Effect of Anemia on Adverse Perinatal Outcomes Is Greater in Black Women at Varying Hemoglobin Concentrations [ID: 1380962

Abstract

INTRODUCTION: Maternal anemia affects 40% of pregnancies worldwide. It is associated with adverse birth outcomes, including preterm birth (PTB), which disproportionally affects Black women. We compared adverse perinatal outcomes and anemia as defined by World Health Organization/Centers for Disease Control and Prevention (hemoglobin [Hb]<11 g/dL) and institutional guidelines (Hb<12 g/dL), among Black women. METHODS: Institutional review board-approved retrospective cohort study was performed on patients delivered at Community Regional Medical Center, Fresno, California, from 2015 to 2016. Data abstraction included gestational age, first- and third-trimester Hb, race and ethnicity, parity, maternal age, mode of delivery, and neonatal outcomes. Exclusion criteria included hemoglobinopathies, tobacco use, uterine abnormalities, multiple gestation, and prior PTB or cervical surgery. RESULTS: Birth outcomes of 1,305 term and 990 PTB were analyzed for anemia at Hb less than 11 g/dL and less than 12 g/dL. Black women with PTB (83.8%) had significantly higher rates of anemia compared to term (68.8%) at Hb less than 12 g/dL (P<.05) versus Hb less than 11 g/dL (P>.05). Compared with other ethnicities (n=2,104), Black women (n=193) showed significantly higher rate of first- (47.60% versus 24.3%; P<.01) and third-trimester anemia (75.10% versus 59.50%, P<.01), low birth weight (LBW) neonates (38.70% versus 26.20% not-AA, P<.1), and lower 1- and 5-minute Apgar scores (32.30% and 15.30% versus 22.90% and 8.70% not-AA, respectively; P<.05) at Hb less than 12 g/dL. CONCLUSION: Significant association of anemia with PTB, LBW, and lower Apgar scores was noted in Black women at HB less than 12 g/dL. Further studies with larger sample sizes are needed to evaluate the need for redefining anemia Hb concentration for Black women, which may help initiate early treatment and prevent adverse perinatal outcomes.