Chang Shih-Chen, O'Brien Kimberly O, Nathanson Maureen Schulman, Mancini Jeri, Witter Frank R
Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205-2179, USA.
J Nutr. 2003 Jul;133(7):2348-55. doi: 10.1093/jn/133.7.2348.
Relationships between hemoglobin concentrations and birth outcomes have not been well characterized in African-American adolescents despite the fact that this group is at a higher risk of early childbearing. To address this issue, we characterized the prevalence of anemia and maternal factors associated with anemia in pregnant African-American adolescents. A retrospective medical chart review was undertaken of 918 adolescents who had received prenatal care at an inner-city maternity clinic between 1990 and 2000. Multiple log-linear regression analyses were used to address relationships between hemoglobin and adverse birth outcomes. The prevalence of anemia during the third trimester averaged 57-66% and was substantially higher than typically reported in adolescent and adult women. Multiparity, inadequate prenatal care, low prepregnancy BMI, history of self-reported cigarette use and infection with sexually transmitted diseases were significantly associated with lower hemoglobin during pregnancy. Adolescents with pre-eclampsia had higher hemoglobin (P < 0.01). Compared with the reference group (106-120 g/L), high hemoglobin (>120 g/L) during the second and third trimester significantly increased the risk of low birth weight (risk ratio (RR) = 3.11; [CI] 1.35, 7.13), and in the second-trimester cohort only, high hemoglobin concentrations increased the risk of preterm delivery (RR = 2.33; [CI] 1.07, 5.05). A U-shaped distribution between hemoglobin concentration and adverse birth outcomes was found in the third-trimester cohort when the reference range was decreased to 96-105 g/L to adjust for potentially lower hemoglobin concentrations among the African-American population. Our results suggest that additional medical attention may be warranted in pregnant African-American adolescents with hemoglobin concentrations of <or=95 g/L or >120 g/L.
尽管非裔美国青少年早孕风险较高，但血红蛋白浓度与出生结局之间的关系尚未得到充分描述。为解决这一问题，我们对非裔美国孕妇青少年贫血的患病率及与贫血相关的母体因素进行了描述。对1990年至2000年间在市中心一家产科诊所接受产前护理的918名青少年进行了回顾性病历审查。采用多元对数线性回归分析来研究血红蛋白与不良出生结局之间的关系。孕晚期贫血患病率平均为57%-66%，显著高于青少年和成年女性的典型报告患病率。多胎妊娠、产前护理不足、孕前BMI较低、自述吸烟史以及性传播疾病感染与孕期血红蛋白水平较低显著相关。患有先兆子痫的青少年血红蛋白水平较高（P<0.01）。与参照组（106-120 g/L）相比，孕中期和孕晚期血红蛋白水平较高（>120 g/L）显著增加了低出生体重风险（风险比（RR）=3.11；[可信区间]1.35，7.13），仅在孕中期队列中，高血红蛋白浓度增加了早产风险（RR=2.33；[可信区间]1.07，5.05）。当参照范围降至96-105 g/L以校正非裔美国人群中可能较低的血红蛋白浓度时，在孕晚期队列中发现血红蛋白浓度与不良出生结局之间呈U形分布。我们的结果表明，对于血红蛋白浓度≤95 g/L或>120 g/L的非裔美国孕妇青少年，可能需要给予更多医疗关注。
