TY - JOUR
T1 - Anemia and adverse outcomes in pregnancy
T2 - subgroup analysis of the CLIP cluster-randomized trial in India
AU - the CLIP working group
AU - Bone, Jeffrey N.
AU - Bellad, Mrutyunjaya
AU - Goudar, Shivaprasad
AU - Mallapur, Ashalata
AU - Charantimath, Umesh
AU - Ramadurg, Umesh
AU - Katageri, Geetanjali
AU - Lesperance, Maria
AU - Woo Kinshella, Mai Lei
AU - Suleman, Raiya
AU - Vidler, Marianne
AU - Sharma, Sumedha
AU - Derman, Richard
AU - Magee, Laura A.
AU - von Dadelszen, Peter
AU - Bannale, Shashidhar G.
AU - Chougala, Keval S.
AU - Dhamanekar, Vaibhav B.
AU - Joshi, Anjali M.
AU - Kamble, Namdev A.
AU - Kengapur, Gudadayya S.
AU - Kudachi, Uday S.
AU - Mastiholi, Sphoorthi S.
AU - I Mungarwadi, Geetanjali
AU - Sevene, Esperança
AU - Munguambe, Khátia
AU - Sacoor, Charfudin
AU - Macete, Eusébio
AU - Boene, Helena
AU - Amose, Felizarda
AU - Augusto, Orvalho
AU - Bique, Cassimo
AU - Ilda Biz, Ana
AU - Chiaú, Rogério
AU - Cutana, Silvestre
AU - Filimone, Paulo
AU - Gonçálves, Emília
AU - Macamo, Marta
AU - Macuacua, Salésio
AU - Maculuve, Sónia
AU - Mandlate, Ernesto
AU - Matavele, Analisa
AU - Mocumbi, Sibone
AU - Mulungo, Dulce
AU - Nhamirre, Zefanias
AU - Nhancolo, Ariel
AU - Nkumbula, Cláudio
AU - Nobela, Vivalde
AU - Hoodbhoy, Zahra
AU - Ahmed, Imran
N1 - Publisher Copyright:
© 2022, The Author(s).
PY - 2022/12
Y1 - 2022/12
N2 - Background: Iron-deficiency anemia is a known risk factor for several adverse perinatal outcomes, but data on its impact on specific maternal morbidities is less robust. Further, information on associations between anemia in early pregnancy and subsequent outcomes are understudied. Methods: The study population was derived from the Community Level Interventions for Pre-eclampsia (CLIP) trial in Karnataka State, India (NCT01911494). Included were women who were enrolled in either trial arm, delivered by trial end date, and had a baseline measure of hemoglobin (Hb). Anemia was classified by WHO standards into four groups: none (Hb ≥ 11 g/dL), mild (10.0 g/dL ≤ Hb < 11.0 g/dL), moderate (7.0 g/dL ≤ Hb < 10.0 g/dL) and severe (Hb < 7.0 g/dL). Targeted maximum likelihood estimation was used to estimate confounder-adjusted associations between anemia and a composite (and its components) of adverse maternal outcomes, including pregnancy hypertension. E-values were calculated to assess robustness to unmeasured confounding. Results: Of 11,370 women included, 10,066 (88.5%) had anemia, that was mild (3690, 32.5%), moderate (6023, 53.0%), or severe (68, 0.6%). Almost all women (> 99%) reported taking iron supplements during pregnancy. Blood transfusions was more often administered to those with anemia that was mild (risk ratio [RR] 2.16, 95% confidence interval [CI] 1.31–3.56), moderate (RR 2.37, 95% CI 1.56–3.59), and severe (RR 5.70, 95% CI 3.00–10.85). No significant association was evident between anemia severity and haemorrhage (antepartum or postpartum) or sepsis, but there was a U-shaped association between anemia severity and pregnancy hypertension and pre-eclampsia specifically, with the lowest risk seen among those with mild or moderate anemia. Conclusion: In Karnataka State, India, current management strategies for mild-moderate anemia in early pregnancy are associated with similar rates of adverse maternal or perinatal outcomes, and a lower risk of pregnancy hypertension and preeclampsia, compared with no anemia in early pregnancy. Future research should focus on risk mitigation for women with severe anemia, and the potential effect of iron supplementation for women with normal Hb in early pregnancy.
AB - Background: Iron-deficiency anemia is a known risk factor for several adverse perinatal outcomes, but data on its impact on specific maternal morbidities is less robust. Further, information on associations between anemia in early pregnancy and subsequent outcomes are understudied. Methods: The study population was derived from the Community Level Interventions for Pre-eclampsia (CLIP) trial in Karnataka State, India (NCT01911494). Included were women who were enrolled in either trial arm, delivered by trial end date, and had a baseline measure of hemoglobin (Hb). Anemia was classified by WHO standards into four groups: none (Hb ≥ 11 g/dL), mild (10.0 g/dL ≤ Hb < 11.0 g/dL), moderate (7.0 g/dL ≤ Hb < 10.0 g/dL) and severe (Hb < 7.0 g/dL). Targeted maximum likelihood estimation was used to estimate confounder-adjusted associations between anemia and a composite (and its components) of adverse maternal outcomes, including pregnancy hypertension. E-values were calculated to assess robustness to unmeasured confounding. Results: Of 11,370 women included, 10,066 (88.5%) had anemia, that was mild (3690, 32.5%), moderate (6023, 53.0%), or severe (68, 0.6%). Almost all women (> 99%) reported taking iron supplements during pregnancy. Blood transfusions was more often administered to those with anemia that was mild (risk ratio [RR] 2.16, 95% confidence interval [CI] 1.31–3.56), moderate (RR 2.37, 95% CI 1.56–3.59), and severe (RR 5.70, 95% CI 3.00–10.85). No significant association was evident between anemia severity and haemorrhage (antepartum or postpartum) or sepsis, but there was a U-shaped association between anemia severity and pregnancy hypertension and pre-eclampsia specifically, with the lowest risk seen among those with mild or moderate anemia. Conclusion: In Karnataka State, India, current management strategies for mild-moderate anemia in early pregnancy are associated with similar rates of adverse maternal or perinatal outcomes, and a lower risk of pregnancy hypertension and preeclampsia, compared with no anemia in early pregnancy. Future research should focus on risk mitigation for women with severe anemia, and the potential effect of iron supplementation for women with normal Hb in early pregnancy.
KW - Anemia in pregnancy
KW - Global health
KW - Hypertension
UR - http://www.scopus.com/inward/record.url?scp=85130028220&partnerID=8YFLogxK
U2 - 10.1186/s12884-022-04714-y
DO - 10.1186/s12884-022-04714-y
M3 - Article
C2 - 35562720
AN - SCOPUS:85130028220
SN - 1471-2393
VL - 22
JO - BMC Pregnancy and Childbirth
JF - BMC Pregnancy and Childbirth
IS - 1
M1 - 407
ER -