产妇贫血与分娩时脐带血氧含量的关系。
The relationship between maternal anemia and umbilical cord oxygen content at delivery.
机构信息
Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO.
Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO.
出版信息
Am J Obstet Gynecol MFM. 2021 Jan;3(1):100270. doi: 10.1016/j.ajogmf.2020.100270. Epub 2020 Oct 22.
BACKGROUND
Anemia is one of the most commonly diagnosed comorbidities in pregnancy and is known to increase the risk of obstetrical complications. However, little is known about the effect of anemia on placental oxygen transfer and fetal oxygenation.
OBJECTIVE
This study examined the relationship between maternal anemia and fetal oxygenation status at delivery as measured by umbilical cord partial pressure of oxygen.
STUDY DESIGN
This is a secondary analysis of a prospective cohort study of singleton term deliveries with universal admission complete blood count and umbilical cord gases between 2010 and 2014. Maternal anemia was defined as hemoglobin of ≤10 g/dL on admission. The primary outcomes were umbilical artery and vein partial pressure of oxygen; the secondary outcomes were acidemia (umbilical artery pH of <7.1), hypoxemia (umbilical artery or umbilical vein partial pressure of oxygen at the <5th percentile), and hyperoxemia (umbilical artery/umbilical vein partial pressure of oxygen at the >90th percentile). Outcomes were compared between patients with and without anemia.
RESULTS
Maternal anemia was associated with a significantly higher umbilical artery partial pressure of oxygen (median [interquartile range], 20 [16-24] vs 19 [15-24] mm Hg; P=.01) and umbilical vein partial pressure of oxygen (median [interquartile range], 30 [25-36] vs 29 [23-34] mm Hg; P<.01). Neonates born to anemic mothers were more likely to have umbilical vein hyperoxemia (15.7% vs 10.9%; adjusted odds ratio, 1.51; 95% confidence interval, 1.26-1.81) with no difference in umbilical artery hyperoxemia. There was no difference in the rates of umbilical artery or umbilical vein hypoxemia. Although maternal anemia was associated with a significant difference in umbilical artery pH (7.28±0.060 vs 7.27±0.065; P<.01), there was no difference in the rate of neonatal acidemia between groups (1.6% vs 1.9%; adjusted odds ratio, 0.93; 95% confidence interval, 0.55-1.55).
CONCLUSION
Umbilical cord oxygen content is higher in anemic mothers. Maternal anemia may lead to adaptations in maternal, placental, and fetal physiology, allowing for easier unloading of oxygen to the placenta and increased oxygen transfer to the fetus.
背景
贫血是妊娠中最常见诊断出的合并症之一，已知会增加产科并发症的风险。然而，对于贫血对胎盘氧转移和胎儿氧合的影响知之甚少。
目的
本研究通过测量脐动脉血氧分压，检查产妇贫血与分娩时胎儿氧合状态之间的关系。
研究设计
这是一项对 2010 年至 2014 年间接受常规全血细胞计数和脐动脉血气检查的单胎足月分娩前瞻性队列研究的二次分析。产妇贫血定义为入院时血红蛋白值≤10 g/dL。主要结局为脐动脉和脐静脉血氧分压；次要结局为酸中毒（脐动脉 pH 值<7.1）、低氧血症（脐动脉或脐静脉血氧分压处于第 5 百分位数以下）和高氧血症（脐动脉/脐静脉血氧分压处于第 90 百分位数以上）。比较贫血患者与非贫血患者的结局。
结果
产妇贫血与脐动脉血氧分压（中位数[四分位距]，20[16-24] vs 19[15-24]mmHg；P=.01）和脐静脉血氧分压（中位数[四分位距]，30[25-36] vs 29[23-34]mmHg；P<.01）显著升高相关。贫血产妇的新生儿脐静脉血氧分压升高的可能性更高（15.7% vs 10.9%；调整后优势比，1.51；95%置信区间，1.26-1.81），而脐动脉血氧分压升高无差异。脐动脉或脐静脉低氧血症的发生率无差异。尽管产妇贫血与脐动脉 pH 值（7.28±0.060 vs 7.27±0.065；P<.01）有显著差异，但两组新生儿酸中毒的发生率无差异（1.6% vs 1.9%；调整后优势比，0.93；95%置信区间，0.55-1.55）。
结论
贫血产妇的脐动脉血氧含量更高。产妇贫血可能导致母体、胎盘和胎儿生理的适应性改变，从而更容易将氧气卸至胎盘，并增加向胎儿的氧气转移。
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