印度和巴基斯坦前瞻性队列研究中的母体贫血及母婴和新生儿结局。
Maternal anaemia and maternal, fetal, and neonatal outcomes in a prospective cohort study in India and Pakistan.
机构信息
Department of Obstetrics & Gynecology, Christiana Care Health System, Newark, DE, USA.
KLE Academy of Higher Education and Research, Belgaum, India.
出版信息
BJOG. 2019 May;126(6):737-743. doi: 10.1111/1471-0528.15585. Epub 2019 Jan 24.
OBJECTIVE
To describe the association of maternal anaemia with maternal, fetal, and neonatal outcomes.
DESIGN
Prospective cohort study.
SETTING
Rural India and Pakistan.
POPULATION
Pregnant women residing in the study catchment area.
METHODS
We performed an analysis of a prospective pregnancy registry in which haemoglobin is commonly obtained as well as maternal, fetal, and neonatal outcomes for 42 days post-delivery. Women 40 years or older who delivered before 20 weeks or had a haemoglobin level of <3.0 g/dl were excluded. Our primary exposure was maternal anaemia, which was categorised in keeping with World Health Organization criteria based on a normal (≥11 g/dl), mild (>10-10.9 g/dl), moderate (7-9.9 g/dl) or severe (<7 g/dl). haemoglobin level. The primary maternal outcome was maternal death, the primary fetal outcome was stillbirth, and the primary neonatal outcome was neonatal mortality <28 days.
RESULTS
A total of 92 247 deliveries and 93 107 infants were included, of which 87.8% were born to mothers who were anaemic (mild 37.9%, moderate 49.1%, and severe 0.7%). Maternal mortality (number per 100 000) was not associated with anaemia: normal 124, mild 106, moderate 135, and severe 325 (P = 0.64). Fetal and neonatal mortality was associated with severe anaemia: stillbirth rate (n/1000)-normal 27.7, mild 25.8, moderate 30.1, and severe 90.9; P < 0.0001; 28-day neonatal mortality (n/1000)-normal 24.7, mild 22.9, moderate 28.1, and severe 72.6 (P < 0.0001). Severe maternal anaemia was also associated with low birthweight (<2500 and <1500 g), preterm birth, and postpartum haemorrhage.
CONCLUSION
Severe maternal anaemia is associated with higher risks of poor maternal, fetal, and neonatal outcomes but other degrees of anaemia are not. Interventions directed at preventing severe anaemia in pregnant women should be considered.
TWEETABLE ABSTRACT
Severe maternal anaemia is associated with adverse fetal and neonatal outcomes in low/middle-income countries.
目的
描述母体贫血与母婴及新生儿结局的关系。
设计
前瞻性队列研究。
地点
印度和巴基斯坦农村地区。
人群
居住在研究集水区的孕妇。
方法
我们对一个前瞻性妊娠登记处进行了分析，该登记处通常会检测血红蛋白，以及产妇、胎儿和新生儿产后 42 天的结局。40 岁或以上的妇女、20 周前分娩或血红蛋白水平<3.0g/dl 的妇女被排除在外。我们的主要暴露因素是母体贫血，根据世界卫生组织的标准，根据正常（≥11g/dl）、轻度（>10-10.9g/dl）、中度（7-9.9g/dl）或重度（<7g/dl）的血红蛋白水平进行分类。主要产妇结局为产妇死亡，主要胎儿结局为死胎，主要新生儿结局为 28 天内新生儿死亡。
结果
共纳入 92247 例分娩和 93107 例婴儿，其中 87.8%的母亲患有贫血（轻度 37.9%，中度 49.1%，重度 0.7%）。产妇死亡率（每 10 万人中的人数）与贫血无关：正常 124，轻度 106，中度 135，重度 325（P=0.64）。胎儿和新生儿死亡率与严重贫血有关：死产率（每 1000 例中的人数）-正常 27.7，轻度 25.8，中度 30.1，重度 90.9；P<0.0001；28 天新生儿死亡率（每 1000 例中的人数）-正常 24.7，轻度 22.9，中度 28.1，重度 72.6（P<0.0001）。严重母体贫血也与低出生体重（<2500 克和<1500 克）、早产和产后出血有关。
结论
严重的母体贫血与较差的母婴和新生儿结局相关，但其他程度的贫血则不然。应考虑针对预防孕妇严重贫血的干预措施。
推文摘要
严重的母体贫血与中低收入国家的不良母婴和新生儿结局相关。
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