Tehran University of Medical Sciences Journal of Family and Reproductive Health 1735-8949 20 2 2026 09 13 134 145 Leila Sahebi Maternal-Fetal and Neonatal Research Center, Family Health Research Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Hossein Dalili Maternal-Fetal and Neonatal Research Center, Family Health Research Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Mazyar Babagoli Maternal-Fetal and Neonatal Research Center, Family Health Research Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran AND Center for Orthopedic Trans-Disciplinary Applied Research, Tehran University of Medical Sciences, Tehran, Iran Atefeh Sabbagh Maternal-Fetal and Neonatal Research Center, Family Health Research Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran 2026 05 20 2026 07 11 Objective: Maternal hemoglobin concentration during pregnancy is a key indicator of placental–fetal oxygen delivery and may influence neonatal outcomes. Despite existing evidence, prospective cohort data in the Iranian population remain limited. This study aimed to investigate the association between maternal hemoglobin concentration and neonatal outcomes while controlling for potential confounding factors. Materials and methods: This prospective cohort study was conducted over a six‑month period.  A total of 263 eligible mother–neonate pairs were included in the analysis. Maternal hemoglobin concentration was measured at 28 weeks of gestation, and participants were categorized into two groups: Hb < 11 g/dL (anemia) and Hb ≥ 11 g/dL. Neonatal outcomes were investigated in two groups. Statistical analyses were performed using independent t‑tests, chi‑square tests, and univariate and multivariate linear and logistic regression models, adjusting for gestational age, mode of delivery, parity, maternal conditions, and iron supplementation. Results: The incidence of RDS was calculated 56% (33 neonates) and 26% (48 neonates) in mothers with anemia and normal, respectively. Neonates born to mothers with Hb ≥ 11 g/dL had a significantly lower risk of RDS compared with those born to anemic mothers (adjusted OR = 0.64; P < 0.01). No significant association was observed between maternal anemia and either birth weight or birth length in multivariate analysis. Conclusion: Adequate maternal hemoglobin concentration is associated with a reduced risk of neonatal RDS. Timely screening and appropriate management of maternal anemia may play an important role in improving neonatal respiratory outcomes. https://jfrh.tums.ac.ir/index.php/jfrh/article/view/3744 https://jfrh.tums.ac.ir/index.php/jfrh/article/download/3744/764