The Association Between Haemoglobin Levels in the First 20 Weeks of Pregnancy and Pregnancy Outcomes

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2019 Nov 14

PMID 31721799

Citations 12

Authors

Deborah A Randall

Jillian A Patterson

Felicity Gallimore

Jonathan M Morris

Therese M McGee

Jane B Ford

Affiliations

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Abstract

Background: Low haemoglobin has been linked to adverse pregnancy outcomes. Our study aimed to assess the association of haemoglobin (Hb) in the first 20 weeks of pregnancy, and restoration of low Hb levels, with pregnancy outcomes in Australia.

Methods: Clinical data for singleton pregnancies from two tertiary public hospitals in New South Wales were extracted for 2011-2015. The relationship between the lowest Hb result in the first 20 weeks of pregnancy and adverse outcomes was determined using adjusted Poisson regression. Those with Hb <110 g/L were classified into 'restored' and 'not restored' based on Hb results from 21 weeks onwards, and risk of adverse outcomes explored with adjusted Poisson regression.

Results: Of 31,906 singleton pregnancies, 4.0% had Hb <110 and 10.2% had ≥140 g/L at ≤20 weeks. Women with low Hb had significantly higher risks of postpartum haemorrhage, transfusion, preterm birth, very low birthweight, and having a baby transferred to higher care or stillbirth. High Hb was also associated with higher risks of preterm, very low birthweight, and transfer to higher care/stillbirth. Transfusion was the only outcome where risk decreased with increasing Hb. Risk of transfusion was significantly lower in the 'restored' group compared with the 'not restored' group (OR 0.39, 95% CI 0.22-0.70), but restoration of Hb did not significantly affect the other outcomes measured.

Conclusions: Women with both low and high Hb in the first 20 weeks of pregnancy had higher risks of adverse outcomes than those with normal Hb. Restoring Hb after 20 weeks did not improve most adverse outcome rates but did reduce risk of transfusion.

Citing Articles

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The impact of maternal serum biomarkers on maternal and neonatal outcomes in twin pregnancies: a retrospective cohort study conducted at a tertiary hospital.

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PMID: 37968861 PMC: 10655792. DOI: 10.1177/10760296231214536.

References

Chatterjee R, Shand A, Nassar N, Walls M, Khambalia A . Iron supplement use in pregnancy - Are the right women taking the right amount?. Clin Nutr. 2015; 35(3):741-7. DOI: 10.1016/j.clnu.2015.05.014. View

Dobbins T, Sullivan E, Roberts C, Simpson J . Australian national birthweight percentiles by sex and gestational age, 1998-2007. Med J Aust. 2012; 197(5):291-4. DOI: 10.5694/mja11.11331. View

Allen L . Anemia and iron deficiency: effects on pregnancy outcome. Am J Clin Nutr. 2000; 71(5 Suppl):1280S-4S. DOI: 10.1093/ajcn/71.5.1280s. View

Munoz M, Pena-Rosas J, Robinson S, Milman N, Holzgreve W, Breymann C . Patient blood management in obstetrics: management of anaemia and haematinic deficiencies in pregnancy and in the post-partum period: NATA consensus statement. Transfus Med. 2017; 28(1):22-39. DOI: 10.1111/tme.12443. View

Kavle J, Stoltzfus R, Witter F, Tielsch J, Khalfan S, Caulfield L . Association between anaemia during pregnancy and blood loss at and after delivery among women with vaginal births in Pemba Island, Zanzibar, Tanzania. J Health Popul Nutr. 2008; 26(2):232-40. PMC: 2740668. View

Austin P . Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples. Stat Med. 2009; 28(25):3083-107. PMC: 3472075. DOI: 10.1002/sim.3697. View

Dewey K, Oaks B . U-shaped curve for risk associated with maternal hemoglobin, iron status, or iron supplementation. Am J Clin Nutr. 2017; 106(Suppl 6):1694S-1702S. PMC: 5701708. DOI: 10.3945/ajcn.117.156075. View

Murphy J, ORiordan J, Newcombe R, Coles E, Pearson J . Relation of haemoglobin levels in first and second trimesters to outcome of pregnancy. Lancet. 1986; 1(8488):992-5. DOI: 10.1016/s0140-6736(86)91269-9. View

Pena-Rosas J, De-Regil L, Garcia-Casal M, Dowswell T . Daily oral iron supplementation during pregnancy. Cochrane Database Syst Rev. 2015; (7):CD004736. PMC: 8918165. DOI: 10.1002/14651858.CD004736.pub5. View

10.

Sinha P, Kuruba N . Ante-partum haemorrhage: an update. J Obstet Gynaecol. 2008; 28(4):377-81. DOI: 10.1080/01443610802091487. View

11.

Vahanian S, Lavery J, Ananth C, Vintzileos A . Placental implantation abnormalities and risk of preterm delivery: a systematic review and metaanalysis. Am J Obstet Gynecol. 2015; 213(4 Suppl):S78-90. DOI: 10.1016/j.ajog.2015.05.058. View

12.

Drukker L, Hants Y, Farkash R, Ruchlemer R, Samueloff A, Grisaru-Granovsky S . Iron deficiency anemia at admission for labor and delivery is associated with an increased risk for Cesarean section and adverse maternal and neonatal outcomes. Transfusion. 2015; 55(12):2799-806. DOI: 10.1111/trf.13252. View

13.

Ford J, Roberts C, Simpson J, Vaughan J, Cameron C . Increased postpartum hemorrhage rates in Australia. Int J Gynaecol Obstet. 2007; 98(3):237-43. DOI: 10.1016/j.ijgo.2007.03.011. View

14.

Gonzales G, Steenland K, Tapia V . Maternal hemoglobin level and fetal outcome at low and high altitudes. Am J Physiol Regul Integr Comp Physiol. 2009; 297(5):R1477-85. PMC: 2777782. DOI: 10.1152/ajpregu.00275.2009. View

15.

Milman N . Iron and pregnancy--a delicate balance. Ann Hematol. 2006; 85(9):559-65. DOI: 10.1007/s00277-006-0108-2. View

16.

Isbister J . The three-pillar matrix of patient blood management--an overview. Best Pract Res Clin Anaesthesiol. 2013; 27(1):69-84. DOI: 10.1016/j.bpa.2013.02.002. View

17.

Stevens G, Finucane M, De-Regil L, Paciorek C, Flaxman S, Branca F . Global, regional, and national trends in haemoglobin concentration and prevalence of total and severe anaemia in children and pregnant and non-pregnant women for 1995-2011: a systematic analysis of population-representative data. Lancet Glob Health. 2014; 1(1):e16-25. PMC: 4547326. DOI: 10.1016/S2214-109X(13)70001-9. View

18.

Owiredu W, Osakunor D, Turpin C, Owusu-Afriyie O . Laboratory prediction of primary postpartum haemorrhage: a comparative cohort study. BMC Pregnancy Childbirth. 2016; 16:17. PMC: 4727344. DOI: 10.1186/s12884-016-0805-3. View

19.

Patterson J, Roberts C, Bowen J, Irving D, Isbister J, Morris J . Blood transfusion during pregnancy, birth, and the postnatal period. Obstet Gynecol. 2014; 123(1):126-133. DOI: 10.1097/AOG.0000000000000054. View

20.

Knight M, Callaghan W, Berg C, Alexander S, Bouvier-Colle M, Ford J . Trends in postpartum hemorrhage in high resource countries: a review and recommendations from the International Postpartum Hemorrhage Collaborative Group. BMC Pregnancy Childbirth. 2009; 9:55. PMC: 2790440. DOI: 10.1186/1471-2393-9-55. View