Maternal Hemoglobin Concentration Research Articles

Maternal Haemoglobin and Short-Term Neonatal Outcome in Preterm Neonates

ObjectiveTo determine whether there is a significant association between maternal haemoglobin measured before delivery and short-term neonatal outcome in very preterm neonates.Study designWe included prospectively all live births occurring from 25 to 32+6 weeks of gestation in a tertiary care centre between January 1st 2009 and December 31st 2011. Outborn infants and infants presenting with lethal malformations were excluded. Three hundred and thirty-nine mothers and 409 infants met the inclusion criteria. For each mother-infant pair a prospective record of epidemiologic data was performed and maternal haemoglobin concentration recorded within 24 hours before delivery was retrospectively researched. Maternal haemoglobin was divided into quartiles with the second and the third one regarded as reference as they were composed of normal haemoglobin values. Short-term outcome was defined as poor in case of death during hospital stay and/or grades III/IV intraventricular haemorrhage and/or periventricular leukomalacia and/or necessity of ventriculoperitoneal shunt.ResultsThe global rate of poor short-term neonatal outcome was 11.4% and was significantly associated with low maternal haemoglobin values. This association remained significant after adjustment for antenatal corticosteroids therapy, gestational age, parity, mechanism of preterm birth, mode of delivery and birth weight (aOR = 2.97 CI 95% [1.36–6.47]). There was no relation between short-term neonatal outcome and high maternal haemoglobin concentration values.ConclusionWe show that low maternal haemoglobin concentration at delivery is an independent risk factor for poor short-term neonatal outcome in very preterm neonates. This study is one of the first to show such an association within the preterm population.

Is low iron status a risk factor for neural tube defects?

Folic acid supplements can protect against neural tube defects (NTDs). Low folate and low vitamin B12 status may be maternal risk factors for having an NTD affected pregnancy. However, not all NTDs are preventable by having an adequate folate/ B12 status and other potentially modifiable factors may be involved. Folate and vitamin B12 status have important links to iron metabolism. Animal studies support an association between poor iron status and NTDs, but human data are scarce. We examined the relevance of low iron status in a nested NTD case-control study of women within a pregnant population-based cohort. Pregnant women were recruited between 1986 and 1990, when vitamin or iron supplementation in early pregnancy was rare. Blood samples, taken at an average of 14 weeks gestation, were used to measure ferritin and hemoglobin in 64 women during an NTD affected pregnancy and 207 women with unaffected pregnancies. No significant differences in maternal ferritin or hemoglobin concentrations were observed between NTD affected and nonaffected pregnancies (case median ferritin 16.9 µg/L and hemoglobin 12.4 g/dl versus 15.4 µg/L and 12.3g/dl in controls). As reported previously, red cell folate and vitamin B12 concentrations were significantly lower in cases. Furthermore, there was no significant association of iron status with type of NTD lesion (anencephaly or spina bifida). We conclude that low maternal iron status during early pregnancy is not an independent risk factor for NTDs. Adding iron to folic acid for periconceptional use may improve iron status but is not likely to prevent NTDs.

Is maternal anemia associated with small placental volume in the first trimester?

To clarify whether maternal anemia could reduce placental volume in the early gestation. A prospective cross-sectional study was conducted. Consecutive women who visited at 11-13 + 6 weeks' gestation were enrolled. Subjects were divided into two groups by maternal hemoglobin concentration. Cases with maternal anemia were defined as a hemoglobin level less than 11 g/dl on a blood test (cases), and the others were defined as controls. An ultrasound examination was performed to measure the placental volume and the uterine arterial blood flow. The three-dimensional volume of the placenta using virtual organ computer-aided analysis (VOCAL) technique was acquired by transabdominal ultrasonography. Placental volumes were compared in women with and without anemia. 31 cases and 486 controls were analyzed. Maternal characteristics were not different between two groups except anemia. Placental volumes were 63.6 ± 22.2 and 60.9 ± 22.8 cm(3) (ns), uterine arterial RIs were 0.7 ± 0.1 and 0.8 ± 0.1 (ns), and PIs were 1.7 ± 0.5 and 1.8 ± 0.6 (ns) in cases and controls, respectively. Maternal anemia was not associated with reduced placental volume and uterine arterial Doppler wave form at 11-13 weeks' gestation.

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.

Coverage and efficacy of intermittent preventive treatment with sulphadoxine pyrimethamine against malaria in pregnancy in Côte d¿Ivoire five years after its implementation

The World Health Organization (WHO) recommends for sub-Saharan Africa a package of prompt and effective case-management combined with the delivery of insecticide-treated nets (ITN) and intermittent preventive treatment during pregnancy (IPTp) with sulphadoxine-pyrimethamine (SP) through the national antenatal care (ANC) programs. Implemented in Côte d’Ivoire around 2005, few Data on IPTp coverage and efficacy in the country are available. A multicentre, cross-sectional survey was conducted in Côte d’Ivoire from September 2009 to May 2010 at six urban and rural antenatal clinics. IPTp-sp coverage, Socio-economic and obstetrical data of mothers and neonate birth weights were documented. Peripheral blood as well as placental and cord blood were used to prepare thick and thin blood films. In addition, pieces of placental tissues were used to prepare impression smears and maternal haemoglobin concentration was measured. Regression logistics were used to study factors associated with placental malaria and LBW (<2.500 grams). A total of 1317 delivered women were enrolled with a median age of 26 years. A proportion of 43.28% of the women had received at least two doses of IPTsp during the current pregnancy although a high proportion (90.4%) of women received antenatal care and made enough visits (≥ 2). Variability in the results was observed depending on the type of area (rural/urban). Plasmodium falciparum was detected in the peripheral blood of 97 women (7.3%) and in the placenta of 119 women (9%). LBW infants were born to 18.8% (22/107) of women with placental malaria and 8.5% (103/1097) of women without placental malaria. LBW was associated with placental malaria. This study found relative low coverage of IPTp in the study areas which supported findings that high ANC attendance does not guarantee high IPTp coverage. Urgent efforts are required to improve service delivery of this important intervention.

Maternal Vitamin A Deficiency during Pregnancy and Its Relation with Maternal and Neonatal Hemoglobin Concentrations among Poor Egyptian Families

Background. Vitamin A deficiency (VAD) during pregnancy represents a major public health problem in developing countries. Anemia is a common consequence of VAD. We aimed to measure serum retinol concentrations of a sample of poor Egyptian mothers and correlate it with their Hb% and cord Hb%. Methods. This cross-sectional study included 200 healthy mothers and their healthy full term newborns. Maternal and cord blood samples were collected for CBC and measurement of serum retinol concentrations. Results. Forty-seven mothers (23.5%) had VAD and 50% were anemic. Mothers with VAD had a significantly lower mean Hb% and a significantly higher frequency of anemia (95.7%) compared to mothers without VAD (35.9%). The relative risk for anemia among mothers with VAD was 2.7 (CI = 2.12–3.3). Newborns of mothers with VAD had a significantly lower mean cord Hb% compared to newborns of mothers without VAD. Maternal serum retinol concentrations were positively correlated with maternal Hb% and cord Hb%. Conclusion. Maternal VAD during pregnancy among poor mothers is associated with maternal anemia and lower Hb% of newborns at birth. Vitamin A supplementation is highly recommended for this vulnerable group.

Anaemia, prenatal iron use, and risk of adverse pregnancy outcomes: systematic review and meta-analysis

Objectives To summarise evidence on the associations of maternal anaemia and prenatal iron use with maternal haematological and adverse pregnancy outcomes; and to evaluate potential exposure-response relations of dose of...

Malaria Risk Factors in Women on Intermittent Preventive Treatment at Delivery and Their Effects on Pregnancy Outcome in Sanaga-Maritime, Cameroon

Malaria is known to have a negative impact on pregnant women and their foetuses. The efficacy of Sulfadoxine-Pyrimethamine (SP) used for intermittent preventive treatment (IPT) is being threatened by increasing levels of resistance. This study assessed malaria risk factors in women on intermittent preventive treatment with SP (IPTp-SP) at delivery and their effects on pregnancy outcome in Sanaga-Maritime Division, Cameroon. Socio-economic and obstetrical data of mothers and neonate birth weights were documented. Peripheral blood from 201 mothers and newborns as well as placental and cord blood were used to prepare thick and thin blood films. Maternal haemoglobin concentration was measured. The overall malaria parasite prevalence was 22.9% and 6.0% in mothers and newborns respectively. Monthly income lower than 28000 FCFA and young age were significantly associated with higher prevalence of placental malaria infection (p = 0.0048 and p = 0.019 respectively). Maternal infection significantly increased the risk of infection in newborns (OR = 48.4; p<0.0001). Haemoglobin concentration and birth weight were lower in infected mothers, although not significant. HIV infection was recorded in 6.0% of mothers and increased by 5-folds the risk of malaria parasite infection (OR = 5.38, p = 0.007). Attendance at antenatal clinic and level of education significantly influenced the utilisation of IPTp-SP (p<0.0001 and p = 0.018 respectively). Use of SP and mosquito net resulted in improved pregnancy outcome especially in primiparous, though the difference was not significant. Malaria infection in pregnancy is common and increases the risk of neonatal malaria infection. Preventive strategies are poorly implemented and their utilization has overall reasonable effect on malaria infection and pregnancy outcome.

Soluble CD163, a Product of Monocyte/Macrophage Activation, Is Inversely Associated with Haemoglobin Levels in Placental Malaria

In Plasmodium falciparum malaria, activation of monocytes and macrophages (monocytes/macrophages) can result in the production of various inflammatory mediators that contribute to immunopathology. Soluble CD163 (sCD163) is a specific marker of monocyte/macrophage activation typically found at increased levels during various inflammatory conditions and can be associated with poor clinical outcomes. To better understand the relationships between levels of sCD163 and clinical parameters in women with placental malaria, we measured plasma sCD163 levels in maternal peripheral and placental blood compartments at delivery and determined their correlations with birth weight and maternal haemoglobin concentrations. sCD163 levels were negatively correlated with birth weight only in the placental compartment (r = −0.145, p = 0.03) and were inversely correlated with maternal haemoglobin concentrations, both in peripheral blood (r = −0.238, p = 0.0004) and in placental blood (r = −0.259, p = 0.0001). These inverse relationships suggest a potential role for monocyte/macrophage activation in the pathogenesis of malaria in pregnancy, particularly in relation to malaria-associated anaemia.

PF.25 Relationship Between Maternal Antibody Level and Fetal Haemoglobin Concentration in Pregnancies Complicated by Rhesus-D Alloimmunization

BackgroundCurrently, maternal Rh-D antibody levels are primarily used to triage which alloimmunized women warrant enhanced surveillance with middle cerebral artery Doppler. Traditionally, maternal Rh-D antibody levels ≤15 IU/ml have indicated,...

Micronutrient Supplementation and Pregnancy Outcomes

Beyond perinatal folic acid supplementation, the need for additional prenatal prophylaxis of iron with or without other micronutrients remains unclear. We aim to investigate the maternal and infant health effects of iron plus folic acid and multiple micronutrient supplements vs folic acid alone when provided to pregnant women with no or mild anemia. In this randomized double-blind controlled trial, 18,775 nulliparous pregnant women with mild or no anemia were enrolled from 5 counties of northern China from May 2006 through April 2009. Women were randomly assigned to daily folic acid (400 μg) (control), folic acid-iron (30 mg), or folic acid, iron, and 13 additional vitamins and minerals provided before 20 weeks gestation to delivery. Primary outcome was perinatal mortality. Secondary outcomes included neonatal and infant mortality, preterm delivery, birth weight, birth length, gestational duration, and maternal hemoglobin concentration and anemia. A total of 92.7% of women consumed 80% to 100% of supplements as instructed. On average, women consumed 177 supplements. Compared with daily prenatal folic acid, supplementation with iron-folic acid with or without other micronutrients did not affect the rate of perinatal mortality (8.8, 8.7, and 8.3, respectively) per 1000 births, and relative risks (RRs) were 1.00 (95% CI, 0.68-1.46; P = .99) and 0.94 (95% CI, 0.64-1.39; P = .76), respectively. Risk of other adverse maternal and infant outcomes also did not differ, except that RRs for third-trimester maternal anemia were 0.72 (95% CI, 0.63-0.83; P < .001) and 0.71 (95% CI, 0.62-0.82; P < .001), respectively. Prenatal iron-folic acid and other micronutrient supplements provided to Chinese women with no or mild anemia prevented later pregnancy anemia beyond any benefit conferred by folic acid alone but did not affect perinatal mortality or other infant outcomes. clinicaltrials.gov Identifier: NCT00133744.

Anemia before pregnancy and risk of preterm birth, low birth weight and small-for-gestational-age birth in Korean women

Maternal prepregnancy hemoglobin concentration has rarely been explored as a risk of poor birth outcomes. This study examined whether women with anemia before pregnancy would be at higher risk of preterm birth, low birth weight (LBW) and small-for-gestational-age (SGA) birth. This retrospective cohort study was conducted on 70,895 Korean women who delivered a singleton in 1999, with their prepregnancy hemoglobin concentration measured at health examinations in 1997-1999. A logistic model was used to adjust for confounding variables and calculate odds ratios (ORs) and 95% confidence intervals (CIs). In adjusted analysis, moderate-to-severe anemia (hemoglobin <100 g/l) before pregnancy was associated with preterm birth (OR, 1.53; 95% CI, 1.05-2.23; P=0.027), LBW (OR, 1.81; 95% CI, 1.24-2.64; P=0.002) and SGA (OR, 1.71; 95% CI, 1.35-2.17; P<0.001) when compared with prepregnancy hemoglobin of 120-149 g/l. Mild anemia (hemoglobin of 100-119 g/l) was also associated with LBW (OR, 1.21; 95% CI, 1.06-1.39; P=0.005) and SGA (OR, 1.15; 95% CI, 1.06-1.25; P=0.001). The risk of preterm birth, LBW and SGA across 11 prepregnancy hemoglobin groups depended on the severity of anemia (P for trend=0.042, 0.019, and 0.001, respectively). A high hemoglobin concentration (≥150 g/l), however, was not associated with adverse birth outcomes. Anemia, not high hemoglobin concentration, before pregnancy was associated with an elevated risk of preterm birth, LBW and SGA, and the risk increased with the severity of anemia in Korean women.

561: Relationship between maternal antibody level and fetal hemoglobin concentration in pregnancies complicated by Rh-D alloimmunization

Background Currently, maternal Rh-D antibody levels are primarily used to triage which alloimmunized women warrant enhanced surveillance with middle cerebral artery Doppler. Traditionally, maternal Rh-D antibody levels ≤15 IU/ml have indicated, at worst, mild anaemia and provided reassurance. This threshold has not been widely studied. Methods A prospective cohort study of all intrauterine fetal transfusions (IUT) for Rh-D alloimmunization performed at our tertiary fetal medicine unit from 1996–2011. Fetal haemoglobin (Hb) levels at the time of IUT were adjusted for gestational age (multiples of median [MoM]) and correlated with the maternal serum Rh-D antibody level taken on the day of IUT, or ≤2 weeks prior to the transfusion. Results 260 IUTs were performed, of which 195 were for Rh-D alloimmunzation in 82 pregnancies. No significant correlation was demonstrated between fetal Hb and serum antibody levels (Spearman r = 0.08; p = 0.35). Rates of mild (0.65–0.84 MoM), moderate (0.55–0.64 MoM) and severe ( 15 IU/ml for detecting any fetal anaemia ( 15 IU/ml detecting moderate-severe anaemia ( 8 IU/ml, the sensitivity, specificity, PPV and NPV of maternal serum antibody levels detecting any fetal anaemia were 96%, 5%, 85% and 17% respectively. Conclusion The widely used Rh-D threshold of >15 IU/ml may miss a substantial proportion of cases of fetal anaemia.

Malaria and gravidity interact to modify maternal haemoglobin concentrations during pregnancy

BackgroundPrimigravidity is one of the main risk factors for both malaria and anaemia. Since the implementation of intermittent preventive treatment (IPTp) in sub-Saharan Africa, the relationship between anaemia and gravidity and its evolution during pregnancy has been little explored. This study aimed to evaluate the impact of gravidity on the variation of haemoglobin during pregnancy according to the timing of gestation.MethodsData from three studies carried out in nearby areas in south Benin (Ouidah, Comé, Allada) between 2005 and 2012 were analysed. At inclusion (first antenatal visit, ANV1) women’s age, area of residence, schooling, gravidity, gestational age, weight and height were recorded. Thick blood smears were performed on ANV1, second visit (ANV2) and at delivery. In Allada, women’s serum ferritin and CRP concentrations were also assessed. The impact of gravidity on maternal haemoglobin (Hb) was analysed using a logistic or linear regression depending on the outcome. The statistical significance was set to P < 0.05.ResultsIn total, data from 3,591 pregnant women were analysed. Both univariate and multivariate analyses showed a constant association between Hb concentrations and gravidity in the three periods of Hb assessment (ANV1, ANV2 and delivery). Mean Hb concentration was significantly lower in primigravidae than in multigravidae at ANV1 (mean difference = -2.4 g/L, CI 95%: [-3.4, -1.4], P < 0.001). Afterwards, there was a significant increase in primigravidae only, with a tendency to reversal between primigravidae and multigravidae, which was confirmed at delivery (mean difference = 2.8 g/L, CI 95%: [1.3, 4.2], P < 0.001). The prevalence of malaria infection was halved between ANV1 and delivery in primigravidae while it decreased by only 38% among multigravidae, who were less prone to malaria infection (prevalence at ANV1, 20% and 10% respectively). Iron deficiency was more common in multigravidae, and it decreased slightly in this group between ANV1 and delivery.ConclusionIn a context of IPTp, Hb levels improved progressively throughout pregnancy in primigravidae, likely as a result of reduction in malaria infection. In multigravidae, the improvement was less perceptible and anaemia was mainly due to iron deficiency.

Associations Between Maternal Nutritional Characteristics and the Anthropometric Indices of Their Full-term and Pre-term Newborns

A retrospective descriptive study was designed to compare maternal nutritional characteristics with the anthropometric data of their full-term and pre-term newborns. 100 post-partum women and their newborns were selected from Government Hospital, Mumbai. The case records and hospital records were examined to gather information about the last known pre-pregnancy weight, gestational weight gain, placental weight, gestational age of mothers. Prenatal data with regard to maternal height, third trimester weight and hemoglobin concentration were recorded by the hospital. Postnatal data with regard to maternal mid upper arm circumference and neonatal birth weight, length, mid upper arm circumference, head circumference, chest circumference was recorded using standardized technique. The technique of three days diet recall was used to obtain the maternal third trimester dietary intake. Maternal third trimester daily nutrient intake among terms deliveries was significantly higher (with regard to energy (2254 kcal), protein (69.7 g), carbohydrate (320.3 g)) as compared to those with pre-term deliveries (energy (2048 kcal), protein (59.7 g), carbohydrate (285.4 g)) (p<0.05). Though not statistically significant, the average birth weight of ter m newborns (2849 g) was higher than pre-term newborns (2772 g) (p=0.444). Positive correlations were noted with maternal third trimester hemoglobin concentration and birth weight (r=0.587, p=0.001), length (r=0.347, p=0.044), mid upper arm circumference (r=0.387, p=0.028) and chest circumference (r=0.496, p=0.006) of pre-term newborns, after adjustments for pre-pregnancy weight, gestational age (weeks), parity. There was a significant correlation between maternal third trimester energy and carbohydrate intake with birth weight, length, head circumference, chest circumference of term babies. Maternal energy intake did not influence head circumference of pre-term. Protein intake was associated with birth weight of all deliveries. Regression analysis showed positive association between head circumference and fat intake among term delivery (r=0.357, p=0.002). In conclusion, this study showed that maternal third trimester hemoglobin concentration correlated with birth weight, length, mid upper arm circumference and chest circumference of pre-ter m newborns. This study highlights significant dietary influences on anthropometric indices among newborns. Hence nutritional status and hemoglobin concentration of the mothers was found to contribute significantly to the newborns size at birth.

Pedometer-Assessed Physical Activity in Children and Young Adults with CKD

Data on physical activity are limited in children with CKD. The objectives of this study were to measure the level and correlates of physical activity in children and young adults with CKD and to determine the association of physical activity with physical performance and physical functioning. Physical activity was measured for 7 days using pedometers; physical performance was measured by the 6-minute walk distance (6MWD) and physical functioning with the PedsQL 4.0. Study participants were 44 patients 7-20 years of age who had CKD stage 1-4 (n=12), had ESRD and were undergoing dialysis (n=7), or had undergone kidney transplantation (n=25). Participants were very sedentary; they walked 6218 (interquartile range, 3637, 9829) steps per day, considerably less than recommended. Physical activity did not differ among participants in the CKD stage 1-4, ESRD, and transplant groups. Females were less active than males (P<0.01), and physical activity was 44% lower among young adults (18-20 years) than younger participants (P<0.05). Physical activity was associated positively with maternal education and hemoglobin concentration and inversely with body mass index. Respective 6MWD in males and females was 2 and approximately 4 SDs below expected. Low levels of physical activity were associated with poor physical performance and physical functioning, after adjustment for age, sex, and body mass index. In most participants with CKD, physical activity was considerably below recommended levels. Future studies are needed to determine whether increasing physical activity can improve physical performance and physical functioning.

Characteristics of pica practice during pregnancy in a sample of Argentine women

The purpose of this study was to describe the practice of pica during pregnancy in Argentine women. Maternal and fetal characteristics as well as the practice of pica were evaluated during the puerperium in a sample of 1,014 women from five different geographical areas. Pica prevalence for the total sample was 23.2% (95% CI 20.6–25.8). Pagophagia (ice consumption) was the main type of pica practice, followed by geophagia (earth intake) and the ingestion of soap, toothpaste and chalk. The onset of the practice was mainly in the first months of pregnancy. A total of 49.8% of women revealed a family history of pica; 30.6% had pica in childhood and 13.2% suffered from polypica. Women with pica during pregnancy had similar age, pre-pregnancy body mass index (BMI), parity, neonatal birth weight and gestational age compared with non-pica mothers, although maternal haemoglobin concentration was lower in women with pica than in non-pica mothers (p = 0.0001).

Racial disparities in maternal hemoglobin concentrations and pregnancy outcomes

To examine the association of maternal hemoglobin (Hb) concentrations with preterm and low birth weight (LBW) deliveries in African Americans compared to Caucasians. We conducted a retrospective analysis of perinatal data on 17,338 African-American and Caucasian pregnant women who delivered at the George Washington University Hospital (GWUH) between January 1990 and December 2003. We used univariate and logistic regression analyses to examine for associations. Compared to Caucasians (n=9432), African American mothers (n=7906) had a higher incidence of anemia (26.9% vs. 7.1%, P<0.001), preterm (22.1% vs. 12.8%, P<0.001) and LBW (18.6% vs. 9.7%, P<0.001) outcomes. This association increased with decreasing Hb concentrations in each race. Risk for preterm and LBW outcomes were higher in African Americans compared to Caucasians at Hb concentration ≥12 g/dL (P<0.007); however, there were no race-specific risk at Hb concentration <11 g/dL (P>0.05). The association of race with preterm and LBW outcomes relates to maternal Hb. Our findings suggest: a) anemia is a strong risk factor that masks the influence of race, b) African American race could be a surrogate for other factors that contribute to adverse outcomes, and c) Caucasian race could be less adaptive to anemia.

Relationship between maternal hemoglobin concentration andneonatal birth weight

Objective: Pregnancy considerably increases iron needs ina mother and her fetus. The purpose of this study was to assess the relationshipbetween maternal hemoglobin concentration in labor with neonatal birth weight.Methods: A population-based study in Shahid Sadughi Hospitalin Yazd, Iran, was performed by comparing 1842 singleton term pregnanciesof patients with and without anemia and their newborns. Maternal characteristics,including hemoglobin values, were recorded at the labor visit. Maternal anemiawas defined as hemoglobin concentration lower than 10 g/dl during pregnancy.Main outcome measures included birth weight and Apgar score. Linear and logisticregression models were used to analyze data.Results: Anemia (Hb<10 g/dl) was associated witha significantly increased risk of low birth weight (<2500 g).High hemoglobin (>13 g/dl) increased the risk of low birth weightbut it was not significant. The risk of a low Apgar score was significantlyincreased in women with anemia. The minimum incidence of low birth weightoccurs in association with a hemoglobin concentration of 10–13 g/dl.Conclusions: Maternal anemia was significantly associatedwith effect on birth weight. Also Hb>13 g/dl was also associated with anincreased risk of low birth weight.

Maternal hemoglobin concentration and adverse pregnancy outcomes at low and moderate altitudes in Peru

Objective: To identify associations of maternal hemoglobin (Hb) with perinatal outcomes at low and moderate altitudes in Peru. Methods: Study of records with sequential information using perinatal database system. The study included 295 651 pregnant women with their products. Using multiple logistic regression analysis, we estimated the probability of stillbirths, preterm and small for gestational age (SGA) births associated with maternal Hb levels at low (0–1999 m) and moderate altitudes (2000–2999 m). Results: Maternal Hb decreased as pregnancy progressed from first to third trimester at both altitudes. Hb was higher at moderate than at low altitude (p < 0.001). Risks for stillbirths increased with low maternal Hb (odds ratio [OR]: 1.39 for Hb 9–9.9; OR: 1.84 for Hb 8–8.9; OR: 3.25 for Hb 7–7.9; and OR: 7.8 for Hb <7 g/dl); with Hb higher than 14.5 g/dl (OR: 1.31) and with altitudes ≥2000 m (OR: 1.2). High preterm rates were also observed with low Hbs (OR: 1.16 for Hb 9–9.9; OR: 1.64 for Hb 8–8.9; OR: 2.25 for Hb 7–7.9; and OR:2.87 for Hb<7 g/dl) and with Hb higher than 14.5 g/dl (OR: 1.14). High SGA rates were observed in neonates with maternal Hb of 7–7.9 (OR: 1.35) and <7 g/dl (OR:1.57), and higher than 14.5 g/dl (OR: 1.33), and with moderate altitudes (OR: 1.12). The cut-off points for lower risks of stillbirth and preterm births was 10 g/dl, and for SGA 9 g/dl of hemoglobin. Conclusion: Low and high maternal Hb levels and moderate altitude were independent risk factors for adverse perinatal outcomes.