Pregnancy Hemoglobin Research Articles

Haemoglobin concentrations in pregnancy and respiratory and allergic outcomes in childhood: Birth cohort study.

SummaryBackgroundLimited epidemiological evidence suggests that low maternal iron status and anaemia in pregnancy may increase the risk of childhood respiratory and allergic outcomes.ObjectivesTo investigate the relation between maternal haemoglobin concentrations in pregnancy and childhood respiratory and allergic outcomes.MethodsIn the Avon Longitudinal Study of Parents and Children (ALSPAC), we examined associations of maternal haemoglobin concentrations (g/dL) in pregnancy with hayfever, eczema, wheezing, doctor‐diagnosed asthma, allergic sensitisation and total IgE at 7 years, and with lung function at 8‐9 years in the offspring, after controlling for potential confounders (N = 3234‐5335).ResultsMaternal haemoglobin was not associated with offspring hayfever, eczema, wheezing or asthma. However, the first haemoglobin measurement in pregnancy (<18 weeks' gestation) and the last measurement (>28 weeks' gestation) were negatively associated with allergic sensitisation (adjusted odds ratio [95% CI] per g/dL 0.91 [0.83 to 0.99] and 0.90 [0.83 to 0.98], respectively). The last haemoglobin measurement was also negatively associated with total IgE (adjusted geometric mean ratio 0.94 [0.88 to 0.99]). Anaemia (haemoglobin <11 g/dL) in late pregnancy was negatively associated with forced vital capacity (difference in standard deviation score −0.07 [−0.13 to −0.01]).Conclusions and Clinical RelevanceLower maternal haemoglobin in pregnancy may be a risk factor for allergic sensitisation, elevated IgE and lower FVC in childhood, which may reflect effects of lower prenatal iron status. However, maternal haemoglobin was not associated with risk of childhood asthma or other allergic disorders.

The effects of a lipid-based nutrient supplement and antiretroviral therapy in a randomized controlled trial on iron, copper, and zinc in milk from HIV-infected Malawian mothers and associations with maternal and infant biomarkers.

We evaluated effects of antiretroviral (ARV) therapy and lipid‐based nutrient supplements (LNSs) on iron, copper, and zinc in milk of exclusively breastfeeding HIV‐infected Malawian mothers and their correlations with maternal and infant biomarkers. Human milk and blood at 2, 6, and 24 weeks post‐partum and blood during pregnancy (≤30 weeks gestation) were collected from 535 mothers/infant‐pairs in the Breastfeeding, Antiretrovirals, and Nutrition study. The participants received ARV, LNS, ARV and LNS, or no intervention from 0 to 28 weeks post‐partum. ARVs negatively affected copper and zinc milk concentrations, but only at 2 weeks, whereas LNS had no effect. Among all treatment groups, approximately 80–90% of copper and zinc and <50% of iron concentrations met the current adequate intake for infants at 2 weeks and only 1–19% at 24 weeks. Pregnancy haemoglobin was negatively correlated with milk iron at 2 and 6 weeks (r = −.18, p < .02 for both). The associations of the milk minerals with each other were the strongest correlations observed (r = .11–.47, p < .05 for all); none were found with infant biomarkers. At 2 weeks, moderately anaemic women produced milk higher in iron when ferritin was higher or TfR lower. At 6 weeks, higher maternal α‐1‐acid glycoprotein and C‐reactive protein were associated with higher milk minerals in mildly anaemic women. Infant TfR was lower when milk mineral concentrations were higher at 6 weeks and when mothers were moderately anaemic during pregnancy. ARV affects copper and zinc milk concentrations in early lactation, and maternal haemoglobin during pregnancy and lactation could influence the association between milk minerals and maternal and infant iron status and biomarkers of inflammation.

Association between malaria immunity and pregnancy outcomes among Malawian pregnant women receiving nutrient supplementation.

BackgroundMalaria antibody responses measured at delivery have been associated with protection from maternal anaemia and low birth weight deliveries. Whether malarial antibodies present in the first half of pregnancy may protect from these or other poor birth outcomes is unclear. To determine whether malaria antibodies in the first half of pregnancy predict pregnancy outcomes, antibodies were measured to a range of merozoite antigens and to antigens expressed on the surface of parasitized red blood cells (pRBCs) in plasma samples collected at 14–20 weeks of gestation from Malawian women. The latter antibodies were measured as total IgG to pRBCs, and antibodies promoting opsonic phagocytosis of pRBCs. Associations between antibodies and maternal haemoglobin in late pregnancy or newborn size were investigated, after adjusting for potential covariates.ResultsAntibodies to pRBC surface antigens were associated with higher haemoglobin concentration at 36 weeks. Total IgG to pRBCs was associated with 0.4 g/l [(95% confidence interval (0.04, 0.8)] increase in haemoglobin, and opsonizing antibody with 0.5 (0.05, 0.9) increase in haemoglobin for each 10% increase in antibody. These antibodies were not associated with birthweight, placental malaria, or newborn anthropometrics. Antibodies to merozoite antigens and non-placental-binding IEs were not associated with decreased risk of any of these outcomes. In some instances, they were negatively associated with outcomes of interest.ConclusionAntibodies to placental-binding infected erythrocytes may be associated with higher haemoglobin levels in pregnancy, whereas antibodies to other malaria antigens may instead be markers of malaria exposure. Trial registration clinicaltrials.gov NCT01239693. Registered Nov 10, 2010.

Intestinal Worm Infestation and Anaemia in Pregnant Women

Severe Anaemia during pregnancy is an important contributor to maternal mortality, as well as to the low birth weight which is in turn an important risk factor for infant mortality. We aim to determine the prevalence of anaemia in the region amongst pregnant women and identify their problems and to easily provide them with the clinical services. A community based cross sectional study done in PHCRC Chapagaun, Lalitpur from July 17,2011 to September 17,2011. Date from pregnant women presenting at PHCRC, , were filled and analysed using standard guidelines from WHO and Indian council of Medical research. Out of 192 pregnant women, the average age of pregnancy was 21-25 years (46.55), mean haemoglobin (Hb) in pregnancy was 11g/dl. Majority pregnant women are Newar (35.4%) ethnicity,67.7% of them housewives and 31.5% have primary level education. Only 24% was found to have their haemoglobin level in anaemic range. Among the pregnant women (n) =192; 48 (25%) had worm infestation, 119 (62%) had negative stool report and 25 (13%) had other than worms were found. Only about one third of the sample has actually taken albendazole. Aanaemia is prevalent in pregnant women of PHCRC, chapagaun and there was a significant correlation between anaemia and worm infestation. However, the relation among the haemoglobin level, iron, folic acid and albendazole was not significant.

Serum fructosamine a better indicator than glycated hemoglobin for monitoring gestational diabetes mellitus.

Gestational Diabetes mellitus is the condition of glucose intolerance that begins during pregnancy which is associated with both fetal and maternal complications. The measurement of serum fructosamine and glycated hemoglobin in normal and diabetic pregnancy used to investigate the influence of maternal and gestational age on concentrations of glycated proteins in serum and used to evaluate the patient's treatment. This study was done to measure the level of serum fructosamine and Glycated hemoglobin (HbA1c) in Gestational Diabetes mellitus (GDM) patients and to compare with pregnant women without diabetes and healthy non-pregnant adults, to determine the pattern of change in serum fructosamine, influence of serum fructosamine and HbA1c values and to evaluate the efficacy of patient's treatment. In this study the level of fructosamine was positively correlated to HbA1c during 2nd trimesters of gestational period, implying that the level of fructosamine can be used to screen Gestational diabetes mellitus. Correlation of glycated hemoglobin values with serum fructosamine measurements in the accurate determination of glycaemic control provides confirmation of the utility of fructosamine measurement.

Associations of Maternal Iron Intake and Hemoglobin in Pregnancy with Offspring Vascular Phenotypes and Adiposity at Age 10: Findings from the Avon Longitudinal Study of Parents and Children

BackgroundIron deficiency is common during pregnancy. Experimental animal studies suggest that it increases cardiovascular risk in the offspring.ObjectiveTo examine the relationship between maternal pregnancy dietary and supplement iron intake and hemoglobin, with offspring’s arterial stiffness (measured by carotid-radial pulse wave velocity), endothelial function (measured by brachial artery flow mediated dilatation), blood pressure, and adiposity (measured by body mass index), test for mediation by cord ferritin, birth weight, gestational age, and child dietary iron intake, and for effect modification by maternal vitamin C intake and offspring sex.DesignProspective data from 2958 mothers and children pairs at 10 years of age enrolled in an English birth cohort, the Avon Longitudinal Study for Parents and Children (ALSPAC), was analysed.Results2639 (89.2%) mothers reported dietary iron intake in pregnancy below the UK reference nutrient intake of 14.8 mg/day. 1328 (44.9%) reported taking iron supplements, and 129 (4.4%) were anemic by 18 weeks gestation. No associations were observed apart from maternal iron intake from supplements with offspring systolic blood pressure (−0.8 mmHg, 99% CI −1.7 to 0, P = 0.01 in the sample with all relevant data observed, and −0.7 mmHg, 99% CI −1.3 to 0, P = 0.008 in the sample with missing data imputed).ConclusionThere was no evidence of association between maternal pregnancy dietary iron intake, or maternal hemoglobin concentration (which is less likely to be biased by subjective reporting) with offspring outcomes. There was a modest inverse association between maternal iron supplement intake during pregnancy with offspring systolic blood pressure at 10 years.

Can hemoglobin A1c in early pregnancy predict adverse pregnancy outcomes in diabetic patients?

ObjectiveTo examine the association of elevated early pregnancy hemoglobin A1c (HbA1c) levels with adverse pregnancy outcomes in women with preexisting diabetes mellitus. Study DesignRetrospective cohort study of 330 women with preexisting diabetes enrolled in a Diabetes in Pregnancy Program at an academic institution between 2003 and 2011 who had an early HbA1c determination. The frequencies of composite maternal adverse pregnancy outcomes (birth at<37weeks, preeclampsia, and medically indicated birth <39weeks), and composite fetal adverse pregnancy outcomes [shoulder dystocia, Apgar scores<7 at 5minutes, small for gestational age (SGA), large for gestational age (LGA), and stillbirth] were compared between HbA1c categories (<6.5, 6.5–7.4, 7.5–8.4 and ≥8.5%). ResultsThere was no statistically significant difference between composite adverse maternal pregnancy outcomes and composite adverse fetal pregnancy outcomes as well as other individual outcomes between different HbA1c categories. Of the vaginally delivered women in our cohort, the 37 patients with HbA1c levels of≥8.5% had a significantly higher frequency of fetal shoulder dystocia than the 62 with HbA1c levels of<8.5% (24.2 vs. 1.6%, P=0.002). Neonates of patients with HbA1c≥8.5% were more likely to have low five minute Apgar scores than neonates of patients with HbA1c<8.5%, but this was of borderline statistical significance (7.4% vs. 0.5%, P=0.05). ConclusionIn patients with preexisting diabetes mellitus, HbA1c levels of≥8.5% during early pregnancy are not useful in predicting most adverse outcomes, although there may be an increased risk for shoulder dystocia.

Prenatal diagnosis of β-thalassemia in Guangxi Zhuang Autonomous Region, China

The aim of this study was to establish a comprehensive prenatal diagnosis service and to control the birth of thalassemia children in Guangxi Zhuang Automonous Region, China. Prenatal diagnosis was performed in 1,058 couples with 'at risk' β-thalassemia from Guangxi Zhuang Automonous Region. Fetal samplings were collected by chorionic villus sampling in the first trimester, by amniocentesis in the second trimester and by cordocentesis in the third trimester. DNA analysis was carried out using polymerase chain reaction, reverse dot blot assay, multiplex ligation-dependent probe amplification method and DNA sequencing. Automated high-performance liquid chromatography system was used to analyze the fetal hemoglobin in pregnancies in case mutations were unidentified. A total of 12 different β-thalassemia mutations were characterized from 2,116 parents. The most common mutation for β-thalassemia was CD41-42 (-CTTT) followed by CD17 (A→T). Prenatal testing revealed 315 normal fetuses, 500 carriers and 253 β-thalassemia major fetuses. The couples having fetuses with β-thalassemia major were counselled to terminate the pregnancies. Postnatal follow-up confirmed all pregnancies. Our prenatal diagnosis strategy proved to be highly effective in reducing severe thalassemia in pregnant populations.

English

English

Efficacy of micronutrient supplement intake in increasing hemoglobin in pregnancy: dose‐effect comparisons with multiple micronutrient in the MINIMat trial in rural Bangladesh

It is unclear how large amount of supplemental iron is required to reach maximum hemoglobin concentration in pregnancy and whether addition of multiple micronutrients modify supplement efficacy In the MINIMat prenatal nutrition trial in Bangladesh (ISRCTN16581394) 4436 pregnant women were randomised into 3 types of supplement; either 30 mg Fe and 400 μg folic acid (FE30), or 60 mg Fe and 400 μg folic acid (FE60), or a multiple micronutrient supplement (MMS) containing a daily allowance of 15 micronutrients including 30 mg Fe and folic acid starting at around 14 wk. Adherence was monitored by use of a drug container equipped with an electronic device (eDEM; Aprex). Number of capsules taken between wk14 and wk30 were converted to amount of iron before dose‐response on hemoglobin concentrations at wk30 of gestation were evaluated using adjusted multivariate regression analyses. All 3 types of supplement produced a significant dose effect up to a similar intake of iron (about 2400 mg) after which no further significant effect was observed. In the intake range below 2400mg and evaluated per mg iron ingested; efficacy of Fe60 was higher then Fe30 and higher than MMS. There was no such difference between Fe30 and MMS. The results showed that a lower total amount of iron than commonly recommended is required for maximum hemoglobin response and addition of multiple micronutrients did not modify efficacy. Main source of funds came from icddr,b Bangladesh, UNICEF, and Sida Sweden

Glycosylated haemoglobin (HbA1c) in pregnancy

Glycosylated haemoglobin (HbA1c) in pregnancy

Effect of Periodontal Infection on Birth Weight of Infants: A Clinical and Microbiological Study*

Background: Maternal periodontal infection has been proposed to influence pre-term delivery and low birth weight infants through mechanisms involving inflammatory mediators or direct bacterial assault on the amnion. Thus, the aim of the present study was to assess the presence of periodontal pathogens in maternal periodontal infection and their effect on the birth weight of infants. Materials and Methods: The case-control study included 30 mothers with a singleton gestation and gestational age of >37 weeks. Data regarding the periodontal status, pregnancy outcome variables, hemoglobin levels (Hb%) and other factors that may influence adverse pregnancy outcomes were collected. A qualitative analysis of the predominant anaerobic organisms was conducted. The data was analysed using one-way ANOVA test and Scheffe’s test. Results: The microbiological results showed that prevalent colonies of organisms isolated from the experimental groups were of Bacteroides spp. (n = 3), Fusobacterium spp. (n = 3) and Peptostreptococcus spp. (n = 9). In the control group, Peptostreptococcus spp. (n = 15) were predominant. In the experimental group, it was seen that Bacteroides spp. (p = 0.003) and Fusobacterium spp. (p = 0.050) were statistically significant with the birth weight of the infant. The one-way ANOVA test showed that the birth weight of the infant was inversely proportionate with increase in severity of the periodontal disease. Scheffe’s test showed that presence of a periodontal pocket showed most significance to the birth weight of an infant as compared to presence of local factors or bleeding on probing. Conclusion: The study revealed that the gram negative organisms, Bacteroides spp. and Fusobacterium spp. were significantly associated with the low birth weight (LBW) of the infants, although there was not a significant difference in the clinical periodontal status between the experimental groups and the controls. It could be proposed that specific groups of pathogens may have a contributory role in the risk of LBW.

290: Association of early pregnancy hemoglobin A1c with placental lesions in diabetic pregnancy

290 Association of early pregnancy hemoglobin 1c with placental lesions in diabetic pregnancy Roman Starikov, Vrishali Lopes, Kyle Inman, Dwight Rouse, renna Anderson, Kenneth Chen, Mai He Women & Infants Hospital of RI and the Warren Alpert Medical School of rown University, Obstetrics and Gynecology, Division of Maternal Fetal edicine, Providence, RI, Women & Infants Hospital of RI and the Warren Alpert Medical School of Brown University, Department of Research, Providence, RI, Women & Infants Hospital of RI and the Warren Alpert edical School of Brown University, Department of Medicine, Providence, I, Women & Infants Hospital of RI and the Warren Alpert Medical School of Brown University, Department of Pathology, Providence, RI OBJECTIVE: To examine the association between hemoglobin A1c HbA1c) levels measured during early pregnancy and histopathologcal lesions in the placentas of women with pregestational diabetes ellitus. STUDY DESIGN: Retrospective cohort study conducted from 2003 to 011 at a large tertiary care center. Women included had a singleton estation, pregestational diabetes mellitus, and information about deivery and placental pathology available for review. To quantify plaental lesions, the Index of Placental Changes (IPC) was calculated: PC Total Score 100/(37 n). “Total score” is the total number f lesions identified for a group of patients, 37 is the potential number f distinct lesions (Table), and “n” is the number of placentas examned. The IPC was compared across three groups of patients with iffering HbA1c levels ( 6.5%, 6.5-8.4%, and 8.5%). A linear reression plot was created with HbA1c as the continuous variable and PC as the primary outcome. We controlled for the following conounding variables: mean fasting and two-hour post-prandial glucose alues throughout pregnancy, and type of diabetes (1 vs. 2). RESULTS: 293 placentas were examined. HbA1c was measured at a ean of 9.5 wks’ gestation. 39.9% of women had type 1 and 60.1% had ype 2 diabetes. Median HbA1c was 7.5%(interquartile range 6.5%.9%). 23% of the cohort had HbA1c 6.5%, 41.9% had HbA1c of .5%-8.4%, and 34.8% had HbA1c 8.5%. BMI varied significantly by roup (35.4 vs. 34.4 vs. 32. from lowest to highest, respectively, P 0.04), ut maternal age, gravidity, parity, or race did not. There was no assocition of the IPC with HbA1c whether assessed categorically (10.5 vs. 10.1 s.10.4, respectively, P 0.7) or continuously, P 0.85. CONCLUSION: HbA1c value in early pregnancy does not predict the frequency of placental histopathological lesions among diabetic gravidas.

Glycated hemoglobin in pregnancies at increased risk for gestational diabetes mellitus

The glycated hemoglobin (HbA(1c)) value is increasingly used for the detection of (pre)diabetes, but HbA(1c) decreases during pregnancy. We sought to identify clinical and metabolic correlates of HbA(1c) in pregnancies at increased risk for gestational diabetes mellitus (GDM). We prospectively studied 335 gravidas who received a 3-h 100g oral glucose tolerance test (OGTT) at 24-32 weeks, in most cases after an abnormal glucose challenge test. Several indices of insulin sensitivity and secretion were computed from fasting measurements and the OGTT. HbA(1c) concentrations gradually increased in diet-treated and insulin-treated GDM gravidas compared with non-GDM gravidas. HbA(1c) was higher if the insulin peak was delayed until 180 min compared with 60 or 120 min. Stepwise regression identified the homeostasis modeling assessment of insulin resistance (HOMA-IR) as the first-rank correlate. Other correlates were ethnicity, a low insulin-to-glucose response at 60 min, and gestational age. The HbA(1c) value corresponding to a fasting glucose of 5.1 mmol/l (diagnostic of GDM) was 2 mmol/mol (~0.2%) higher if sampling occurred at 29-32 vs. 24-28 weeks or if ancestry was non-European vs. European. HbA(1c) is strongly associated with insulin resistance; in addition, HbA(1c) captures the first-phase insulin response. However, HbA(1c) varies with gestational age and ethnicity.

Iron intake, haemoglobin and risk of gestational diabetes: a prospective cohort study

ObjectiveTo investigate the possible association between total daily iron intake during pregnancy, haemoglobin in early pregnancy and the risk of gestational diabetes mellitus (GDM) in women at increased risk of...

Association between different levels of hemoglobin in pregnancy and pregnancy outcomes: a registry-based study in Northwest Russia

The association between maternal anemia andpregnancy outcomes has been investigated inmany epidemiological studies, but the findingsremain inconsistent. In our previousstudy based on the Kola Birth Registry (KBR), we observed that maternal anemia defined ashemoglobin concentration below 120 g/l wasnegatively associated with the risk of stillbirthand preterm birth and positively associatedwith foetal growth (1). However, our anemicgroup was heterogeneous and included womenwith hemoglobin between 110 and 120 g/l, which cannot be classified as anemic accordingto the WHO. This study aims to achieve a moredetailed analysis of different maternal hemoglobinconcentrations and their associationswith stillbirth, preterm birth and foetal growthin using the data from the KBR.

Amniotic fluid concentrations of soluble scavenger receptor for hemoglobin (sCD163) in pregnancy complicated by preterm premature rupture of the membranes and histologic chorioamnionitis

Objective. To determine changes in the amniotic fluid, soluble form of scavenger receptor for hemoglobin (sCD163) concentrations during advancing gestation, and in patients with preterm premature rupture of membranes (PPROM) complicated by histological chorioamnionitis were studied.Methods. One hundred and fifty-two women with singleton pregnancies were enrolled. The concentration of sCD163 in amniotic fluid was determined using sandwich enzyme immunoassay technique.Results. Women in the midtrimester had a significantly higher median amniotic fluid sCD163 concentration than those at term not in labor (308 ng/ml vs. 217 ng/ml; p = 0.04). Patients with PPROM and histological chorioamnionitis had a higher median amniotic fluid sCD163 level than those with PPROM without histological chorioamnionitis (885 ng/ml vs. 288 ng/ml; p < 0.0001).Conclusions. Amniotic fluid sCD163 concentrations decrease with advancing gestation. Amniotic fluid sCD163 concentrations are significantly higher in women with PPROM between 24 and 36 gestational weeks with histological chorioamnionitis than those without histological signs of inflammation.

Arterial Stiffness, Fatness, and Physical Fitness

Arterial distensibility and its converse stiffness have come of age as physiological concepts1 and now as a target for intervention. The central hypothesis sustained so far is that an individual’s “arterial stiffness” measured as aortic pulse wave velocity (PWV) is a convenient, integrated index of vascular pathology over a person’s life course, more precise and reliable than other risk factors individually. For example, blood pressure (BP), whether casual or 24 hour, is more sensitive to stimuli and, therefore, more variable. Arterial distensibility is in part dependent on BP, yet its prognostic power is because of its “independence” from BP, including pulse pressure.2 It appears to indicate the general burden of atherosclerotic disease and subclinical damage from multiple risk factors over time: the “wear and tear” of constant distension and recoil (part of “aging”), effects of smoking, lipid metabolism, (hyper)glycemia, ethnicity, how family history expresses itself, etc.3 European hypertension guidelines now include PWV as a recommended but optional measure. The relationship of arterial distensibility with cardiac function and structure, known as aorto-ventricular coupling, is tantalizing because, as a bioengineering feedback loop, cause and effect are still unclear. Many other key questions remain, most critically related to the natural history of arterial stiffness but also fundamental ones of basic structural biology in the vessel wall. A clue to the natural history of arterial stiffness is published in this issue of Hypertension , an Australian study of 9- to 10-year-old, generally prepubescent schoolchildren.4 The study shows a clear relationship among degree of body fat, physical fitness, and arterial stiffness, measured by carotid-femoral PWV. The link of PWV with fitness was not independent of body fat. Why should this article be of interest, being only cross-sectional, whereby association may well …

Amniotic fluid fetal hemoglobin in normal pregnancies and pregnancies complicated with preterm labor or prelabor rupture of membranes

Objective. Hemoglobin and its catabolic products have been associated with amniotic fluid (AF) discoloration and intra-amniotic infection/inflammation (IAI). However, the origin of AF hemoglobin (maternal or fetal) has not been determined. The aims of this study were to determine if fetal hemoglobin can be detected in AF obtained from normal pregnancies, and whether there is an association between AF fetal hemoglobin concentrations and gestational age, spontaneous labor (term and preterm), preterm prelabor rupture of membranes (PPROM) and IAI.Study design. This cross-sectional study included pregnant women in the following groups: (1) mid-trimester (n = 60); (2) term not in labor (n = 21); (3) term in labor (n = 47); (4) spontaneous preterm labor with intact membranes (PTL) without IAI who delivered at term (n = 89); (5) PTL without IAI who delivered preterm (n = 74); (6) PTL with IAI (n = 78); (7) PPROM with (n = 48) and (8) without IAI (n = 48). AF fetal hemoglobin concentrations were determined by ELISA. Non-parametric statistics were used for analyses.Results. (1) Fetal hemoglobin was detected in 80.4% of all AF samples; (2) women at term not in labor had a higher median AF fetal hemoglobin concentration than those at mid-trimester (p = 0.008); (3) labor at term was not associated with a significant difference in the median AF fetal hemoglobin concentration; (4) the median AF fetal hemoglobin concentration was not significantly different among the three PTL groups or between the PPROM groups; (5) women with PTL and IAI had a lower AF fetal hemoglobin percentage of the total hemoglobin than those without IAI who delivered preterm (p = 0.03) or at term (p < 0.001); (6) The median AF fetal hemoglobin concentration was higher in pregnancies complicated with PTL or PPROM than in women at term (p < 0.001 for all comparison).Conclusions. (1) The concentration of immunoreactive AF fetal hemoglobin increases with gestational age; (2) the median AF fetal hemoglobin concentration is higher in pregnancies complicated with PTL or PPROM than in term pregnancies; (3) among women with PTL or PPROM, the AF fetal hemoglobin concentrations were not associated with IAI; (4) however, women with PTL and IAI had a lower percentage of AF fetal hemoglobin of the total hemoglobin than those without IAI, suggesting different mechanisms of disease.

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