Savelugu Municipal Hospital, Ghana Health Service, Savelugu, Northern Region, Ghana
Savelugu Municipal Hospital, Ghana Health Service, Savelugu, Northern Region, Ghana.
BMJ Open. 2024 Aug 13;14(8):e082298. doi: 10.1136/bmjopen-2023-082298.
Small for gestational age (SGA) and large for gestational age (LGA) births are topical issues due to their devastating effects on the life course and are also accountable for neonatal mortalities and long-term morbidities.
We tested the hypothesis that abnormal haemoglobin levels in each trimester of pregnancy will increase the risk of SGA and LGA deliveries in Northern Ghana.
A retrospective cohort study was conducted from April to July 2020.
422 postpartum mothers who had delivered in the last 6-8 weeks before their interview dates were recruited through a systematic random sampling technique from five primary and public health facilities in Northern Ghana.
Using the INTERGROWTH-21st standard, SGA and LGA births were obtained. Haemoglobin levels from antenatal records were analysed to determine their effect on SGA and LGA births by employing multinomial logistic regression after adjusting for sociodemographic and obstetric factors at a significance level of α=0.05.
Prevalence of anaemia in the first, second and third trimesters of pregnancy was 63.5%, 71.3% and 45.3%, respectively, and that of polycythaemia in the corresponding trimesters of pregnancy was 5.9%, 3.6% and 1.7%. About 8.8% and 9.2% of the women delivered SGA and LGA babies, respectively. After adjusting for confounders, anaemic mothers in the third trimester of pregnancy had an increased risk of having SGA births (adjusted OR, aOR 5.56; 95% CI 1.65 to 48.1; p<0.001). Mothers with polycythaemia in the first, second and third trimesters of pregnancy were 93% (aOR 0.07; 95% CI 0.01 to 0.46; p=0.040), 85% (aOR 0.15; 95% CI 0.08 to 0.64; p<0.001) and 88% (aOR 0.12; 95% CI 0.07 to 0.15; p=0.001) protected from having SGA births, respectively. Interestingly, anaemia and polycythaemia across all trimesters of pregnancy were not statistically significant with LGA births.
Anaemia during pregnancy increased from the first to the second trimester and subsequently decreased in the third trimester while polycythaemia consistently decreased from the first to the third trimester. LGA babies were more predominant compared with SGA babies. While anaemia in the third trimester of pregnancy increased the risk of SGA births, polycythaemia across the trimesters offered significant protection. Healthcare providers and stakeholders should target pressing interventions for anaemia reduction throughout pregnancy, especially during the third trimester to achieve healthy birth outcomes.
由于小胎龄儿（SGA）和大胎龄儿（LGA）出生对生命历程有破坏性影响，因此它们是当前的热门话题，同时也是导致新生儿死亡和长期发病的原因。
我们检验了这样一个假设，即妊娠各期血红蛋白水平异常会增加加纳北部 SGA 和 LGA 分娩的风险。
这是一项回顾性队列研究，于 2020 年 4 月至 7 月进行。
通过系统随机抽样技术，从加纳北部的五家初级和公共卫生机构招募了 422 名在访谈日期前 6-8 周分娩的产后母亲。
采用 INTERGROWTH-21st 标准，获得 SGA 和 LGA 分娩。从产前记录中分析血红蛋白水平，以确定其对 SGA 和 LGA 分娩的影响，采用多变量逻辑回归分析，在α=0.05 的显著性水平下调整社会人口统计学和产科因素。
妊娠第一、二、三期贫血的发生率分别为 63.5%、71.3%和 45.3%，相应的妊娠三期红细胞增多症的发生率分别为 5.9%、3.6%和 1.7%。约 8.8%和 9.2%的妇女分别分娩出 SGA 和 LGA 婴儿。调整混杂因素后，妊娠第三期贫血的母亲发生 SGA 分娩的风险增加（调整后的 OR，aOR 5.56；95%CI 1.65 至 48.1；p<0.001）。妊娠第一、二、三期红细胞增多症的母亲发生 SGA 分娩的风险分别降低了 93%（aOR 0.07；95%CI 0.01 至 0.46；p=0.040）、85%（aOR 0.15；95%CI 0.08 至 0.64；p<0.001）和 88%（aOR 0.12；95%CI 0.07 至 0.15；p=0.001）。有趣的是，妊娠各期的贫血和红细胞增多症与 LGA 分娩无统计学意义。
妊娠期间的贫血从第一期到第二期逐渐增加，随后在第三期减少，而红细胞增多症则从第一期到第三期持续减少。与 SGA 婴儿相比，LGA 婴儿更为常见。虽然妊娠第三期的贫血增加了 SGA 分娩的风险，但整个孕期的红细胞增多症可提供显著的保护作用。医疗保健提供者和利益相关者应针对整个孕期的贫血减少采取紧迫的干预措施，尤其是在第三期，以实现健康的分娩结果。
