Role of Oxidative Stress Biomarkers and Antioxidant Enzyme Activity in the Pathophysiology of Maternal Anemia During Pregnancy

Abstract

Objective: To compare oxidative stress markers and antioxidant levels in pregnant women with and without
anemia, and to look at how these markers relate to hemoglobin concentrations.

Study Design: Case-control study
Place and Duration of Study: This study was conducted at the Antenatal Clinics of Kerbala Obstetrics &
Gynecology Teaching Hospital, Iraq from 1st June 2025 to 30th November 2025.

Methods: Forty-nine pregnant women with anemia (hemoglobin under 11 g/dL) were enrolled alongside 50 non- anemic pregnant women who served as controls. Serum levels of malondialdehyde, superoxide dismutase, catalase, and reduced glutathione were determined using standard spectrophotometric techniques.

Results: Antioxidant capacity was lower across the board in anemic women compared with controls: superoxide dismutase (0.051±0.055 vs 0.073±0.047; p=0.029), catalase (2.62±1.93 vs 8.48±4.43; p<0.001) and glutathione (49.05±17.5 7 vs 187.10±56.07; p<0.001). Malondialdehyde, on the other hand, was markedly elevated in the anemic group (7.16±5.01 vs 2.91±2.66 μmol/mL; p<0.001). Hemoglobin showed positive correlations with glutathione (r = 0.614), CAT (r = 0.521), and superoxide dismutase (r = 0.386), and a negative correlation with malondialdehyde (r = −0.547), all reaching p<0.001. In the multiple linear regression model, glutathione (β = 0.391) and malondialdehyde (β = −0.315) emerged as the strongest predictors of hemoglobin, and together the model accounted for 48% of the variance ( R2 = 0.48; p < 0.001).

Conclusion: Pregnant women with anemia showed both heightened lipid peroxidation and weakened antioxidant defenses. The strong links of glutathione and malondialdehyde with hemoglobin point to a role for oxidative stress in maternal anemia and suggest that improving antioxidant status may be worth exploring as a therapeutic avenue.