Geelhoed Diederike, Agadzi Florence, Visser Lucia, Ablordeppey Emelia, Asare Kofi, O'Rourke Peter, Van Leeuwen Jules Schagen, Van Roosmalen Jos
Holy Family Hospital, Berekum and Mathias Hospital, Yeji, Ghana.
Acta Obstet Gynecol Scand. 2006;85(1):49-55. doi: 10.1080/00016340500334794.
Anemia in pregnancy contributes to poor outcome for mother and child in low-income countries. This study analyzes adverse maternal and fetal outcome after severe anemia in pregnancy in rural Ghana.
A cohort study in two (sub)district hospitals, including 157 pregnant women exposed to severe anemia (Hb < 8.0 g/dl) and 152 nonexposed pregnant women (Hb > or = 10.9 g/dl), matched for age and parity strata. Adverse outcomes analyzed were postpartum hemorrhage, need for blood transfusion, maternal mortality, low birth-weight, and perinatal mortality.
Compared to nonexposed women, exposed women had an increased risk of maternal death (5/157 versus 0/152). Fetal outcome did not significantly differ between the study groups, although perinatal mortality was increased with exposure to Hb < 7.0 g/dl (OR 3.1; 95% CI 1.0-9.4), and low birth-weight was increased with exposure to Hb < 6.0 g/dl (OR 2.5; 95% CI 1.2-5.4). Overall fetal outcome was significantly better when hemoglobin prior to childbirth was at least 8.0 g/dl (OR 3.9; 95% CI 1.6-9.6), body mass index at least 20 kg/m2 (OR 2.8; 95% CI 1.5-5.3), and number of antenatal visits at least 4 (OR 2.0; 95%CI 1.1-3.7).
Severe anemia in pregnancy results in relatively poor maternal and fetal outcome. Apparently maternal risks increase prior to fetal risks. In order to improve maternal and fetal outcome, it is recommended that district hospitals in low-income countries make prevention, early diagnosis, and treatment of severe anemia in pregnancy a priority.
在低收入国家，孕期贫血会导致母婴预后不良。本研究分析了加纳农村地区孕期严重贫血后的不良母婴结局。
在两家（分）地区医院进行一项队列研究，纳入157例暴露于严重贫血（血红蛋白<8.0 g/dl）的孕妇和152例未暴露的孕妇（血红蛋白≥10.9 g/dl），按年龄和胎次分层匹配。分析的不良结局包括产后出血、输血需求、孕产妇死亡、低出生体重和围产期死亡。
与未暴露女性相比，暴露女性的孕产妇死亡风险增加（5/157对0/152）。尽管暴露于血红蛋白<7.0 g/dl时围产期死亡率增加（比值比3.1；95%置信区间1.0 - 9.4），暴露于血红蛋白<6.0 g/dl时低出生体重增加（比值比2.5；95%置信区间1.2 - 5.4），但研究组间的胎儿结局无显著差异。当分娩前血红蛋白至少为8.0 g/dl（比值比3.9；95%置信区间1.6 - 9.6）、体重指数至少为20 kg/m²（比值比2.8；95%置信区间1.5 - 5.3）以及产前检查次数至少为4次（比值比2.0；95%置信区间1.1 - 3.7）时，总体胎儿结局明显更好。
孕期严重贫血导致相对较差的母婴结局。显然，母亲的风险先于胎儿风险增加。为改善母婴结局，建议低收入国家的地区医院将孕期严重贫血的预防、早期诊断和治疗作为优先事项。
