Analysis of Pallor Examination for the Identification of Anemia Among Pregnant Women: A Scoping Review

Yuninda Loviana Ersianti,1,* Susi Susanah,2,* Gatot Nyarumenteng Adhipurnawan Winarno,3,* Hadi Susiarno,3 Herry Herman,4 Sofie Rifayani Krisnadi3 1Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia; 2Department of Child Health, Dr. Hasan Sadikin General Hospital/Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia; 3Department of Obstetrics and Gynecology, Dr. Hasan Sadikin General Hospital/Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia; 4Department of Orthopaedic and Traumatology, Dr. Hasan Sadikin General Hospital/Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia*These authors contributed equally to this workCorrespondence: Yuninda Loviana Ersianti, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia, Email yuninda23001@mail.unpad.ac.idAbstract: Anemia affects more than 1.9 billion people globally, with pregnant women being among the most vulnerable. Pallor, a visible sign of reduced hemoglobin levels, is frequently used as a low-cost screening tool, particularly in resource-limited settings. This study aimed to assess the validity of clinical pallor signs for detecting anemia among pregnant women. A scoping review was conducted utilizing multiple databases, including PubMed, ScienceDirect, and Google Scholar. The review followed the PRISMA-ScR reporting guidelines and was systematically structured according to the PEO framework. Out of 812 articles identified, seven selected studies published between 2010 and 2025 were included in the review. The selected studies involved 1,847 participants from countries including India, Indonesia, Pakistan, Ethiopia, and Sri Lanka. This review found a significant association between physical pallor examination of the conjunctiva, buccal mucosa or tongue, and palms with anemia in both pregnant women and women of reproductive age (p< 0.001). This review reported that conjunctival, nailbed, tongue/buccal mucosa, palm pallor, and pallor at any site demonstrated a broad range sensitivity and specificity values ranging from above 0% to 100%. However, the combined pallor examination of the conjunctiva, buccal mucosa or tongue, nail beds, and palms tends to demonstrate high sensitivity and specificity (≥ 70%) in detecting anemia. Therefore, combined pallor assessment is recommended for future research. Nonetheless, further studies are needed to standardize examiner skills, lighting conditions, skin pigmentation considerations, pallor grading systems, and inter-rater reliability analysis. Pallor examination remains a useful initial screening method for detecting moderate to severe anemia in pregnant women in resource-limited settings.Keywords: anemia, pallor examination, diagnostic, validity, pregnant women