Hemoglobin concentrations and adverse birth outcomes in South Asian pregnant women: findings from a prospective Maternal and Neonatal Health Registry.
Hemoglobin concentrations and adverse birth outcomes in South Asian pregnant women: findings from a prospective Maternal and Neonatal Health Registry.
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DOI：
10.1186/s12978-020-01006-6
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发表时间：
2020-11-30
影响因子：
3.4
通讯作者：
Goldenberg RL
中科院分区：
文献类型：
--
作者：
Ali SA;Tikmani SS;Saleem S;Patel AB;Hibberd PL;Goudar SS;Dhaded S;Derman RJ;Moore JL;McClure EM;Goldenberg RL
虽然血红蛋白 (Hb) 浓度与妊娠结局之间的关系经常被研究，但大多数报告都集中在用于定义贫血的特定 Hb 临界值上。很少有研究评估整个 Hb 值范围内的妊娠结局。此外，迄今为止，大多数关于血红蛋白浓度与妊娠结局关系的研究都是在高收入国家进行的。因此，我们试图确定南亚孕妇的母亲血红蛋白浓度范围与不良分娩结果之间的关系。在这项研究中，我们在一项前瞻性孕产妇和新生儿健康登记研究中使用了从两个南亚国家（巴基斯坦 - 信德省和印度的两个地点 - 贝拉加维和那格浦尔）收集的数据。为了评估 Hb 浓度与各种母婴结局之间的关联，我们将 Hb 浓度分为七类。对多个潜在混杂因素进行回归分析，以评估不同 Hb 浓度范围内的不良妊娠结局。 2012 年 1 月至 2018 年 12 月期间，南亚地区登记了 130,888 名孕妇，这些孕妇拥有可用的血红蛋白测量值、已交付并被纳入分析。总体而言，这些站点孕妇的平均血红蛋白浓度为 9.9 g/dL，印度站点为 10.0 g/dL，巴基斯坦站点为 9.5 g/dL。在 6.9% 的巴基斯坦孕妇和 0.2% 的印度孕妇中观察到血红蛋白浓度 < 7 g/dL。在巴基斯坦和印度的研究地点，胎次较高的女性和未受过正规教育的女性的血红蛋白浓度较低。在巴基斯坦站点，年龄 > 35 岁的女性、有 ≥ 4 个孩子的女性以及妊娠晚期的女性更有可能 Hb 浓度 < 7 g/dL，但在印度站点没有发现这些关联。在调整潜在的混杂因素时，对于印度和巴基斯坦来说，较低的血红蛋白浓度与死产、早产、较低的平均出生体重以及低出生体重风险增加相关。在巴基斯坦的站点，有证据表明血红蛋白浓度与低出生体重和新生儿死亡率之间存在 U 形关系，而在印度则与高血压疾病之间存在 U 形关系。这项研究记录了巴基斯坦和印度地区不同 Hb 值范围内孕妇血红蛋白浓度与不良妊娠结局之间的关系。低和高血红蛋白浓度都与至少一些不良结果的风险相关。因此，Hb 值过低和过高都应被视为母亲和胎儿的危险因素。
While the relationship between hemoglobin (Hb) concentrations and pregnancy outcomes has been studied often, most reports have focused on a specific Hb cutoff used to define anemia. Fewer studies have evaluated pregnancy outcomes across the entire range of Hb values. Moreover, to date, most studies of the relationship of Hb concentrations to pregnancy outcomes have been done in high-income countries. Thus, we have sought to determine the relationship between the range of maternal Hb concentrations and adverse birth outcomes among South Asian pregnant women. For this study, we used data collected from two South Asian countries (Pakistan – Sindh Province and two sites in India - Belagavi and Nagpur) in a prospective maternal and newborn health registry study. To assess the association between Hb concentrations and various maternal and fetal outcomes, we classified the Hb concentrations into seven categories. Regression analyses adjusting for multiple potential confounders were performed to assess adverse pregnancy outcomes across the range of Hb concentrations. Between January 2012 and December 2018, 130,888 pregnant women were enrolled in the South Asian sites had a Hb measurement available, delivered and were included in the analyses. Overall, the mean Hb concentration of pregnant women from the sites was 9.9 g/dL, 10.0 g/dL in the Indian sites and 9.5 g/dL in the Pakistan site. Hb concentrations < 7 g/dL were observed in 6.9% of the pregnant Pakistani women and 0.2% of the Indian women. In both the Pakistani and Indian sites, women with higher parity and women with no formal education had lower Hb concentrations. In the Pakistani site, women > 35 years of age, women with ≥4 children and those who enrolled in the third trimester were more likely to have Hb concentrations of < 7 g/dL but these associations were not found for the Indian sites. When adjusting for potential confounders, for both India and Pakistan, lower Hb concentrations were associated with stillbirth, preterm birth, lower mean birthweight, and increased risk of low birthweight. In the Pakistani site, there was evidence of a U-shaped relationship between Hb concentrations and low birth weight, and neonatal mortality, and in India with hypertensive disease. This study documented the relationship between maternal Hb concentrations and adverse pregnancy outcomes in women from the Pakistani and Indian sites across the range of Hb values. Both low and high Hb concentrations were associated with risk of at least some adverse outcomes. Hence, both low and high values of Hb should be considered risk factors for the mother and fetus.
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影响因子：
3.8
作者：
Goudar, Shivaprasad S.;Carlo, Waldemar A.;McClure, Elizabeth M.;Pasha, Omrana;Patel, Archana;Esamai, Fabian;Chomba, Elwyn;Garces, Ana;Althabe, Fernando;Kodkany, Bhalachandra;Sami, Neelofar;Derman, Richard J.;Hibberd, Patricia L.;Liechty, Edward A.;Krebs, Nancy F.;Hambidge, K. Michael;Buekens, Pierre;Moore, Janet;Wallace, Dennis;Jobe, Alan H.;Koso-Thomas, Marion;Wright, Linda L.;Goldenberg, Robert L.
通讯作者：
Goldenberg, Robert L.
DOI：
10.5402/2012/368571
发表时间：
2012
期刊：
ISRN obstetrics and gynecology
影响因子：
--
作者：
Gonzales GF;Tapia V;Fort AL
通讯作者：
Fort AL
影响因子：
4.3
作者：
SAGEN, N;NILSEN, ST;KOLLER, O
通讯作者：
KOLLER, O
影响因子：
1.2
作者：
Mahmood, Tuba;Rehman, Atique U. R.;Kumar, Besham
通讯作者：
Kumar, Besham
DOI：
10.1111/j.1471-0528.1978.tb15857.x
发表时间：
1978-01-01
期刊：
BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY
影响因子：
--
作者：
DUNLOP, W;FURNESS, C;HILL, LM
通讯作者：
HILL, LM