母体血红蛋白水平与不良妊娠结局：来自 2 项英国前瞻性妊娠队列的个体患者数据分析。

Maternal hemoglobin levels and adverse pregnancy outcomes: individual patient data analysis from 2 prospective UK pregnancy cohorts.

机构信息

Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom; NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, United Kingdom.

Department of Obstetrics and Gynaecology, University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom.

出版信息

Am J Clin Nutr. 2023 Mar;117(3):616-624. doi: 10.1016/j.ajcnut.2022.10.011.

DOI:10.1016/j.ajcnut.2022.10.011

PMID:36872020

Abstract

BACKGROUND

Hemoglobin (Hb) is a modifiable risk factor for adverse pregnancy outcomes. Studies have reported conflicting associations between maternal Hb levels and adverse pregnancy outcomes, including preterm birth (PTB), low birth weight (LBW), and perinatal mortality.

OBJECTIVE

In this study, we aimed to estimate the shape and magnitude of associations between maternal Hb levels in early (7-12 wk gestation) and late pregnancy (27-32 wk gestation) and pregnancy outcomes in a high-income setting.

METHODS

We used data from 2 UK population-based pregnancy cohorts: the Avon Longitudinal Study of Parents and Children (ALSPAC) and Pregnancy Outcome Prediction Study (POPS). We used multivariable logistic regression models to examine the relationship between Hb and pregnancy outcomes, adjusting for maternal age, ethnicity, BMI, smoking status, and parity. Main outcome measures were PTB, LBW, small for gestational age (SGA), pre-eclampsia (PET), and gestational diabetes mellitus (GDM).

RESULTS

Mean Hb in ALSPAC were 12.5 g/dL (SD = 0.90) and 11.2 g/dL (SD = 0.92) in early and late pregnancy, respectively, and 12.7 g/dL (SD = 0.82) and 11.4 g/dL (SD = 0.82) in POPS. In the pooled analysis, there was no evidence of associations between a higher Hb in early pregnancy (7-12 wk gestation) and PTB (OR per 1 g/dL of Hb: 1.09; 95% CI: 0.97, 1.22), LBW (1.12: 0.99, 1.26), and SGA (1.06; 0.97, 1.15). Higher Hb in late pregnancy (27-32 wk gestation) was associated with PTB (1.45: 1.30, 1.62), LBW (1.77: 1.57, 2.01), and SGA (1.45: 1.33, 1.58). Higher Hb in early and late pregnancy was associated with PET in ALSPAC (1.36: 1.12, 1.64) and (1.53: 1.29, 1.82), respectively, but not in POPS (1.17:0.99, 1.37) and (1.03: 0.86, 1.23). There was an association with a higher Hb and GDM in ALSPAC in both early and late pregnancy [(1.51: 1.08, 2.11) and (1.35: 1.01, 1.79), respectively], but not in POPS [(0.98: 0.81, 1.19) and (0.83: 0.68, 1.02)].

CONCLUSIONS

Higher maternal Hb may identify the risk of adverse pregnancy outcomes. Further research is required to investigate if this association is causal and to identify the underlying mechanisms.

摘要

背景

血红蛋白（Hb）是不良妊娠结局的可改变风险因素。研究报告称，母体 Hb 水平与不良妊娠结局（包括早产（PTB）、低出生体重（LBW）和围产期死亡）之间存在相互矛盾的关联。

目的

本研究旨在估计高收入环境中母体 Hb 水平在早期（7-12 孕周）和晚期（27-32 孕周）妊娠与妊娠结局之间的关联程度和形态。

方法

我们使用了来自 2 个英国基于人群的妊娠队列的数据：阿冯纵向研究父母和儿童（ALSPAC）和妊娠结局预测研究（POPS）。我们使用多变量逻辑回归模型来检查 Hb 与妊娠结局之间的关系，同时调整了母亲的年龄、种族、BMI、吸烟状况和产次。主要结局指标为 PTB、LBW、胎儿生长受限（SGA）、子痫前期（PET）和妊娠期糖尿病（GDM）。

结果

ALSPAC 中平均 Hb 在早期妊娠（7-12 孕周）和晚期妊娠（27-32 孕周）分别为 12.5 g/dL（SD=0.90）和 11.2 g/dL（SD=0.92），POPS 中分别为 12.7 g/dL（SD=0.82）和 11.4 g/dL（SD=0.82）。在汇总分析中，早期妊娠（7-12 孕周）Hb 水平升高与 PTB（每 1 g/dL Hb 的 OR：1.09；95%CI：0.97，1.22）、LBW（1.12：0.99，1.26）和 SGA（1.06：0.97，1.15）之间没有证据表明存在关联。晚期妊娠（27-32 孕周）Hb 水平升高与 PTB（1.45：1.30，1.62）、LBW（1.77：1.57，2.01）和 SGA（1.45：1.33，1.58）有关。早期和晚期妊娠 Hb 水平升高与 ALSPAC 中的 PET（1.36：1.12，1.64）和（1.53：1.29，1.82）有关，但在 POPS 中没有关联（1.17：0.99，1.37）和（1.03：0.86，1.23）。在 ALSPAC 中，早期和晚期妊娠 Hb 水平升高与 GDM 相关，（1.51：1.08，2.11）和（1.35：1.01，1.79），但在 POPS 中没有关联（0.98：0.81，1.19）和（0.83：0.68，1.02）。