LAUSR

Sir, I read the article, “Assessment and comparison of pregnancy outcome among anaemic and nonanaemic primigravida mothers,”[1] with great interest. It was a hospital-based study conducted to assess the impact of anemia on course and outcome of pregnancy in anemic (hemoglobin 8–10.9 g%) and nonanemic primigravidae. The study is very valuable as it addresses the important issue of anemia in pregnancy which is an important public health concern in India. However, I have the following concerns regarding this study: 1. In this study, a nonprobability purpose sampling methodology was used for sample selection. However, it is not mentioned whether matching was done while selecting the participants for the two groups (anemic and nonanemic). How have the authors accounted for potential confounders is not clear 2. The authors have mentioned a lack of bias as a strength of the study. This statement appears unreasonable especially in view of the nonprobability sampling methodology adopted, the absence of matching and blinding in the study design. All these factors can potentially bias the study results and introduce different types of bias such as sample selection bias, information bias, and confounding bias in the study 3. The authors conclude that mild to moderate anemic pregnant women can have a similar outcome as a normal pregnancy if anemia is detected early in pregnancy and “appropriate care” is given. However, what appropriate care was given and how it differed between the anemic versus nonanemic mothers have not been mentioned. This information is also vital because it will determine the generalizability of the study findings to the community setting. In my opinion, therapeutic protocol should have been elaborated upon. Financial support and sponsorship Nil.