Anaemia during early pregnancy tied to adverse outcomes

  • Randall DA & al.
  • PLoS ONE
  • 1 Jan 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • In early pregnancy (≤20 weeks), the risks for adverse outcomes were higher in women with low and high haemoglobin (Hb) level compared with those with normal Hb
  • Restoration of Hb after 20 weeks did not improve most adverse outcome rates but was associated with a reduction in the risk for transfusion.

Why this matter

  • Findings warrant research to determine why low and high Hb in early pregnancy is linked to poorer outcomes and whether these outcomes can be prevented before or during the pregnancy.

Study design

  • Retrospective study of 31,906 singleton pregnancies (gestational age, 20-42 weeks) using hospital data.
  • Levels of Hb at ≤20 weeks and associations with postpartum haemorrhage (PPH) and blood transfusion at birth or postnatally were assessed.
  • Funding: Australian National Blood Authority Pilot Project.

Key results

  • Overall, 4.0% of the singleton pregnancies had Hb
  • Women with low Hb vs those with normal and high Hb (
  • PPH (15.5% vs 13.4% and 14.7%; P<.05>
  • transfusion (4.9% vs 2.0% and 1.7%; P<.001>
  • preterm birth (
  • stillbirth (2.0% vs 0.7% and 0.7%; P<.001>
  • very low birthweight (
  • transfer to higher care (19.7% vs 15.6% and 18.0%; P<.001>
  • Restored group vs not restored group had significantly lower risk for transfusion (2.6% vs 7.4%; adjusted risk ratio [aRR], 0.39; 95% CI, 0.22-0.70).
  • Restoration of Hb did not significantly affect (restored vs not restored groups):
    • PPH (15.2% vs 15.8%; aRR, 0.96; 95% CI, 0.71-1.29),
    • preterm birth (9.1% vs 11.7%; aRR, 0.91; 95% CI, 0.63-1.30) and
    • transfer to higher care (18.7% vs 22.5%; aRR, 0.89; 95% CI, 0.70-1.14).
  • Limitations

    • Hb results were manually entered in birth data.