Maghsoudlou Siavash, Cnattingius Sven, Stephansson Olof, Aarabi Mohsen, Semnani Shahriar, Montgomery Scott M, Bahmanyar Shahram
Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institute, Karolinska Hospital, SE-171 76, Stockholm, Sweden.
Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran.
BMC Pregnancy Childbirth. 2016 Jun 3;16(1):135. doi: 10.1186/s12884-016-0924-x.
Results of previous studies on the association between maternal haemoglobin concentration during pregnancy and stillbirth risk are inconclusive. It is not clear if haemoglobin concentration before pregnancy has a role. Using prospectively collected information from pre-pregnancy and antenatal visits, we investigated associations of maternal haemoglobin concentrations before and during pregnancy and haemoglobin dilution with stillbirth risk.
In a population-based case-control study from rural Golestan, a province in northern Iran, we identified 495 stillbirths (cases) and randomly selected 2,888 control live births among antenatal health-care visits between 2007 and 2009. Using logistic regression, we estimated associations of maternal haemoglobin concentrations, haemoglobin dilution at different stages of pregnancy, with stillbirth risk.
Compared with normal maternal haemoglobin concentration (110-120 g/l) at the end of the second trimester, high maternal haemoglobin concentration (≥140 g/l) was associated with a more than two-fold increased stillbirth risk (OR = 2.31, 95 % CI [1.30-4.10]), while low maternal haemoglobin concentration (<110 g/l) was associated with a 37 % reduction in stillbirth risk. Haemoglobin concentration before pregnancy was not associated with stillbirth risk. Decreased haemoglobin concentration, as measured during pregnancy (OR = 0.61, 95 % CI [0.46, 0.80]), or only during the second trimester (OR = 0.75, 95 % CI [0.62, 0.90]), were associated with reduced stillbirth risk. The associations were essentially similar for preterm and term stillbirths.
Haemoglobin concentration before pregnancy is not associated with stillbirth risk. High haemoglobin level and absence of haemoglobin dilution during pregnancy could be considered as indicators of a high-risk pregnancy.
先前关于孕期母体血红蛋白浓度与死产风险之间关联的研究结果尚无定论。尚不清楚孕前血红蛋白浓度是否起作用。我们利用孕前和产前检查中前瞻性收集的信息，调查了孕期前后母体血红蛋白浓度及血红蛋白稀释与死产风险的关联。
在伊朗北部戈勒斯坦省农村地区开展的一项基于人群的病例对照研究中，我们确定了495例死产（病例），并在2007年至2009年的产前保健就诊中随机选取了2888例活产对照。我们使用逻辑回归估计了母体血红蛋白浓度、孕期不同阶段的血红蛋白稀释与死产风险的关联。
与孕中期末正常母体血红蛋白浓度（110 - 120 g/l）相比，高母体血红蛋白浓度（≥140 g/l）与死产风险增加两倍多相关（比值比[OR]=2.31，95%置信区间[CI][1.30 - 4.10]），而低母体血红蛋白浓度（<110 g/l）与死产风险降低37%相关。孕前血红蛋白浓度与死产风险无关。孕期测量的血红蛋白浓度降低（OR = 0.61，95% CI [0.46, 0.80]），或仅在孕中期降低（OR = 0.75，95% CI [0.62, 0.90]），与死产风险降低相关。早产和足月死产的关联基本相似。
孕前血红蛋白浓度与死产风险无关。孕期血红蛋白水平高且无血红蛋白稀释可被视为高危妊娠的指标。
