TY - JOUR
T1 - Hemoglobin concentrations and adverse birth outcomes in South Asian pregnant women
T2 - findings from a prospective Maternal and Neonatal Health Registry
AU - Ali, Sumera Aziz
AU - Tikmani, Shiyam Sunder
AU - Saleem, Sarah
AU - Patel, Archana B.
AU - Hibberd, Patricia L.
AU - Goudar, Shivaprasad S.
AU - Dhaded, Sangappa
AU - Derman, Richard J.
AU - Moore, Janet L.
AU - McClure, Elizabeth M.
AU - Goldenberg, Robert L.
N1 - Funding Information:
The Global Network’s Maternal Newborn Health Registry (MNHR) is a multi-site, prospective, ongoing, active surveillance system to track pregnancies and births in defined geographic communities (clusters), each with approximately 300 to 500 deliveries per year. The MNHR is funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) through grants to the NICHD Global Network for Women’s and Children’s Health ( ClinicalTrials.gov Identifier: NCT01073475 ). The aim of the MNHR is to document birth outcomes in defined geographical areas and provide population-based rates of stillbirth, neonatal and maternal deaths, and other adverse outcomes. The details of the MNHR are described elsewhere [].
Funding Information:
Publication of this supplement was funded by grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (U10HD076457, U10HD078438, U01 HD040636).
Publisher Copyright:
© 2020, The Author(s).
PY - 2020/11
Y1 - 2020/11
N2 - Background: 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. Methods: 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. Findings: 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. Interpretation: 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.
AB - Background: 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. Methods: 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. Findings: 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. Interpretation: 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.
KW - Anemia
KW - Global network
KW - Hemoglobin concetrations
KW - India
KW - Neonatal mortality
KW - Pakistan
KW - Pregnancy outcome
KW - South Asia
KW - Stillbirth
UR - http://www.scopus.com/inward/record.url?scp=85096942199&partnerID=8YFLogxK
U2 - 10.1186/s12978-020-01006-6
DO - 10.1186/s12978-020-01006-6
M3 - Article
C2 - 33256770
AN - SCOPUS:85096942199
SN - 1742-4755
VL - 17
JO - Reproductive Health
JF - Reproductive Health
M1 - 154
ER -