The University of Sydney Northern Clinical School, Clinical and Population Perinatal Health Research, St Leonards, NSW, Australia.
Northern Sydney Local Health District, Kolling Institute, St Leonards, NSW, Australia.
Vox Sang. 2019 Nov;114(8):842-852. doi: 10.1111/vox.12839. Epub 2019 Aug 27.
This study aimed to describe how haemoglobin trajectories in pregnant Australian women were associated with subsequent postpartum haemorrhage, blood transfusion and other outcomes.
The study was conducted in two tertiary public hospitals in Australia, using routinely collected maternity and hospital data on singleton pregnancies (2011-2015). Latent class growth modelling defined trajectories among those with at least one haemoglobin in each of three antenatal time periods (0-15, 16-30 and 31+ weeks; n = 7104). Observed over expected ratios were calculated after predicting expected outcomes with adjusted logistic regression.
The mean minimum haemoglobin levels across the three periods were 127·9, 116·5 and 119·3 g/l. We identified seven groups of women with similar haemoglobin trajectories: five with parallel U-shaped trajectories, one with increasing and one with decreasing trajectory. Thirty-eight women (0.5%) had very low haemoglobin across the pregnancy and the highest adverse outcomes, including higher than expected blood transfusion risk. One hundred thirteen women (1.6%) with a progressively decreasing trajectory also had higher risk of transfusion. Women with high haemoglobin across the antenatal period had higher than expected risk of preterm birth, small for gestational age and infants transferred to higher care.
Haemoglobin trajectories across pregnancy can predict women at higher risk of requiring transfusion around birth. Women who maintain high haemoglobins across the pregnancy are worthy of increased surveillance as they carry increased risks of newborn morbidity.
本研究旨在描述澳大利亚孕妇的血红蛋白轨迹与产后出血、输血和其他结局的关系。
该研究在澳大利亚的两家三级公立医院进行，使用常规收集的单胎妊娠产妇和医院数据（2011-2015 年）。潜在类别增长模型在至少有三个产前时间段（0-15、16-30 和 31+周）中每一个时间段都有一个血红蛋白的孕妇中定义了轨迹（n=7104）。在使用调整后的逻辑回归预测预期结局后，计算了观察到的与预期的比值。
三个时期的平均最低血红蛋白水平分别为 127.9、116.5 和 119.3g/l。我们确定了具有相似血红蛋白轨迹的七组妇女：五组具有平行 U 形轨迹，一组具有增加轨迹，一组具有减少轨迹。38 名妇女（0.5%）在整个孕期的血红蛋白非常低，出现了最高的不良结局，包括输血风险高于预期。113 名（1.6%）血红蛋白逐渐下降的妇女也有更高的输血风险。整个孕期血红蛋白较高的妇女早产、小于胎龄儿和婴儿转入更高护理的风险高于预期。
整个孕期的血红蛋白轨迹可以预测分娩前后需要输血的妇女风险较高。在整个孕期保持较高血红蛋白的妇女值得增加监测，因为她们有新生儿发病率增加的风险。
