708: Is gestational anemia a risk factor of severe maternal morbidity?

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Preoperative anemia is a well-known risk factor for postoperative complications. Anemia during pregnancy is frequent and associated with an increased incidence of adverse outcomes for the infant. However, its association with severe maternal complications remains poorly documented. The objective of this study was to explore the association between gestational anemia and severe acute maternal morbidity (SAMM). We performed a case-control study nested in the EPIMOMS study, a French prospective population study (2012- 2013). Cases were women with SAMM (n=2018), and controls were women who delivered without SAMM (n=3234). Anemia was explored in 2 (hemoglobinemia [Hb]≥11g/dL or not) and 3 classes ([Hb] < 10, 10-11, ≥11g/dL). Hemoglobin level was measured before SAMM in cases and before delivery in controls. The association between gestational anemia and SAMM was studied overall, according to the timing of SAMM occurrence (antepartum, intra-postpartum), to the causal pathology (obstetric hemorrhage, hypertensive pregnancy disorders, others) and by mode of delivery, through univariate then multivariate logistic regression adjusted for maternal, pregnancy and delivery characteristics using multiple imputation of missing data. The prevalence of gestational anemia was 25.3% in cases and 16.3% in controls (p<0.001). Gestational anemia was significantly associated with SAMM overall (Adjusted Odds Ratio aOR=1.7 95%CI [1.5;2.0]), ante-partum (aOR=2.2 95%CI [1.6;3.0]), and intra-postpartum (aOR= 1.7 95%CI [1.4;2.0]) and for both vaginal (aOR=1.6 95%CI [1.3 -1.9]) or cesarean delivery (aOR=1.7 95%CI [(1.3-2.2]). Within intra-postpartum SAMM, gestational anemia was significantly associated with severe obstetric hemorrhage (aOR=1.7 95%CI [1.4;2.0]), severe pregnancy hypertensive disorder (aOR=1.4 95%CI[1.0;2.1]) and other cause of SAMM (aOR=1.4 95%CI [1.0;2.1]), mainly represented by digestive and psychiatric disorders. In this French population-based study, gestational anemia affects one pregnant woman out of 6. Gestational anemia is a risk factor for severe acute maternal morbidity overall, antepartum and intra-postpartum and from all considered causal categories. These results highlight the importance of diagnosing and treating anemia during pregnancy.