利用电子健康记录评估妊娠期间贫血和缺铁的患病率。

Use of the Electronic Health Record to Assess Prevalence of Anemia and Iron Deficiency in Pregnancy.

机构信息

Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.

US Public Health Service Commissioned Corps, Atlanta, GA, USA.

出版信息

J Nutr. 2021 Nov 2;151(11):3588-3595. doi: 10.1093/jn/nxab254.

DOI:10.1093/jn/nxab254

PMID:34386820

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9550311/

Abstract

BACKGROUND

In the United States, the prevalence of anemia, iron deficiency (ID), and iron-deficiency anemia (IDA) during pregnancy remains largely unknown as data at the national or state level are limited or nonexistent, respectively.

OBJECTIVES

In an effort to identify opportunities to improve maternal health surveillance, we assessed the feasibility of anemia, ID, and IDA surveillance among first-trimester pregnancies using electronic health records (EHRs).

METHODS

We identified pregnancies among Kaiser Permanente Northwest members aged ≥18 y during 2005-2016 with first-trimester prenatal care (n = 41,991). Earliest laboratory test results for hemoglobin or hematocrit and ferritin were selected. We describe the proportion of pregnancies screened for and the prevalence of anemia, ID, and IDA; the concordance of anemia status by hemoglobin compared with hematocrit; and the proportion of pregnancies with laboratory-confirmed anemia that also had an International Classification of Diseases diagnostic code related to anemia.

RESULTS

Identified pregnancies included women who were 73.1% non-Hispanic (NH) white, 11.5% Hispanic, 8.5% NH Asian/Pacific Islander, and 2.9% NH black. Hemoglobin and hematocrit results were available for 92.7% (n = 38,923) pregnancies. Anemia prevalence was 2.7% (n = 1045) based on hemoglobin <11.0 g/dL or hematocrit <33%; 45.2% of anemia cases had both low hemoglobin and low hematocrit. Among pregnancies with anemia, 18.9% (n = 197) had a ferritin result; of those, 48.2% had ID (ferritin <15 μg/L). In pregnancies without anemia, 3.4% (n = 1275) had a ferritin result; of those, 23.5% had ID. Based on 1472 pregnancies with both anemia and ID assessed, prevalence of ID and IDA was 26.8% and 6.5%, respectively; estimates likely represent selective screening.

CONCLUSIONS

EHR data have potential to monitor anemia prevalence and trends in health systems where prenatal anemia screening is nearly universal. However, if iron assessment is not routine, then representative estimates of ID or IDA are unattainable.

摘要

背景

在美国，由于国家或州层面的数据有限或不存在，关于孕妇贫血、缺铁（ID）和缺铁性贫血（IDA）的患病率仍知之甚少。

目的

为了寻找改善孕产妇健康监测的机会，我们评估了使用电子健康记录（EHR）对早孕妊娠进行贫血、缺铁和缺铁性贫血监测的可行性。

方法

我们在 2005 年至 2016 年间，从 Kaiser Permanente Northwest 会员中确定了年龄≥18 岁的孕妇（n=41991），并对其进行了早孕产前保健。选择最早的血红蛋白或血细胞比容和铁蛋白实验室检测结果。我们描述了筛查的妊娠比例、贫血、缺铁和缺铁性贫血的患病率；用血红蛋白和血细胞比容比较贫血状态的一致性；以及实验室确诊贫血的妊娠比例，这些妊娠也有与贫血相关的国际疾病分类诊断代码。

结果

所确定的妊娠包括 73.1%的非西班牙裔（NH）白人、11.5%的西班牙裔、8.5%的 NH 亚裔/太平洋岛民和 2.9%的 NH 黑人。92.7%（n=38923）的妊娠有血红蛋白和血细胞比容的结果。根据血红蛋白<11.0 g/dL或血细胞比容<33%，贫血的患病率为 2.7%（n=1045）；45.2%的贫血病例同时有低血红蛋白和低血细胞比容。在贫血的妊娠中，18.9%（n=197）有铁蛋白的结果；其中 48.2%有缺铁（铁蛋白<15 μg/L）。在无贫血的妊娠中，3.4%（n=1275）有铁蛋白的结果；其中 23.5%有缺铁。在 1472 例同时有贫血和缺铁的妊娠中，缺铁和缺铁性贫血的患病率分别为 26.8%和 6.5%；这些估计值可能代表选择性筛查。