孕期前三个月血红蛋白水平与中国女性妊娠期糖尿病、子痫前期和早产的风险相关：一项回顾性研究。
Hemoglobin levels during the first trimester of pregnancy are associated with the risk of gestational diabetes mellitus, pre-eclampsia and preterm birth in Chinese women: a retrospective study.
机构信息
Department of Obstetrics and Gynecology of Peking University First Hospital, Xianmen Street No. 1, Xicheng District, Beijing, 100034, China.
National Institute of Hospital Administration, Beijing, China.
出版信息
BMC Pregnancy Childbirth. 2018 Jun 26;18(1):263. doi: 10.1186/s12884-018-1800-7.
BACKGROUND
Hemoglobin (Hb) measurement is a standard test among pregnant women during the first perinatal visit that is used to evaluate physical status and anemia. However, studies focusing on Hb levels and pregnancy outcomes are scarce. This study aimed to determine whether Hb levels in early pregnancy were associated with the risk of gestational diabetes mellitus (GDM), pre-eclampsia (PE) and preterm birth.
METHODS
A hospital-based retrospective study was conducted among 21,577 singleton, non-smoking pregnancies between June 2013 and January 2015. The demographic data and medical information of each participant were collected individually through questionnaires and patient medical records. Odds ratios were generated using a multivariate logistic regression analysis to evaluate the relative risk of GDM, PE and preterm birth continuously and across different hemoglobin ranges in the overall population and in women from different pre-pregnancy body mass index (BMI) categories, respectively. The level of statistical significance was set at 0.05.
RESULTS
(1) For women who were underweight, normal-weight, overweight and obese, early pregnancy Hb levels were 127.8 ± 10.1 g/L, 129.6 ± 9.7 g/L, 132.2 ± 9.5 g/L and 133.4 ± 9.4 g/L, respectively. (2) Women with GDM and PE had significantly increased Hb levels during early pregnancy compared with controls, whereas women with preterm birth processed significantly decreased Hb levels. (3) After adjusting for confounders, the risks for GDM and PE increased with high maternal Hb (OR: 1.27 for Hb 130-149; OR: 2.06 for Hb ≥ 150 g/L), and the risk for preterm birth decreased with high maternal Hb (OR: 1.30 for Hb 130-149; OR: 2.38 for Hb ≥ 150 g/L) and increased with low maternal Hb (OR: 1.41 for Hb < 110 g/L). Among women whose BMI was < 24 kg/m, high GDM (OR: 1.27 for Hb 130-149; OR: 1.84 for Hb ≥ 150 g/L) and low preterm rates (OR: 0.77 for Hb 130-149; OR: 0.23 for Hb ≥ 150 g/L) were observed with high Hb, whereas in women whose BMI was ≥24 kg/m, only high GDM rates were observed with Hb > 150 g/L (OR: 2.33).
CONCLUSION
These findings suggest that Hb levels during early pregnancy play a role in predicting the risk of GDM, PE and preterm birth.
背景
血红蛋白（Hb）测量是孕妇在围产期第一次就诊时的一项标准检查，用于评估身体状况和贫血。然而，专注于 Hb 水平与妊娠结局关系的研究很少。本研究旨在确定孕早期 Hb 水平是否与妊娠糖尿病（GDM）、子痫前期（PE）和早产风险相关。
方法
这是一项 2013 年 6 月至 2015 年 1 月期间在 21577 例单胎、非吸烟孕妇中进行的基于医院的回顾性研究。通过问卷和患者病历单独收集每位参与者的人口统计学数据和医疗信息。使用多变量逻辑回归分析生成比值比，以评估 GDM、PE 和早产的相对风险，连续和跨越总体人群中不同的血红蛋白范围以及不同孕前体重指数（BMI）类别的女性中的不同血红蛋白范围。统计显著性水平设为 0.05。
结果
（1）对于体重不足、正常体重、超重和肥胖的女性，孕早期 Hb 水平分别为 127.8±10.1 g/L、129.6±9.7 g/L、132.2±9.5 g/L 和 133.4±9.4 g/L。（2）与对照组相比，患有 GDM 和 PE 的女性孕早期的 Hb 水平显著升高，而早产的女性的 Hb 水平显著降低。（3）调整混杂因素后，高母体 Hb 与 GDM 和 PE 风险增加相关（OR：1.27 为 Hb 130-149；OR：2.06 为 Hb≥150 g/L），高母体 Hb 与早产风险降低相关（OR：1.30 为 Hb 130-149；OR：2.38 为 Hb≥150 g/L），低母体 Hb 与早产风险增加相关（OR：1.41 为 Hb<110 g/L）。在 BMI<24 kg/m 的女性中，高 GDM（OR：1.27 为 Hb 130-149；OR：1.84 为 Hb≥150 g/L）和低早产率（OR：0.77 为 Hb 130-149；OR：0.23 为 Hb≥150 g/L）与高 Hb 相关，而在 BMI≥24 kg/m 的女性中，仅 Hb>150 g/L 与 GDM 率高相关（OR：2.33）。
结论
这些发现表明，孕早期的 Hb 水平在预测 GDM、PE 和早产风险方面发挥作用。
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