Stephansson O, Dickman P W, Johansson A, Cnattingius S
Department of Medical Epidemiology, Karolinska Institutet, PO Box 281, SE-171 77, Stockholm, Sweden.
JAMA. 2000;284(20):2611-7. doi: 10.1001/jama.284.20.2611.
High and low maternal hemoglobin concentrations during pregnancy have been reported to increase risk of small-for-gestational-age (SGA) birth, which is a predictor of stillbirth. The relationship between hemoglobin concentration during pregnancy and risk of stillbirth is unclear.
To study the associations among hemoglobin concentration at first measurement during antenatal care, change in hemoglobin concentration during pregnancy, and risk of stillbirth.
DESIGN, SETTING, AND PARTICIPANTS: Population-based, matched case-control study of births from 1987 through 1996 in Sweden including 702 primiparous women with stillbirths occurring at 28 weeks' gestation or later and 702 primiparous women with live births.
Risk of stillbirth, classified as malformed or nonmalformed, antepartum or intrapartum, preterm or term, and SGA or non-SGA, compared by maternal hemoglobin concentration at first antenatal measurement and weekly changes in hemoglobin concentration during pregnancy, adjusted for maternal age, body mass index, height, smoking, socioeconomic status, and week of first hemoglobin measurement.
In multivariate analyses, compared with women with hemoglobin concentrations of 126 to 135 g/L at first antenatal measurement, women with concentrations of 146 g/L or higher were at increased risk of stillbirth (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.0-3.3). This risk was slightly increased when the analysis was restricted to antepartum stillbirths without malformations (OR, 2.0; 95% CI, 1.1-3.8). When we further restricted the analyses to preterm and SGA antepartum nonmalformed stillbirths, the ORs increased to 2.7 (95% CI, 1.1-6.4) and 4.2 (95% CI, 1.3-13. 9), respectively. Excluding women with preeclampsia and eclampsia further increased these risks. Average weekly change in hemoglobin concentration during early or late pregnancy was not significantly associated with risk of stillbirth, although a larger decrease in concentration tended to be protective. Anemia (hemoglobin concentration <110 g/L) was not significantly associated with risk of stillbirth in multivariate analyses (OR, 1.2; 95% CI, 0.5-2.7).
High hemoglobin concentration at first measurement during antenatal care appears to be associated with increased risk of stillbirth, especially preterm and SGA antepartum stillbirths. JAMA. 2000;284:2611-2617.
据报道，孕期孕妇血红蛋白浓度过高或过低都会增加小于胎龄儿（SGA）出生的风险，而小于胎龄儿是死产的一个预测指标。孕期血红蛋白浓度与死产风险之间的关系尚不清楚。
研究产前检查首次测量时的血红蛋白浓度、孕期血红蛋白浓度变化与死产风险之间的关联。
设计、地点和参与者：基于人群的配对病例对照研究，研究对象为1987年至1996年在瑞典出生的婴儿，包括702名孕周在28周及以后发生死产的初产妇和702名活产初产妇。
根据产前首次测量时孕妇的血红蛋白浓度以及孕期血红蛋白浓度的每周变化情况，将死产风险分为畸形或非畸形、产前或产时、早产或足月、小于胎龄儿或非小于胎龄儿，并进行比较，同时对产妇年龄、体重指数、身高、吸烟情况、社会经济地位以及首次测量血红蛋白的孕周进行校正。
在多变量分析中，与产前首次测量时血红蛋白浓度为126至135 g/L的女性相比，血红蛋白浓度为146 g/L及以上的女性死产风险增加（比值比[OR]，1.8；95%置信区间[CI]，1.0 - 3.3）。当分析仅限于无畸形的产前死产时，这种风险略有增加（OR，2.0；95% CI，1.1 - 3.8）。当我们进一步将分析限制在早产和小于胎龄儿的产前非畸形死产时，比值比分别增至2.7（95% CI，1.1 - 6.4）和4.2（95% CI，1.3 - 13.9）。排除患有先兆子痫和子痫的女性后，这些风险进一步增加。孕期早期或晚期血红蛋白浓度的平均每周变化与死产风险无显著关联，尽管浓度下降幅度较大往往具有保护作用。在多变量分析中，贫血（血红蛋白浓度<110 g/L）与死产风险无显著关联（OR，1.2；95% CI，0.5 - 2.7）。
产前检查首次测量时血红蛋白浓度过高似乎与死产风险增加有关，尤其是早产和小于胎龄儿的产前死产。《美国医学会杂志》。2000年；284：2611 - 2617。
