4
Pathway analysis. Pathway enrichment and topology analyses identified several neonatal metabolic pathways associated with anemia during pregnancy: beta-oxidation of very long-chain fatty acids, oxidation of branched-chain fatty acids, mitochondrial beta-oxidation of long-chain saturated fatty acids, and fatty acid metabolism. P < 0.05
Fig. 5
Fig. 5
Sensitive analysis. (A) Pathway enrichment and topology analyses indicate neonatal metabolic pathways in normal birth weight(NBW) infants associated with anemia during pregnancy: beta-oxidation of very long-chain fatty acids, oxidation of branched-chain fatty acids, mitochondrial beta-oxidation of long-chain saturated fatty acids, fatty acid metabolism, aspartate metabolism and the urea cycle. (B) Pathway enrichment and topology analyses indicate neonatal metabolic pathways term infants(TI) associated with anemia during pregnancy: beta-oxidation of very long-chain fatty acids, oxidation of branched-chain fatty acids, mitochondrial beta-oxidation of long-chain saturated fatty acids, fatty acid metabolism, aspartate metabolism, and the urea cycle
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