Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI (Drs Harrison, Colvin, and McIntosh); Maternal Fetal Medicine, Advocate Medical Group, Chicago, IL (Dr Harrison).
Medical College of Wisconsin, Milwaukee, WI (Ms Lauhon).
Am J Obstet Gynecol MFM. 2021 Sep;3(5):100395. doi: 10.1016/j.ajogmf.2021.100395. Epub 2021 May 13.
Maternal anemia is a common pregnancy complication and often leads to a requirement for additional treatments and interventions. Identifying the frequency at which women with antenatally diagnosed anemia experience severe morbidity at the time of admission to the labor and delivery unit will guide future recommendations regarding screening and interventions for anemia during pregnancy.
The objective of this study was to evaluate the association between antenatally diagnosed anemia and severe maternal morbidity as defined by the Centers for Disease Control and Prevention in a large, contemporary, US cohort. Neonatal outcomes were also examined.
This was a secondary analysis of the Consortium on Safe Labor database from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, which collected data on 228,438 deliveries in 19 United States hospitals from 2002 to 2008. This analysis included women with viable, singleton gestations and excluded stillbirths and gestations with severe congenital anomalies. Women with a diagnosis of antenatal anemia were compared with those without. Identification of diagnoses of antenatal anemia was obtained via electronic medical record abstraction and International Classification of Diseases coding according to each hospital protocol within the Consortium on Safe Labor. The primary maternal outcome consisted of a composite of severe maternal morbidity as defined by the Centers for Disease Control and Prevention and included maternal death, eclampsia, thrombosis, transfusion, hysterectomy, and maternal intensive care unit admission. The primary neonatal outcome was a composite that included a 5-minute Apgar score of <7, hypoxic ischemic encephalopathy, respiratory distress syndrome, necrotizing enterocolitis, seizures, intracranial hemorrhage, periventricular or intraventricular hemorrhage, neonatal sepsis, neonatal intensive care unit admission, and neonatal death. Each outcome within the composites was assessed individually along with other additional secondary outcomes, including a composite of severe maternal morbidity not including transfusion morbidity. All statistical analyses were performed with Stata version 14.2 (StataCorp LLC, College Station, TX) using Student's t test, chi-square test, Fisher's exact test, and Wilcoxon rank-sum (Mann-Whitney U) test, as appropriate. A multivariable logistic regression was performed with potential confounding variables entered into the regression equation if they differed between groups at a significance level of P<.05.
A total of 166,566 women met the inclusion criteria. From the original cohort, 56,734 women could not be included because of an unknown diagnosis of anemia. Of those included, 10,217 (6.1%) were diagnosed with anemia during the pregnancy. Women with anemia were more likely to be younger, non-Hispanic Black, single, multiparous, and have a higher prepregnancy body mass index than those without anemia. The frequency of the primary maternal composite outcome, the neonatal composite outcome, and other secondary outcomes including the severe maternal morbidity composite not including transfusion, maternal death, transfusion during labor and the postpartum period, hysterectomy, postpartum hemorrhage, infectious morbidity, cesarean delivery, and preterm delivery were more common in women with anemia (P<.05). After multivariable logistic regression analysis adjusting for confounders, higher rates of severe maternal morbidity remained persistently associated with anemia (adjusted odds ratio, 2.04; 95% confidence interval, 1.86-2.23) in addition to the association of anemia with the severe maternal morbidity composite not including transfusion, maternal death, thrombosis, transfusion, hysterectomy, intensive care unit admission, postpartum hemorrhage, hypertensive disorders of pregnancy, cesarean delivery, and infectious morbidity. The composite neonatal outcome also remained associated with anemia after adjusting for confounders (adjusted odds ratio, 1.14; 95% confidence interval, 1.06-1.23).
Women with antepartum anemia experienced increased rates of severe maternal morbidity and other serious adverse outcomes. Diagnosis and treatment of anemia during the antepartum period may lead to the identification and treatment of women at higher risk for maternal morbidity and mortality.
孕产妇贫血是一种常见的妊娠并发症，通常需要额外的治疗和干预。确定在分娩和分娩单位入院时产前诊断为贫血的女性出现严重发病率的频率，将指导未来关于妊娠期间贫血筛查和干预的建议。
本研究旨在评估在大型当代美国队列中，根据疾病控制和预防中心的定义，产前诊断的贫血与严重产妇发病率之间的关联。还检查了新生儿结局。
这是 Eunice Kennedy Shriver 国家儿童健康与人类发展研究所的安全分娩联盟数据库的二次分析，该数据库收集了 19 家美国医院 2002 年至 2008 年间 228438 例分娩的数据。本分析包括有存活、单胎妊娠的妇女，并排除死产和严重先天性畸形的妊娠。将患有产前贫血的妇女与没有贫血的妇女进行比较。通过电子病历摘要和根据安全分娩联盟内每家医院的协议使用国际疾病分类编码来识别产前贫血的诊断。主要产妇结局包括疾病控制和预防中心定义的严重产妇发病率的复合指标，包括产妇死亡、子痫、血栓形成、输血、子宫切除术和产妇重症监护病房入院。主要新生儿结局是一种复合指标，包括 5 分钟 Apgar 评分<7、缺氧缺血性脑病、呼吸窘迫综合征、坏死性小肠结肠炎、癫痫发作、颅内出血、脑室周围或脑室内出血、新生儿败血症、新生儿重症监护病房入院和新生儿死亡。每个复合指标内的结局以及其他附加次要结局，包括不包括输血发病率的严重产妇发病率复合指标，都单独进行了评估。所有统计分析均使用 Stata 版本 14.2（StataCorp LLC，德克萨斯州学院站）进行，使用学生 t 检验、卡方检验、Fisher 精确检验和 Wilcoxon 秩和（Mann-Whitney U）检验（如适用）。使用多元逻辑回归，将潜在混杂变量纳入回归方程，如果它们在组间差异有统计学意义（P<.05）。
共有 166566 名妇女符合纳入标准。在原始队列中，由于无法确定贫血的诊断，有 56734 名妇女无法纳入。在纳入的人群中，有 10217 人（6.1%）在怀孕期间被诊断为贫血。与没有贫血的妇女相比，患有贫血的妇女更年轻、非西班牙裔黑人、单身、多产、孕前体重指数更高。主要产妇复合结局、新生儿复合结局以及其他次要结局，包括不包括输血的严重产妇复合结局、产妇死亡、分娩和产后输血、子宫切除术、产后出血、传染性发病率、剖宫产和早产的频率在贫血妇女中更为常见（P<.05）。在调整混杂因素后的多变量逻辑回归分析中，严重产妇发病率与贫血之间仍存在较高的关联（调整后的优势比，2.04；95%置信区间，1.86-2.23），除了贫血与不包括输血的严重产妇发病率复合结局、产妇死亡、血栓形成、输血、子宫切除术、重症监护病房入院、产后出血、妊娠高血压疾病、剖宫产和传染性发病率之间的关联。调整混杂因素后，新生儿复合结局也与贫血相关（调整后的优势比，1.14；95%置信区间，1.06-1.23）。
产前贫血的妇女发生严重产妇发病率和其他严重不良结局的风险增加。在产前期间对贫血的诊断和治疗可能会导致识别和治疗产妇发病率和死亡率较高的妇女。
