Little Mark P, Brocard Pauline, Elliott Paul, Steer Philip J
Department of Epidemiology and Public Health, Imperial College London, Faculty of Medicine, St. Mary's Campus, Norfolk Place, United Kingdom.
Am J Obstet Gynecol. 2005 Jul;193(1):220-6. doi: 10.1016/j.ajog.2004.11.053.
Failure of fetal growth during pregnancy, and preterm birth, are the major causes of stillbirth and early neonatal death. The objective of the study was to determine the association between maternal hemoglobin concentration during pregnancy and perinatal mortality.
The design was prospective, using data on 222,614 first singleton pregnancies in the St Mary's Maternity Information System database in the Northwest Thames region of London.
The association of perinatal mortality with maternal hemoglobin at first antenatal check was not statistically significant (P>.10), but a statistically significant (P<.001) U-shaped pattern was found with lowest recorded maternal hemoglobin concentration. Both early neonatal mortality and stillbirth rates were statistically significantly (P<.005) associated with lowest maternal hemoglobin concentration. The relationship of lowest hemoglobin with early neonatal mortality was largely mediated by the effect of preterm birth, and that between lowest hemoglobin and stillbirth by fetal growth restriction. The lowest perinatal mortality was associated with a lowest recorded maternal hemoglobin concentration of between 9-11 g/dL.
There is an optimal range of lowest hemoglobin concentration in pregnancy, and on either side of this perinatal mortality is increased. The effect of lowest hemoglobin is largely mediated through associations with preterm birth and fetal growth restriction.
孕期胎儿生长受限和早产是死产及早期新生儿死亡的主要原因。本研究的目的是确定孕期母体血红蛋白浓度与围产期死亡率之间的关联。
采用前瞻性设计，使用伦敦西北泰晤士地区圣玛丽妇产信息系统数据库中222,614例首次单胎妊娠的数据。
首次产前检查时围产期死亡率与母体血红蛋白的关联无统计学意义（P>0.10），但发现记录的母体血红蛋白浓度最低时存在统计学显著（P<0.001）的U型模式。早期新生儿死亡率和死产率均与最低母体血红蛋白浓度存在统计学显著关联（P<0.005）。最低血红蛋白与早期新生儿死亡率的关系很大程度上由早产的影响介导，而最低血红蛋白与死产之间的关系则由胎儿生长受限介导。最低围产期死亡率与记录的最低母体血红蛋白浓度在9 - 11 g/dL之间相关。
孕期存在一个最低血红蛋白浓度的最佳范围，在此范围两侧围产期死亡率都会增加。最低血红蛋白的影响很大程度上通过与早产和胎儿生长受限的关联来介导。
