TY - JOUR
T1 - International values for haemoglobin distributions in healthy pregnant women
AU - Ohuma, Eric O.
AU - Young, Melissa F.
AU - Martorell, Reynaldo
AU - Ismail, Leila Cheikh
AU - Peña-Rosas, Juan Pablo
AU - Purwar, Manorama
AU - Garcia-Casal, Maria Nieves
AU - Gravett, Michael G.
AU - de Onis, Mercedes
AU - Wu, Qing Qing
AU - Carvalho, Maria
AU - Jaffer, Yasmin A.
AU - Lambert, Ann
AU - Bertino, Enrico
AU - Papageorghiou, Aris T.
AU - Barros, Fernando C.
AU - Bhutta, Zulfiqar A.
AU - Kennedy, Stephen H.
AU - Villar, Jose
N1 - Funding Information:
This study was supported by the Bill & Melinda Gates Foundation. The funders were not involved in the analysis or writing of the study. This work was commissioned and financially supported by the Evidence and Programme Guidance Unit, Department of Nutrition for Health and Development, WHO, Geneva, Switzerland. EOO received an honorarium from WHO for this work. The WHO BMGF award that funded anaemia was 64662 (2016-2019). USAID has funded anaemia through various awards this year (69730, 69278, 70209). JV and SHK were responsible for conceiving the INTERGROWTH-21st Project. JPPR and MNGC conceived the protocol in collaboration with EOO and JV. EOO performed the statistical analyses on the maternal Hb data in collaboration with JV. EOO wrote the paper in collaboration with JV, MY, RM, MdO and SHK with input from all co-authors. All co-authors read the report and made suggestions about its content. We would like to thank the Health Authorities in Pelotas, Brazil; Beijing, China; Nagpur, India; Turin, Italy; Nairobi, Kenya; Muscat, Oman; Oxford, UK and Seattle, USA, who facilitated the project by allowing participation of these study sites as collaborating centers. We are extremely grateful to Philips Medical Systems who provided the ultrasound equipment and technical assistance throughout the project. We also thank MedSciNet UK Ltd for setting up the INTERGROWTH-21st web-site and for the development, maintenance and support of the on-line data management system. We thank the parents and infants who participated in the studies and the more than 200 members of the research teams who made the implementation of this project possible. The participating hospitals included: Brazil, Pelotas (Hospital Miguel Piltcher, Hospital São Francisco de Paula, Santa Casa de Misericórdia de Pelotas, and Hospital Escola da Universidade Federal de Pelotas); China, Beijing (Beijing Obstetrics & gynecology Hospital, Shunyi Maternal & Child Health Centre, and Shunyi General Hospital); India, Nagpur (Ketkar Hospital, Avanti Institute of Cardiology Private Limited, Avantika Hospital, Gurukrupa Maternity Hospital, Mulik Hospital & Research Centre, Nandlok Hospital, Om Women's Hospital, Renuka Hospital & Maternity Home, Saboo Hospital, Brajmonhan Taori Memorial Hospital, and Somani Nursing Home); Kenya, Nairobi (Aga Khan University Hospital, MP Shah Hospital and Avenue Hospital); Italy, Turin (Ospedale Infantile Regina Margherita Sant’ Anna and Azienda Ospedaliera Ordine Mauriziano); Oman, Muscat (Khoula Hospital, Royal Hospital, Wattayah Obstetrics & Gynaecology Poly Clinic, Wattayah Health Centre, Ruwi Health Centre, Al-Ghoubra Health Centre and Al-Khuwair Health Centre); UK, Oxford (John Radcliffe Hospital) and USA, Seattle (University of Washington Hospital, Swedish Hospital, and Providence Everett Hospital). Full acknowledgement of all those who contributed to the development of the INTERGROWTH-21st Project protocol appears at www.intergrowth21.org.uk, All documentation, protocols, data collection forms, and clinical tools are freely available on the INTERGROWTH-21st website www.intergrowth21.org.uk. EOO guarantees that the manuscript is an honest, accurate, and transparent account of the study being reported and that no aspects have been omitted.
Funding Information:
ATP reports personal fees from BJOG, grants from Bill and Melinda Gates Foundation, grants from European Research Council, grants from National Institute of Health Research, grants from Grand Challenges Research Fund, outside the submitted work. JPPR and MNGC are full time staff members of the WHO. The authors alone are responsible for the views expressed in this publication and they do not necessarily represent the official position, decisions, policy or views of the World Health Organization. The WHO receives partial financial support from the Bill & Melinda Gates Foundation, and the US Centers for Disease Control and Prevention to support its work in the area of nutrition. Donors do not fund specific guidelines and do not participate in any decision related to the guideline development process. All other authors declare no competing interests.
Funding Information:
This study was supported by the Bill & Melinda Gates Foundation. The funders were not involved in the analysis or writing of the study. This work was commissioned and financially supported by the Evidence and Programme Guidance Unit, Department of Nutrition for Health and Development, WHO, Geneva, Switzerland. EOO received an honorarium from WHO for this work. The WHO BMGF award that funded anaemia was 64662 (2016-2019). USAID has funded anaemia through various awards this year (69730, 69278, 70209).
Publisher Copyright:
© 2020 World Health Organization
PY - 2020/12
Y1 - 2020/12
N2 - Background: Anaemia in pregnancy is a global health problem with associated morbidity and mortality. Methods: A secondary analysis of prospective, population-based study from 2009 to 2016 to generate maternal haemoglobin normative centiles in uncomplicated pregnancies in women receiving optimal antenatal care. Pregnant women were enrolled <14 weeks’ gestation in the Fetal Growth Longitudinal Study (FGLS) of the INTERGROWTH-21st Project which involved eight geographically diverse urban areas in Brazil, China, India, Italy, Kenya, Oman, United Kingdom and United States. At each 5 ± 1 weekly visit until delivery, information was collected about the pregnancy, as well as the results of blood tests taken as part of routine antenatal care that complemented the study's requirements, including haemoglobin values. Findings: A total of 3502 (81%) of 4321 women who delivered a live, singleton newborn with no visible congenital anomalies, contributed at least one haemoglobin value. Median haemoglobin concentrations ranged from 114.6 to 121.4 g/L, 94 to 103 g/L at the 3rd centile, and from 135 to 141 g/L at the 97th centile. The lowest values were seen between 31 and 32 weeks’ gestation, representing a mean drop of 6.8 g/L compared to 14 weeks’ gestation. The percentage variation in maternal haemoglobin within-site was 47% of the total variance compared to 13% between sites. Interpretation: We have generated International, gestational age-specific, smoothed centiles for maternal haemoglobin concentration compatible with better pregnancy outcomes, as well as adequate neonatal and early childhood morbidity, growth and development up to 2 years of age. Funding: Bill & Melinda Gates Foundation Grant number 49038.
AB - Background: Anaemia in pregnancy is a global health problem with associated morbidity and mortality. Methods: A secondary analysis of prospective, population-based study from 2009 to 2016 to generate maternal haemoglobin normative centiles in uncomplicated pregnancies in women receiving optimal antenatal care. Pregnant women were enrolled <14 weeks’ gestation in the Fetal Growth Longitudinal Study (FGLS) of the INTERGROWTH-21st Project which involved eight geographically diverse urban areas in Brazil, China, India, Italy, Kenya, Oman, United Kingdom and United States. At each 5 ± 1 weekly visit until delivery, information was collected about the pregnancy, as well as the results of blood tests taken as part of routine antenatal care that complemented the study's requirements, including haemoglobin values. Findings: A total of 3502 (81%) of 4321 women who delivered a live, singleton newborn with no visible congenital anomalies, contributed at least one haemoglobin value. Median haemoglobin concentrations ranged from 114.6 to 121.4 g/L, 94 to 103 g/L at the 3rd centile, and from 135 to 141 g/L at the 97th centile. The lowest values were seen between 31 and 32 weeks’ gestation, representing a mean drop of 6.8 g/L compared to 14 weeks’ gestation. The percentage variation in maternal haemoglobin within-site was 47% of the total variance compared to 13% between sites. Interpretation: We have generated International, gestational age-specific, smoothed centiles for maternal haemoglobin concentration compatible with better pregnancy outcomes, as well as adequate neonatal and early childhood morbidity, growth and development up to 2 years of age. Funding: Bill & Melinda Gates Foundation Grant number 49038.
KW - Anaemia
KW - Healthy pregnant women
KW - INTERGROWTH-21st
KW - International Haemoglobin values
UR - http://www.scopus.com/inward/record.url?scp=85097068245&partnerID=8YFLogxK
U2 - 10.1016/j.eclinm.2020.100660
DO - 10.1016/j.eclinm.2020.100660
M3 - Article
AN - SCOPUS:85097068245
SN - 2589-5370
VL - 29-30
JO - eClinicalMedicine
JF - eClinicalMedicine
M1 - 100660
ER -