Association of haemoglobin levels in the first trimester and at 26–30 weeks with fetal and neonatal outcomes: a secondary analysis of the Global Network for Women's and Children's Health's ASPIRIN Trial
Year: 2021
Type: article
Abstract: Objective Limited data are available from low‐ and middle‐income countries (LMICs) on the relationship of haemoglobin levels to adverse outcomes at different times during pregnancy. We evaluated the association of haemoglobin levels in nulliparous women at two times in pregnancy with pregnancy outcomes. Design ASPIRIN Trial data were used to study the association between haemoglobin levels measured at 6+0–13+6 weeks and 26+0–30+0 weeks of gestation with fetal and neonatal outcomes. Setting Obstetric care facilities in Pakistan, India, Kenya, Zambia, The Democratic Republic of the Congo and Guatemala. Population A total of 11 976 pregnant women. Methods Generalised linear models were used to obtain adjusted relative risks and 95% CI for adverse outcomes. Main outcome measures Preterm birth, stillbirth, neonatal death, small for gestational age (SGA) and birthweight <2500 g. Results The mean haemoglobin levels at 6+0–13+6 weeks and at 26–30 weeks of gestation were 116 g/l (SD 17) and 107 g/l (SD 15), respectively. In general, pregnancy outcomes were better with increasing haemoglobin. At 6+0–13+6 weeks of gestation, stillbirth, SGA and birthweight <2500 g, were significantly associated with haemoglobin of 70–89 g/l compared with haemoglobin of 110–129 g/l The relationships of adverse pregnancy outcomes with various haemoglobin levels were more marked at 26–30 weeks of gestation. Conclusions Both lower and some higher haemoglobin concentrations are associated with adverse fetal and neonatal outcomes at 6+0–13+6 weeks and at 26–30 weeks of gestation, although the relationship with low haemoglobin levels appears more consistent and generally stronger. Tweetable abstract Both lower and some higher haemoglobin concentrations were associated with adverse fetal and neonatal outcomes at 6–13 weeks and 26–30 weeks of gestation.
Institutions: Aga Khan University, Christiana Hospital, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Thomas Jefferson University, RTI International, Institute of Nutrition of Central America and Panama, University of Colorado Anschutz, University of Colorado Denver, Ecole de santé publique de Kinshasa, University of North Carolina at Chapel Hill, University Teaching Hospital, University of Alabama at Birmingham, Lata Medical Research Foundation, Datta Meghe Institute of Higher Education and Research, Boston University, Moi University, Indiana University Indianapolis, Indiana University School of Medicine, National Institutes of Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Columbia University
Language: English
Subfield: Hematology
Field: Medicine
Domain: Health Sciences
Open Access status: green
Awards: A Strategy to Reduce Stunting of Growth in Early Infancy: a Global Network Study, The University of North Carolina-Kinshasa School of Public Health Research Partnership in the Democratic Republic of Congo; a Model for Improving Women's and Children's Health Through Research, Leveraging the Global Network to implement health interventions to improve maternal and child outcomes in a rapidly changing environment, TJU-JNMC Global Network for Women's and Children's Health Research Unit, Global Network for Women's and Children's Health Research Data Coordinating Center, Boston University/Lata Medical Research Foundation Global Network for Women's Children's Health Research Unit
OpenAlex ID: W3132340601