Hubert Department of Global Health, Emory University, Atlanta, Georgia.
Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, Rhode Island.
Ann N Y Acad Sci. 2019 Aug;1450(1):47-68. doi: 10.1111/nyas.14093. Epub 2019 Apr 17.
Maternal anemia is a well-recognized global health problem; however, there remain questions on specific hemoglobin (Hb) thresholds that predict health risk or protection for mother and child. We conducted a systematic review and meta-analysis to examine the associations of maternal Hb concentrations with a range of maternal and infant health outcomes, accounting for the timing of measurement (preconception, and first, second, and third trimesters), etiology of anemia, and cutoff category. The systematic review included 272 studies and the meta-analysis included 95 studies. Low maternal Hb (<110 g/L) was associated with poor birth outcomes (low birth weight, preterm birth, small-for-gestational-age (SGA), stillbirth, and perinatal and neonatal mortality) and adverse maternal outcomes (postpartum hemorrhage, preeclampsia, and blood transfusion). High maternal Hb (>130 g/L) was associated with increased odds of SGA, stillbirth, preeclampsia, and gestational diabetes. Relationships varied by the timing of measurement and cutoff category (stronger associations with lower cutoffs); limited data were available on anemia etiology. There were insufficient data for other maternal outcomes and long-term child health outcomes. Current data are insufficient for determining if revisions to current Hb cutoffs are required. Pooled high-quality individual-level data analyses, as well as prospective cohort studies, would be valuable to inform the reevaluation of Hb cutoffs.
母亲贫血是一个公认的全球健康问题；然而，对于预测母亲和儿童健康风险或保护的具体血红蛋白（Hb）阈值仍存在疑问。我们进行了系统评价和荟萃分析，以检查母亲 Hb 浓度与一系列母亲和婴儿健康结果的关联，同时考虑了测量时间（受孕前、第一、第二和第三个三个月）、贫血的病因和截止类别。系统评价包括 272 项研究，荟萃分析包括 95 项研究。低母亲 Hb（<110 g/L）与不良出生结局（低出生体重、早产、小于胎龄儿（SGA）、死产以及围产期和新生儿死亡）和不良母亲结局（产后出血、子痫前期和输血）相关。高母亲 Hb（>130 g/L）与 SGA、死产、子痫前期和妊娠糖尿病的几率增加相关。这些关系因测量时间和截止类别而异（较低的截止值关联更强）；贫血病因的相关数据有限。其他母亲结局和儿童长期健康结局的数据不足。目前的数据不足以确定是否需要修订当前的 Hb 截止值。汇总高质量的个体水平数据分析以及前瞻性队列研究将有助于重新评估 Hb 截止值。
