Abstract：Anemia is a common complication during pregnancy and is closely associated with adverse maternal and infant outcomes. Etiology based diagnostic classification and individualized treatment are standard requirements in clinical guidelines for the prevention and management of anemia during pregnancy. Although guidelines for anemia in pregnancy worldwide have emphasized etiological classification and individualized treatment, the existing criteria for severity grading cannot adequately capture the substantial differences among anemias of diverse etiologies, thus limiting the accurate assessment of maternal and neonatal health risks. This article retrieved relevant literature published from 2017 to 2025 and systematically reviewed the etiologies of different types of gestational anemia and their associations with maternal and infant health. Nutritional deficiency anemia primarily affects placental function and the metabolism of hematopoietic substrates, thereby increasing the risk of adverse pregnancy outcomes such as postpartum hemorrhage, postpartum depression, postpartum infection, hypertensive disorders of pregnancy, as well as fetal preterm birth, low birth weight, and neural tube defects. Hereditary anemia, due to intrinsic red blood cell defects, leads to maternal heart failure, iron overload, and adverse outcomes in offspring, including growth restriction and death. Its pathological changes are primary and persistent, more easily causing systemic maternal damage, and may affect the fetus through both genetic inheritance from mother to child and the intrauterine pathological environment. Other pathological anemias during pregnancy, such as aplastic anemia associated with pregnancy and autoimmune hemolytic anemia associated with pregnancy, have complex mechanisms, limited research, and unclear etiologies. The pathological mechanisms and clinical outcomes vary among different etiologies of gestational anemia. It is necessary to adopt an approach oriented to etiology, improve research on etiological mechanisms and risk assessment systems, so as to provide a reference for optimizing prevention and treatment strategies for gestational anemia and reducing maternal and infant health risks.
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