Maternal Hemoglobin Concentration and Pregnancy Outcome: A Study of the Effects of Elevation in El Alto, Bolivia

Abstract

Iron-defciency anemia is often under-diagnosed in developing coun- tries, specifcally in pregnant populations in regions of high altitude. Hemoglobin levels are not consistently adjusted for elevation, and therefore many anemic pa- tients are left undiagnosed. The purpose of this study was to incorporate current parameters for diagnosing anemia in pregnancy at high altitudes, and to evaluate the effects of appropriately adjusted hemoglobin concentrations on pregnancy out- come. A few studies have examined the effect of elevation on hemoglobin status, and other studies have considered the effects of anemia of pregnancy; however, there is a lack of data demonstrating that altitude-adjusted hemoglobin levels ac- curately predict pregnancy outcome. Using the Student t-Test, multiple linear re- gression, and ANOVA statistical analyses, various factors of pregnancy outcome were compared between anemic and non-anemic groups, as defned by hemoglobin cut-off levels adjusted for trimester of pregnancy and altitude. when appropriate adjustments were used, maternal anemia was associated with lower infant Apgar scores at both one minute and fve minutes after birth, as well as complication of labor, lower gestational age at birth, and higher parity. This study demonstrates the importance of altitude and trimester specifc adjustments to maternal hemoglobin levels in order to accurately diagnose anemia in pregnancy. In addition, a clear cor- relation is seen between maternal hemoglobin level and pregnancy outcome.