Gonzales Gustavo F, Tapia Vilma, Gasco Manuel, Carrillo Carlos E
Department of Biological and Physiological Sciences, Lima, Peru.
J Matern Fetal Neonatal Med. 2012 Jul;25(7):1105-10. doi: 10.3109/14767058.2011.623200. Epub 2011 Oct 17.
To identify associations of maternal hemoglobin (Hb) with perinatal outcomes at low and moderate altitudes in Peru.
Study of records with sequential information using perinatal database system. The study included 295 651 pregnant women with their products. Using multiple logistic regression analysis, we estimated the probability of stillbirths, preterm and small for gestational age (SGA) births associated with maternal Hb levels at low (0-1999 m) and moderate altitudes (2000-2999 m).
Maternal Hb decreased as pregnancy progressed from first to third trimester at both altitudes. Hb was higher at moderate than at low altitude (p < 0.001). Risks for stillbirths increased with low maternal Hb (odds ratio [OR]: 1.39 for Hb 9-9.9; OR: 1.84 for Hb 8-8.9; OR: 3.25 for Hb 7-7.9; and OR: 7.8 for Hb <7 g/dl); with Hb higher than 14.5 g/dl (OR: 1.31) and with altitudes ≥ 2000 m (OR: 1.2). High preterm rates were also observed with low Hbs (OR: 1.16 for Hb 9-9.9; OR: 1.64 for Hb 8-8.9; OR: 2.25 for Hb 7-7.9; and OR:2.87 for Hb<7 g/dl) and with Hb higher than 14.5 g/dl (OR: 1.14). High SGA rates were observed in neonates with maternal Hb of 7-7.9 (OR: 1.35) and <7 g/dl (OR:1.57), and higher than 14.5 g/dl (OR: 1.33), and with moderate altitudes (OR: 1.12). The cut-off points for lower risks of stillbirth and preterm births was 10 g/dl, and for SGA 9 g/dl of hemoglobin.
Low and high maternal Hb levels and moderate altitude were independent risk factors for adverse perinatal outcomes.
确定秘鲁低海拔和中等海拔地区孕妇血红蛋白（Hb）与围产期结局之间的关联。
使用围产期数据库系统对具有连续信息的记录进行研究。该研究纳入了295651名孕妇及其分娩产物。采用多因素逻辑回归分析，我们估计了低海拔（0 - 1999米）和中等海拔（2000 - 2999米）地区与孕妇Hb水平相关的死产、早产和小于胎龄（SGA）儿出生的概率。
在两个海拔地区，随着孕期从第一阶段进展到第三阶段，孕妇Hb均下降。中等海拔地区的Hb高于低海拔地区（p < 0.001）。孕妇Hb水平低时，死产风险增加（血红蛋白9 - 9.9克/分升时比值比[OR]：1.39；血红蛋白8 - 8.9克/分升时OR：1.84；血红蛋白7 - 7.9克/分升时OR：3.25；血红蛋白<7克/分升时OR：7.8）；血红蛋白高于14.5克/分升时（OR：1.31）以及海拔≥2000米时（OR：1.2）。Hb水平低时也观察到早产率较高（血红蛋白9 - 9.9克/分升时OR：1.16；血红蛋白8 - 8.9克/分升时OR：1.64；血红蛋白7 - 7.9克/分升时OR：2.25；血红蛋白<7克/分升时OR：2.87）以及血红蛋白高于14.5克/分升时（OR：1.14）。在母亲血红蛋白为7 - 7.9克/分升（OR：1.35）和<7克/分升（OR：1.57）、高于14.5克/分升（OR：1.33）以及中等海拔地区（OR：1.12）的新生儿中观察到SGA率较高。死产和早产较低风险的截断点为血红蛋白10克/分升，SGA为血红蛋白9克/分升。
孕妇Hb水平过低或过高以及中等海拔是围产期不良结局的独立危险因素。
