Nair Manisha, Churchill David, Robinson Susan, Nelson-Piercy Cathy, Stanworth Simon J, Knight Marian
National Perinatal Epidemiology Unit (NPEU), Nuffield Department of Population Health, University of Oxford, Oxford, UK.
The Royal Wolverhampton Hospital NHS Trust, New Cross Hospital, Wolverhampton, UK.
Br J Haematol. 2017 Dec;179(5):829-837. doi: 10.1111/bjh.14961. Epub 2017 Oct 26.
The study objectives were to examine the association of maternal haemoglobin with stillbirth and perinatal death in a multi-ethnic population in England. We conducted a retrospective cohort analysis using anonymised maternity data from 14 001 women with singleton pregnancies ≥24 weeks' gestation giving birth between 2013 and 2015 in two hospitals - the Royal Wolverhampton NHS Trust and Guy's and St Thomas' NHS Foundation Trust. Multivariable logistic regression analyses were undertaken to analyse the associations between maternal haemoglobin at first visit and at 28 weeks with stillbirth and perinatal death, adjusting for 11 other risk factors. Results showed that 46% of the study population had anaemia (haemoglobin <110 g/l) at some point during their pregnancy. The risk of stillbirth and perinatal death decreased linearly per unit increase in haemoglobin concentration at first visit (adjusted odds ratio [aOR] stillbirth = 0·70, 95% confidence interval [CI] 0·58-0·85, aOR perinatal death = 0·71, 95% CI 0·60-0·84) and at 28 weeks (aOR stillbirth = 0·83, 95% CI 0·66-1·04; aOR perinatal death = 0·86, 95%CI 0·67-1·12). Compared with women with haemoglobin ≥110 g/l, the risk of stillbirth and perinatal death was five- and three-fold higher in women with moderate-severe anaemia (haemoglobin <100 g/l) at first visit and 28 weeks, respectively. These findings have clinical and public health importance.
该研究的目的是在英格兰的一个多民族人群中，考察孕妇血红蛋白水平与死产及围产期死亡之间的关联。我们利用来自14001名单胎妊娠且妊娠≥24周的女性的匿名产科数据，进行了一项回顾性队列分析。这些女性于2013年至2015年期间在两家医院分娩，分别是皇家伍尔弗汉普顿国民保健服务信托基金医院和盖伊与圣托马斯国民保健服务基金会信托基金医院。采用多变量逻辑回归分析，以分析首次就诊时和孕28周时孕妇血红蛋白水平与死产及围产期死亡之间的关联，并对其他11个风险因素进行了校正。结果显示，46%的研究人群在孕期的某个阶段患有贫血（血红蛋白<110 g/l）。首次就诊时，血红蛋白浓度每升高一个单位，死产和围产期死亡风险呈线性下降（校正比值比[aOR]死产=0·70，95%置信区间[CI] 0·58 - 0·85，aOR围产期死亡=0·71，95% CI 0·60 - 0·84）；孕28周时，aOR死产=0·83，95% CI 0·66 - 1·"04；aOR围产期死亡=0·86，95%CI 0·67 - 1·12）。与血红蛋白≥110 g/l的女性相比，首次就诊和孕28周时患有中度至重度贫血（血红蛋白<100 g/l）的女性，其死产和围产期死亡风险分别高出5倍和3倍。这些发现具有临床和公共卫生意义。
