Arya Sumedha, Akbari-Moghaddam Maryam, Liu Yang, Press Elissa, Muraca Giulia M, VanderMeulen Heather, Barrett Jon, Zeller Michelle P, Hacker Michele R, Callum Jeannie
Canadian Blood Services, Toronto, ON; University of Toronto, Toronto, ON; Harvard T.H. Chan School of Public Health, Boston, MA.
Department of Computing and Software, McMaster University, Hamilton, ON; Michael G. DeGroote Centre for Transfusion Research, Hamilton, ON.
J Obstet Gynaecol Can. 2025 Feb;47(2):102721. doi: 10.1016/j.jogc.2024.102721. Epub 2024 Nov 28.
Anemia in pregnancy has negative impacts on maternal and neonatal morbidity and mortality and has been described as an issue of health equity. The primary aim of our study was to describe the rates of anemia near delivery and assess whether this correlates with neighbourhood-level income status.
We conducted a retrospective cohort study of pregnant persons delivering from January 2012 through December 2022 at 2 large academic centres. We used log-binomial regression to estimate the association between neighbourhood-level income quintile and anemia near delivery, defined as a hemoglobin <110 g/L within 30 days of delivery, controlling for maternal age, parity, thalassemia trait, number of fetuses, blood group, and service provider type. Secondary maternal and fetal outcomes were analyzed descriptively.
A total of 51 782 deliveries were included; the majority were singleton (97%) pregnancies delivered vaginally (61%). Although 77% of patients had a complete blood count done within 30 days of delivery, only 13% had a ferritin value checked within 9 months of delivery. Approximately 30% of all patients were anemic near delivery, with higher rates of anemia in lower income quintiles; patients in the lowest income quintile were 18% more likely to be anemic than those in the highest income quintile (relative risk 1.18; 95% CI 1.12-1.25).
Even within a high-resource academic setting, anemia in pregnancy is common. Given the high rates of anemia in our study, particularly, amongst patients in lower income quintiles, widespread targeted educational and system interventions are required to ensure equitable patient care.
孕期贫血对孕产妇和新生儿的发病率及死亡率有负面影响，且被视为一个健康公平问题。我们研究的主要目的是描述临产前贫血的发生率，并评估其是否与社区层面的收入状况相关。
我们对2012年1月至2022年12月在2个大型学术中心分娩的孕妇进行了一项回顾性队列研究。我们使用对数二项回归来估计社区层面收入五分位数与临产前贫血之间的关联，临产前贫血定义为分娩后30天内血红蛋白<110 g/L，同时控制产妇年龄、产次、地中海贫血特质、胎儿数量、血型和服务提供者类型。对次要的孕产妇和胎儿结局进行了描述性分析。
共纳入51782例分娩；大多数为单胎妊娠（97%），经阴道分娩（61%）。尽管77%的患者在分娩后30天内进行了全血细胞计数，但只有13%的患者在分娩后9个月内检查了铁蛋白值。所有患者中约30%在临产前贫血，低收入五分位数人群的贫血率更高；收入最低五分位数的患者贫血的可能性比收入最高五分位数的患者高18%（相对风险1.18；95%置信区间1.12 - 1.25）。
即使在资源丰富的学术环境中，孕期贫血也很常见。鉴于我们研究中贫血发生率较高，尤其是在低收入五分位数的患者中，需要广泛开展有针对性的教育和系统干预措施，以确保提供公平的患者护理。
