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Limited data are available from low- and middle-income countries (LMICs) on the relationship of haemoglobin levels to adverse outcomes at different times during pregnancy. We evaluated the association of haemoglobin levels in nulliparous women at two times in pregnancy with pregnancy outcomes. ASPIRIN Trial data were used to study the association between haemoglobin levels measured at 6 -13 weeks and 26 -30 weeks of gestation with fetal and neonatal outcomes. Obstetric care facilities in Pakistan, India, Kenya, Zambia, The Democratic Republic of th