Redefining Maternal Anemia in Pregnancy and Postpartum (ReMAPP) is a multisite, prospective, open cohort study nested within the ongoing PRISMA Maternal and Newborn Health study. Participants are pregnant women who provide serial hemoglobin samples using gold standard methods at 20 weeks, 20 weeks, 28 weeks, and 36 weeks gestation and at six weeks and six months postpartum. We will use two analytical approaches to estimate hemoglobin thresholds: (1) clinical decision limits for gestational-age-specific anemia based on associations of hemoglobin levels with adverse maternal, fetal, and neonatal health outcomes and (2) reference limits for mild, moderate, and severe anemia based on tail statistical percentiles of hemoglobin values in a clinically healthy subpopulation. We also will conduct biomarker-intensive testing among a subset of participants in each trimester to explore underlying contributing factors of maternal anemia.
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