Maternal anemia during pregnancy and its association with the gut microbiota profile in pregnant and postpartum women, and their infants: a cohort study

Jenna Mandell, Department of Epidemiology, Columbia University Mailman School of Public Health, New York, USA.
Laura E. Caulfield, Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Sameera Talegawkar, Department of Exercise and Nutrition Science, Milken Institute School of Public Health, The George Washington University, Washington DC, USA.
Jyoti S. Mathad, Department of Medicine, Weill Cornell Medical College, New York, USA.
Shilpa Naik, Department of Obstetrics and Gynecology, Byramjee Jeejeebhoy Government Medical College, Pune, India.
Mallika Alexander, Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India.
Mehr Shafiq, Department of Epidemiology, Columbia University Mailman School of Public Health, New York, USA.
Vandana Kulkarni, Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India.
Prasad Deshpande, Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India.
Yuan-Mou Mao, Department of Epidemiology, Columbia University Mailman School of Public Health, New York, USA; National Taiwan University, Taipei, Taiwan.
Michael S. Humphreys, Institute for Genome Sciences and Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, MD.
Bing Ma, Institute for Genome Sciences and Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, MD.
Johanna B. Holm, Institute for Genome Sciences and Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, MD.
Ramesh Bhosale, Department of Obstetrics and Gynecology, Byramjee Jeejeebhoy Government Medical College, Pune, India.
Khalil G. Ghanem, Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
Aarti Kinikar, Department of Obstetrics and Gynecology, Byramjee Jeejeebhoy Government Medical College, Pune, India.
Tian Wang, Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY.
Shuang Wang, Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY.
Jacques Ravel, Institute for Genome Sciences and Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, MD.
Amita Gupta, Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
Rupak Shivakoti, Department of Epidemiology, Columbia University Mailman School of Public Health, New York, USA. Electronic address: rs3895@cumc.columbia.edu.

Document Type

Journal Article

Publication Date

9-25-2025

Journal

The American journal of clinical nutrition

DOI

10.1016/j.ajcnut.2025.09.035

Keywords

Bacterial abundance; Dysbiosis; Infant morbidity; Microbiome; Micronutrient deficiencies; Nutritional status; Perinatal and Postnatal outcomes

Abstract

BACKGROUND: Anemia is highly prevalent in resource-limited settings, especially during pregnancy and postpartum, and is linked to adverse maternal-infant health outcomes. The role of gut microbiota in anemia during pregnancy remains poorly understood, despite the recognized links between microbiota and maternal-infant health. OBJECTIVE: This study evaluates the association between maternal anemia during pregnancy and the gut microbiota profile in pregnant and postpartum women, and their infants. METHODS: A longitudinal cohort study was conducted in Pune, India. 218 pregnant women were enrolled at 13 to 34 weeks of gestation and followed through 1 year postpartum. We examined the cross-sectional association of maternal anemia (hemoglobin <110 g/L) with gut microbiota during the second and third trimesters, and the prospective association of maternal anemia during pregnancy with gut microbiota at 6 months for postpartum mothers and infants. Multivariable models (linear, PERMANOVA and ANCOM-BC) compared α-diversity, β-diversity (Bray-Curtis distance), and abundance of taxa by anemia status. RESULTS: While gut microbial α-diversity and β-diversity did not differ significantly by maternal anemia status, significant differences in taxa abundance by maternal anemia status among mothers were observed, with log fold changes [95% CI] for Flavonifractor (0.523 [0.27, 0.77]) and Enterococcus (0.821 [0.542, 1.1]). In infants, significant differences in taxa abundance by maternal anemia status were also found, including Coproccocus_2 (-0.628 [-0.91, -0.36]) and Desulfovibrio (-2.05 [-2.31, -1.78]). CONCLUSION: Our findings reveal a distinct gut microbiota profile in mothers and infants by maternal anemia status. We identified specific taxa that are linked to anemia-related conditions (e.g. iron deficiency) and maternal-infant health outcomes. Future longitudinal studies should explore potential transgenerational associations of maternal anemia with infant microbiota and evaluate whether microbiota-informed interventions, alongside anemia treatments, could improve maternal-infant health outcomes.

Department

Epidemiology

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