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Severity of Anemia During Pregnancy and Adverse Maternal and Fetal Outcomes

IMPORTANCE: Anemia is the most widespread nutritional deficiency among pregnant females in the world. Despite numerous studies on anemia, evidence is limited about the association of severity of anemia with maternal and fetal health. OBJECTIVE: To investigate the association between severity of anem...

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Autores principales: Shi, Huifeng, Chen, Lian, Wang, Yuanyuan, Sun, Mengxing, Guo, Yijie, Ma, Shang, Wang, Xiaoli, Jiang, Hai, Wang, Xiaoxia, Lu, Jie, Ge, Lin, Dong, Shu, Zhuang, Yu, Zhao, Yangyu, Wei, Yuan, Ma, Xudong, Qiao, Jie
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Medical Association 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8814908/
https://www.ncbi.nlm.nih.gov/pubmed/35113162
http://dx.doi.org/10.1001/jamanetworkopen.2021.47046
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author Shi, Huifeng
Chen, Lian
Wang, Yuanyuan
Sun, Mengxing
Guo, Yijie
Ma, Shang
Wang, Xiaoli
Jiang, Hai
Wang, Xiaoxia
Lu, Jie
Ge, Lin
Dong, Shu
Zhuang, Yu
Zhao, Yangyu
Wei, Yuan
Ma, Xudong
Qiao, Jie
author_facet Shi, Huifeng
Chen, Lian
Wang, Yuanyuan
Sun, Mengxing
Guo, Yijie
Ma, Shang
Wang, Xiaoli
Jiang, Hai
Wang, Xiaoxia
Lu, Jie
Ge, Lin
Dong, Shu
Zhuang, Yu
Zhao, Yangyu
Wei, Yuan
Ma, Xudong
Qiao, Jie
author_sort Shi, Huifeng
collection PubMed
description IMPORTANCE: Anemia is the most widespread nutritional deficiency among pregnant females in the world. Despite numerous studies on anemia, evidence is limited about the association of severity of anemia with maternal and fetal health. OBJECTIVE: To investigate the association between severity of anemia during pregnancy and risk of maternal and fetal adverse outcomes. DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used data from China’s Hospital Quality Monitoring System from January 1, 2016, to December 31, 2019, for pregnant females aged 15 to 49 years with birth outcomes reported at 1508 hospitals with maternity services in mainland China. EXPOSURES: Anemia of varying severity during pregnancy was identified from daily standardized electronic inpatient discharge records using corresponding codes of the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision. Mild anemia was defined as a hemoglobin concentration of 100 to 109 g/L (to convert g/L to g/dL, divide by 10.0); moderate anemia, as 70 to 99 g/L; and severe anemia, as less than 70 g/L. MAIN OUTCOMES AND MEASURES: The main outcomes included 6 maternal outcomes (placental abruption, preterm birth, severe postpartum hemorrhage, shock, admission to the intensive care unit [ICU], and maternal mortality) and 3 neonatal outcomes (fetal growth restriction, malformation, and stillbirth). Multivariable logistic regression models were used to estimate the odds ratios (ORs) and 95% CIs of these outcomes among pregnant females with varying severity of anemia. RESULTS: Among 18 948 443 pregnant females aged 15 to 49 years (mean [SD] age, 29.42 [4.87] years), 17.78% were diagnosed with anemia during pregnancy, including 9.04% with mild anemia, 2.62% with moderate anemia, 0.21% with severe anemia, and 5.90% with anemia of unknown severity. Compared with no anemia, anemia severity during pregnancy was associated with increased risks of placental abruption (mild: adjusted OR [aOR], 1.36 [95% CI, 1.34-1.38]; moderate: aOR, 1.98 [95% CI, 1.93-2.02]; severe: aOR, 3.35 [95% CI, 3.17-3.54]), preterm birth (mild: aOR, 1.08 [95% CI, 1.07-1.08]; moderate: aOR, 1.18 [95% CI, 1.17-1.19]; severe: aOR, 1.36 [95% CI, 1.32-1.41]), severe postpartum hemorrhage (mild: aOR, 1.45 [95% CI, 1.43-1.47]; moderate: aOR, 3.53 [95% CI, 3.47-3.60]; severe: 15.65 [95% CI, 15.10-16.22]), and fetal malformation (mild: aOR, 1.15 [95% CI, 1.14-1.17]; moderate: aOR, 1.19 [95% CI, 1.16-1.21]; severe: aOR, 1.62 [95% CI, 1.52-1.73]). Compared with no anemia, moderate or severe anemia were associated with increased risks of maternal shock (moderate: aOR, 1.50 [95% CI, 1.41-1.60]; severe: aOR, 14.98 [95% CI, 13.91-16.13]), ICU admission (moderate: aOR, 1.08 [95% CI, 1.01-1.16]; severe: aOR, 2.88 [95% CI, 2.55-3.25]), maternal death (moderate: aOR, 0.45 [95% CI, 0.30-0.65]; severe: aOR, 1.56 [95% CI, 0.97-2.48], fetal growth restriction (moderate: aOR, 0.80 [95% CI, 0.78-0.82]; severe: aOR, 1.08 [95% CI, 1.00-1.17]), and stillbirth (moderate: aOR,0.79 [95% CI, 0.76-0.81]; severe: aOR, 1.86 [95% CI, 1.75-1.98]), and mild anemia was associated with decreased risks (maternal shock: aOR, 0.67 [95% CI, 0.63-0.71]; ICU admission: aOR, 0.80 [95% CI, 0.76-0.84]; maternal death: aOR, 0.37 [95% CI, 0.29-0.49]; fetal growth restriction: aOR, 0.79 [95% CI, 0.77-0.80]; stillbirth: aOR, 0.59 [95% CI, 0.58-0.61]) after adjusting for sociodemographic characteristics and other complications during pregnancy. CONCLUSIONS AND RELEVANCE: The findings suggest that anemia during pregnancy is associated with maternal and fetal health outcomes and that mild anemia is associated with improved maternal and fetal survival and fetal growth. Further work is needed to validate the concentration of hemoglobin at which optimal maternal and fetal health are achieved.
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spelling pubmed-88149082022-02-16 Severity of Anemia During Pregnancy and Adverse Maternal and Fetal Outcomes Shi, Huifeng Chen, Lian Wang, Yuanyuan Sun, Mengxing Guo, Yijie Ma, Shang Wang, Xiaoli Jiang, Hai Wang, Xiaoxia Lu, Jie Ge, Lin Dong, Shu Zhuang, Yu Zhao, Yangyu Wei, Yuan Ma, Xudong Qiao, Jie JAMA Netw Open Original Investigation IMPORTANCE: Anemia is the most widespread nutritional deficiency among pregnant females in the world. Despite numerous studies on anemia, evidence is limited about the association of severity of anemia with maternal and fetal health. OBJECTIVE: To investigate the association between severity of anemia during pregnancy and risk of maternal and fetal adverse outcomes. DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used data from China’s Hospital Quality Monitoring System from January 1, 2016, to December 31, 2019, for pregnant females aged 15 to 49 years with birth outcomes reported at 1508 hospitals with maternity services in mainland China. EXPOSURES: Anemia of varying severity during pregnancy was identified from daily standardized electronic inpatient discharge records using corresponding codes of the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision. Mild anemia was defined as a hemoglobin concentration of 100 to 109 g/L (to convert g/L to g/dL, divide by 10.0); moderate anemia, as 70 to 99 g/L; and severe anemia, as less than 70 g/L. MAIN OUTCOMES AND MEASURES: The main outcomes included 6 maternal outcomes (placental abruption, preterm birth, severe postpartum hemorrhage, shock, admission to the intensive care unit [ICU], and maternal mortality) and 3 neonatal outcomes (fetal growth restriction, malformation, and stillbirth). Multivariable logistic regression models were used to estimate the odds ratios (ORs) and 95% CIs of these outcomes among pregnant females with varying severity of anemia. RESULTS: Among 18 948 443 pregnant females aged 15 to 49 years (mean [SD] age, 29.42 [4.87] years), 17.78% were diagnosed with anemia during pregnancy, including 9.04% with mild anemia, 2.62% with moderate anemia, 0.21% with severe anemia, and 5.90% with anemia of unknown severity. Compared with no anemia, anemia severity during pregnancy was associated with increased risks of placental abruption (mild: adjusted OR [aOR], 1.36 [95% CI, 1.34-1.38]; moderate: aOR, 1.98 [95% CI, 1.93-2.02]; severe: aOR, 3.35 [95% CI, 3.17-3.54]), preterm birth (mild: aOR, 1.08 [95% CI, 1.07-1.08]; moderate: aOR, 1.18 [95% CI, 1.17-1.19]; severe: aOR, 1.36 [95% CI, 1.32-1.41]), severe postpartum hemorrhage (mild: aOR, 1.45 [95% CI, 1.43-1.47]; moderate: aOR, 3.53 [95% CI, 3.47-3.60]; severe: 15.65 [95% CI, 15.10-16.22]), and fetal malformation (mild: aOR, 1.15 [95% CI, 1.14-1.17]; moderate: aOR, 1.19 [95% CI, 1.16-1.21]; severe: aOR, 1.62 [95% CI, 1.52-1.73]). Compared with no anemia, moderate or severe anemia were associated with increased risks of maternal shock (moderate: aOR, 1.50 [95% CI, 1.41-1.60]; severe: aOR, 14.98 [95% CI, 13.91-16.13]), ICU admission (moderate: aOR, 1.08 [95% CI, 1.01-1.16]; severe: aOR, 2.88 [95% CI, 2.55-3.25]), maternal death (moderate: aOR, 0.45 [95% CI, 0.30-0.65]; severe: aOR, 1.56 [95% CI, 0.97-2.48], fetal growth restriction (moderate: aOR, 0.80 [95% CI, 0.78-0.82]; severe: aOR, 1.08 [95% CI, 1.00-1.17]), and stillbirth (moderate: aOR,0.79 [95% CI, 0.76-0.81]; severe: aOR, 1.86 [95% CI, 1.75-1.98]), and mild anemia was associated with decreased risks (maternal shock: aOR, 0.67 [95% CI, 0.63-0.71]; ICU admission: aOR, 0.80 [95% CI, 0.76-0.84]; maternal death: aOR, 0.37 [95% CI, 0.29-0.49]; fetal growth restriction: aOR, 0.79 [95% CI, 0.77-0.80]; stillbirth: aOR, 0.59 [95% CI, 0.58-0.61]) after adjusting for sociodemographic characteristics and other complications during pregnancy. CONCLUSIONS AND RELEVANCE: The findings suggest that anemia during pregnancy is associated with maternal and fetal health outcomes and that mild anemia is associated with improved maternal and fetal survival and fetal growth. Further work is needed to validate the concentration of hemoglobin at which optimal maternal and fetal health are achieved. American Medical Association 2022-02-03 /pmc/articles/PMC8814908/ /pubmed/35113162 http://dx.doi.org/10.1001/jamanetworkopen.2021.47046 Text en Copyright 2022 Shi H et al. JAMA Network Open. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the CC-BY License.
spellingShingle Original Investigation
Shi, Huifeng
Chen, Lian
Wang, Yuanyuan
Sun, Mengxing
Guo, Yijie
Ma, Shang
Wang, Xiaoli
Jiang, Hai
Wang, Xiaoxia
Lu, Jie
Ge, Lin
Dong, Shu
Zhuang, Yu
Zhao, Yangyu
Wei, Yuan
Ma, Xudong
Qiao, Jie
Severity of Anemia During Pregnancy and Adverse Maternal and Fetal Outcomes
title Severity of Anemia During Pregnancy and Adverse Maternal and Fetal Outcomes
title_full Severity of Anemia During Pregnancy and Adverse Maternal and Fetal Outcomes
title_fullStr Severity of Anemia During Pregnancy and Adverse Maternal and Fetal Outcomes
title_full_unstemmed Severity of Anemia During Pregnancy and Adverse Maternal and Fetal Outcomes
title_short Severity of Anemia During Pregnancy and Adverse Maternal and Fetal Outcomes
title_sort severity of anemia during pregnancy and adverse maternal and fetal outcomes
topic Original Investigation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8814908/
https://www.ncbi.nlm.nih.gov/pubmed/35113162
http://dx.doi.org/10.1001/jamanetworkopen.2021.47046
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