Wainstock Tamar, Walfisch Asnat, Sergienko Ruslan, Sheiner Eyal
The Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Early Hum Dev. 2019 Jan;128:15-20. doi: 10.1016/j.earlhumdev.2018.11.002. Epub 2018 Nov 13.
Maternal anemia (Hemoglobin, <11 mg/dl) has been shown to affect fetal growth and pregnancy outcome. We aimed to study a possible association between maternal anemia and the risk for neurological morbidity in the offspring, during a follow-up period of up to 18 years.
A population-based cohort analysis was performed at the Soroka University Medical Center (SUMC), a single regional tertiary center comparing total and specific subtypes of neurological morbidities associated with hospitalizations among children stratified by three maternal post-partum hemoglobin categories: ≥11 mg/dl (no anemia); 11.0 mg/dl > Hb ≥ 7 mg/dl (mild-to-moderate anemia) and <7 mg/dl (severe anemia). Data on pregnancy course and outcome, and later offspring hospitalizations, were compared between the three study groups. All singleton deliveries between the years 1991-2014 were included in the analysis, and congenital malformations were excluded. A Kaplan-Meier survival curve was used to compare cumulative hospitalization incidence based on maternal anemia status, and a Weibull survival multivariable hazard model was constructed to adjust for confounding variables.
The study population included 217,358 deliveries of which 50.6% were in mothers who were not anemic, 49.0% in mothers with moderate anemia and 0.4% in mothers with severe anemia. During the follow up period (0-18 years, median 10.22 years), 2.1% of offspring were hospitalized with a neurological diagnoses. Neurological hospitalization incidence decreased from 2.95/1000 person years, in the severe anemia group, to 2.32/1000 person years and 2.01/1000 person years, among the mild-to-moderate and no anemia groups, respectively (p = 0.007). The association between maternal anemia and offspring long-term pediatric neurological morbidity remained significant in a Weibull hazards model controlled for gestational age, delivery mode, SGA and insufficient prenatal care (adjusted HR 1.55; 1.05-2.31 and adjusted HR 1.13; 1.06-1.20; among the severe and mild-to-moderate anemia, vs. no anemia, respectively).
Children born to anemic mothers are at an increased risk for pediatric neurological-related hospitalizations.
已证实孕妇贫血（血红蛋白<11mg/dl）会影响胎儿生长及妊娠结局。我们旨在研究孕妇贫血与子代在长达18年随访期内发生神经疾病的风险之间可能存在的关联。
在索罗卡大学医学中心（SUMC）进行了一项基于人群的队列分析，该中心是一个单一的地区三级医疗中心，比较了按三种产后血红蛋白类别分层的儿童因住院相关的神经疾病的总体及特定亚型：≥11mg/dl（无贫血）；11.0mg/dl＞血红蛋白≥7mg/dl（轻度至中度贫血）及<7mg/dl（重度贫血）。比较了三个研究组之间的妊娠过程及结局数据，以及子代随后的住院情况。分析纳入了1991年至2014年间所有单胎分娩，排除了先天性畸形。采用Kaplan-Meier生存曲线比较基于孕妇贫血状况的累积住院发病率，并构建了Weibull生存多变量风险模型以校正混杂变量。
研究人群包括217,358例分娩，其中50.6%为非贫血母亲的分娩，49.0%为中度贫血母亲的分娩，0.4%为重度贫血母亲的分娩。在随访期（0至18年，中位时间10.22年）内，2.1%的子代因神经疾病诊断而住院。神经疾病住院发病率从重度贫血组的2.95/1000人年降至轻度至中度贫血组的2.32/1000人年及非贫血组的2.01/1000人年（p = 0.007）。在控制了胎龄、分娩方式、小于胎龄儿及产前检查不足的Weibull风险模型中，孕妇贫血与子代长期儿科神经疾病之间的关联仍然显著（重度和轻度至中度贫血组与非贫血组相比，校正风险比分别为1.55；1.05 - 2.31和1.13；1.06 - 1.20）。
贫血母亲所生儿童发生儿科神经疾病相关住院的风险增加。
