早孕期和 26-30 孕周血红蛋白水平与胎儿和新生儿结局的关系：全球妇女儿童健康网络 ASPIRIN 试验的二次分析。
Association of haemoglobin levels in the first trimester and at 26-30 weeks with fetal and neonatal outcomes: a secondary analysis of the Global Network for Women's and Children's Health's ASPIRIN Trial.
机构信息
Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan.
Department of Obstetrics and Gynecology, Christiana Care, Newark, DE, USA.
出版信息
BJOG. 2021 Aug;128(9):1487-1496. doi: 10.1111/1471-0528.16676. Epub 2021 Apr 12.
OBJECTIVE
Limited data are available from low- and middle-income countries (LMICs) on the relationship of haemoglobin levels to adverse outcomes at different times during pregnancy. We evaluated the association of haemoglobin levels in nulliparous women at two times in pregnancy with pregnancy outcomes.
DESIGN
ASPIRIN Trial data were used to study the association between haemoglobin levels measured at 6 -13 weeks and 26 -30 weeks of gestation with fetal and neonatal outcomes.
SETTING
Obstetric care facilities in Pakistan, India, Kenya, Zambia, The Democratic Republic of the Congo and Guatemala.
POPULATION
A total of 11 976 pregnant women.
METHODS
Generalised linear models were used to obtain adjusted relative risks and 95% CI for adverse outcomes.
MAIN OUTCOME MEASURES
Preterm birth, stillbirth, neonatal death, small for gestational age (SGA) and birthweight <2500 g.
RESULTS
The mean haemoglobin levels at 6 -13 weeks and at 26-30 weeks of gestation were 116 g/l (SD 17) and 107 g/l (SD 15), respectively. In general, pregnancy outcomes were better with increasing haemoglobin. At 6 -13 weeks of gestation, stillbirth, SGA and birthweight <2500 g, were significantly associated with haemoglobin of 70-89 g/l compared with haemoglobin of 110-129 g/l The relationships of adverse pregnancy outcomes with various haemoglobin levels were more marked at 26-30 weeks of gestation.
CONCLUSIONS
Both lower and some higher haemoglobin concentrations are associated with adverse fetal and neonatal outcomes at 6 -13 weeks and at 26-30 weeks of gestation, although the relationship with low haemoglobin levels appears more consistent and generally stronger.
TWEETABLE ABSTRACT
Both lower and some higher haemoglobin concentrations were associated with adverse fetal and neonatal outcomes at 6-13 weeks and 26-30 weeks of gestation.
目的
来自中低收入国家（LMICs）的有限数据表明，在妊娠不同时期，血红蛋白水平与不良结局之间存在关联。本研究评估了初产妇在妊娠 6-13 周和 26-30 周两次测量的血红蛋白水平与妊娠结局的关系。
设计
使用 ASPIRIN 试验数据研究了在妊娠 6-13 周和 26-30 周时测量的血红蛋白水平与胎儿和新生儿结局之间的关系。
设置
巴基斯坦、印度、肯尼亚、赞比亚、刚果民主共和国和危地马拉的产科医疗机构。
人群
共有 11976 名孕妇。
方法
使用广义线性模型获得不良结局的调整相对风险和 95%置信区间。
主要观察指标
早产、死胎、新生儿死亡、小于胎龄儿（SGA）和出生体重<2500g。
结果
妊娠 6-13 周和 26-30 周时的平均血红蛋白水平分别为 116g/L（SD 17）和 107g/L（SD 15）。总的来说，随着血红蛋白水平的升高，妊娠结局越好。在妊娠 6-13 周时，与血红蛋白水平为 110-129g/L 相比，血红蛋白水平为 70-89g/L 时，死胎、SGA 和出生体重<2500g 显著相关。在妊娠 26-30 周时，各种血红蛋白水平与不良妊娠结局的关系更为明显。
结论
在妊娠 6-13 周和 26-30 周时，较低和一些较高的血红蛋白浓度都与胎儿和新生儿不良结局相关，尽管与低血红蛋白水平的关系似乎更为一致且通常更强。
推文摘要
在妊娠 6-13 周和 26-30 周时，较低和一些较高的血红蛋白浓度都与胎儿和新生儿不良结局相关。
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