TY - JOUR
T1 - Maternal anaemia and maternal, fetal, and neonatal outcomes in a prospective cohort study in India and Pakistan
AU - Parks, S.
AU - Hoffman, M. K.
AU - Goudar, S. S.
AU - Patel, A.
AU - Saleem, S.
AU - Ali, S. A.
AU - Goldenberg, R. L.
AU - Hibberd, P. L.
AU - Moore, J.
AU - Wallace, D.
AU - McClure, E. M.
AU - Derman, R. J.
N1 - Funding Information:
This study was supported by the following grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD): NICHD Global Network for Women’s and Children’s Health (ClinicalTrials.-gov Identifier: NCT01073475).
Funding Information:
a Department of Obstetrics & Gynecology, Christiana Care Health System, Newark, DE, USA b KLE Academy of Higher Education and Research, Belgaum, India c Lata Medical Research Foundation, Nagpur, India d Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan e Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA f Department of Global Health, Boston University School of Public Health, Boston, MA, USA g RTI International, Research Triangle Park, NC, USA h Thomas Jefferson University, Philadelphia, PA, USA Correspondence: MK Hoffman, Department of Obstetrics & Gynecology, 4755 Ogletown-Stanton Road, Newark, DE 19718, USA. Email: mhoffman@christianacare.org
Funding Information:
The following ethical approvals were obtained prior to the initiation of the study: Belgaum—University of Missouri, 28 April 2008, and JN Medical College, 17 January 2008 (FWA#00000766). Pakistan—Columbia University (FWA# 00005917), 14 March 2008, and Aga Khan University (FWA #00001177), 14 March 2008. Nagpur—Boston University (FWA# 00004517), 31 July 2008, and Lata Medical Research Foundation (FWA# 00012971), 2 April 2008; RTI (Data coordinating Center) (FWA #00003331), 28 January 2008.
Publisher Copyright:
© 2018 Royal College of Obstetricians and Gynaecologists
PY - 2019/5
Y1 - 2019/5
N2 - Objective: To describe the association of maternal anaemia with maternal, fetal, and neonatal outcomes. Design: Prospective cohort study. Setting: Rural India and Pakistan. Population: Pregnant women residing in the study catchment area. Methods: We performed an analysis of a prospective pregnancy registry in which haemoglobin is commonly obtained as well as maternal, fetal, and neonatal outcomes for 42 days post-delivery. Women 40 years or older who delivered before 20 weeks or had a haemoglobin level of <3.0 g/dl were excluded. Our primary exposure was maternal anaemia, which was categorised in keeping with World Health Organization criteria based on a normal (≥11 g/dl), mild (>10–10.9 g/dl), moderate (7–9.9 g/dl) or severe (<7 g/dl). haemoglobin level. The primary maternal outcome was maternal death, the primary fetal outcome was stillbirth, and the primary neonatal outcome was neonatal mortality <28 days. Results: A total of 92 247 deliveries and 93 107 infants were included, of which 87.8% were born to mothers who were anaemic (mild 37.9%, moderate 49.1%, and severe 0.7%). Maternal mortality (number per 100 000) was not associated with anaemia: normal 124, mild 106, moderate 135, and severe 325 (P = 0.64). Fetal and neonatal mortality was associated with severe anaemia: stillbirth rate (n/1000)—normal 27.7, mild 25.8, moderate 30.1, and severe 90.9; P < 0.0001; 28-day neonatal mortality (n/1000)—normal 24.7, mild 22.9, moderate 28.1, and severe 72.6 (P < 0.0001). Severe maternal anaemia was also associated with low birthweight (<2500 and <1500 g), preterm birth, and postpartum haemorrhage. Conclusion: Severe maternal anaemia is associated with higher risks of poor maternal, fetal, and neonatal outcomes but other degrees of anaemia are not. Interventions directed at preventing severe anaemia in pregnant women should be considered. Tweetable abstract: Severe maternal anaemia is associated with adverse fetal and neonatal outcomes in low/middle-income countries.
AB - Objective: To describe the association of maternal anaemia with maternal, fetal, and neonatal outcomes. Design: Prospective cohort study. Setting: Rural India and Pakistan. Population: Pregnant women residing in the study catchment area. Methods: We performed an analysis of a prospective pregnancy registry in which haemoglobin is commonly obtained as well as maternal, fetal, and neonatal outcomes for 42 days post-delivery. Women 40 years or older who delivered before 20 weeks or had a haemoglobin level of <3.0 g/dl were excluded. Our primary exposure was maternal anaemia, which was categorised in keeping with World Health Organization criteria based on a normal (≥11 g/dl), mild (>10–10.9 g/dl), moderate (7–9.9 g/dl) or severe (<7 g/dl). haemoglobin level. The primary maternal outcome was maternal death, the primary fetal outcome was stillbirth, and the primary neonatal outcome was neonatal mortality <28 days. Results: A total of 92 247 deliveries and 93 107 infants were included, of which 87.8% were born to mothers who were anaemic (mild 37.9%, moderate 49.1%, and severe 0.7%). Maternal mortality (number per 100 000) was not associated with anaemia: normal 124, mild 106, moderate 135, and severe 325 (P = 0.64). Fetal and neonatal mortality was associated with severe anaemia: stillbirth rate (n/1000)—normal 27.7, mild 25.8, moderate 30.1, and severe 90.9; P < 0.0001; 28-day neonatal mortality (n/1000)—normal 24.7, mild 22.9, moderate 28.1, and severe 72.6 (P < 0.0001). Severe maternal anaemia was also associated with low birthweight (<2500 and <1500 g), preterm birth, and postpartum haemorrhage. Conclusion: Severe maternal anaemia is associated with higher risks of poor maternal, fetal, and neonatal outcomes but other degrees of anaemia are not. Interventions directed at preventing severe anaemia in pregnant women should be considered. Tweetable abstract: Severe maternal anaemia is associated with adverse fetal and neonatal outcomes in low/middle-income countries.
KW - Anaemia
KW - low birthweight
KW - postpartum haemorrhage
KW - stillbirth
UR - http://www.scopus.com/inward/record.url?scp=85060613738&partnerID=8YFLogxK
U2 - 10.1111/1471-0528.15585
DO - 10.1111/1471-0528.15585
M3 - Article
C2 - 30554474
AN - SCOPUS:85060613738
SN - 1470-0328
VL - 126
SP - 737
EP - 743
JO - BJOG: An International Journal of Obstetrics and Gynaecology
JF - BJOG: An International Journal of Obstetrics and Gynaecology
IS - 6
ER -