Anemia during pregnancy remains a major public health problem, particularly in low- and middle-income countries, where it contributes significantly to maternal and perinatal morbidity. This prospective observational study was conducted in Babylon, Iraq, to determine the prevalence, risk factors, and outcomes associated with maternal anemia. A total of 200 pregnant women at 20 weeks of gestation or more were recruited from private clinics and hospitals between January and June 2025 and followed until delivery. Data collection included sociodemographic characteristics, obstetric history, nutritional practices, and lifestyle factors. Laboratory investigations were performed to assess hemoglobin and serum ferritin levels, while pregnancy and neonatal outcomes were recorded at delivery. The prevalence of anemia was 46%, with the majority of cases classified as mild or moderate, while severe anemia was uncommon (5.4%). Anemia was more frequent among rural residents, housewives, and women of low socioeconomic status. A previous miscarriage, a short interpregnancy interval, and a history of iron deficiency anemia were significantly associated with maternal anemia. Nutritional factors played a crucial role, with lower rates of iron supplementation, inadequate intake of iron-rich foods, and higher prevalence of tea consumption during meals observed in the anemic group. Laboratory findings confirmed significantly reduced hemoglobin and serum ferritin concentrations among anemic women compared with their non-anemic counterparts. Maternal anemia was significantly associated with adverse perinatal outcomes, including preterm birth, low birth weight, and reduced Apgar scores at 5 minutes. Although cesarean delivery and perinatal mortality were more frequent among anemic mothers, these differences were not statistically significant. This study underscores the high burden of maternal anemia in Babylon and its multifactorial determinants. Targeted interventions focusing on nutritional counseling, supplementation adherence, and improved antenatal care are essential to mitigate the risks and improve maternal and neonatal outcomes.

Index Terms: Maternal anemia; Iron deficiency; Pregnancy outcomes; Risk factors; Nutritional status; Iraq.