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Maternal anemia and adverse pregnancy outcomes
Descriptive
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Title
Maternal anemia and adverse pregnancy outcomes
Name
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Zhang
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Qiaoyi
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1964-
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Qiaoyi Zhang
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author
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Ananth
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Cande
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Advisory Committee
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Cande V Ananth
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chair
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Rhoads
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George
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Advisory Committee
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George Rhoads
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dissertation committee member
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Smulian
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John
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Advisory Committee
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John C Smulian
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internal member
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Li
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Zhu
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Advisory Committee
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Zhu Li
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outside member
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Rutgers University
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degree grantor
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Graduate School - New Brunswick
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theses
OriginInfo
DateCreated
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2008
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2008-01
Language
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English
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electronic
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application/pdf
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x, 135 pages
Abstract
Background: Maternal anemia is a ubiquitous pregnancy complication, and has been associated with an array of adverse perinatal and reproductive outcomes. Despite scores studies, the association between anemia and perinatal outcomes remains poorly understood. The objectives of our study were to describe the epidemiology of maternal anemia, and to examine the associations of maternal anemia with perinatal mortality and preterm birth.
Method: A prospective cohort study was conducted, using existing data from a population-based pregnancy-monitoring system in 13 counties in East China (1993-96). Women who delivered singleton infants at 20 to 44 weeks with at least one hemoglobin assessment during pregnancy were included (n=164,667). The prevalence of anemia (hemoglobin <10 g/dL) during pregnancy and rates of stillbirth, neonatal death, and preterm birth were estimated. Multivariable log-Binomial regression models were used to evaluate risk factors associated with anemia. Associations between anemia and adverse outcomes were examined using multiple Cox proportional hazards regression models after adjusting for a variety of confounding factors.
Results: The overall prevalence of anemia was 32.6%, with substantial variations across trimesters (11%, 20%, and 26% in the 1st, 2nd and 3rd trimesters, respectively). Older maternal age, lower education, farm occupation, delayed prenatal care, pregnancy-induced hypertension and preeclampsia were associated with increased risk for anemia, whereas peri-conceptional folic acid use was associated with reduced risk for 1st trimester anemia. Anemia in the first half of pregnancy was associated with increased risk of stillbirth (adjusted hazard ratio (HR) 1.7, 95% confidence internal (CI) 1.1, 2.7), but not neonatal deaths. Anemia in the 1st trimester was associated with increased risk for preterm premature rupture of membranes (PROM). Women with hemoglobin ≤5 g/dL were at highest risk (HR 3.3, 95% CI 1.4, 7.7) with progressively declining risk with increasing hemoglobin levels. In contrast, anemia in the 3rd trimester was associated with reduced risk for all preterm birth and spontaneous preterm labor, potentially due to hemo-dilution. Anemia was not associated with medically indicated preterm birth.
Conclusion: Anemia in early pregnancy was associated with increased risk for stillbirth and preterm PROM. These findings underscore that early identification and treatment to alleviate anemia may help improve adverse pregnancy outcomes and related complications.
Method: A prospective cohort study was conducted, using existing data from a population-based pregnancy-monitoring system in 13 counties in East China (1993-96). Women who delivered singleton infants at 20 to 44 weeks with at least one hemoglobin assessment during pregnancy were included (n=164,667). The prevalence of anemia (hemoglobin <10 g/dL) during pregnancy and rates of stillbirth, neonatal death, and preterm birth were estimated. Multivariable log-Binomial regression models were used to evaluate risk factors associated with anemia. Associations between anemia and adverse outcomes were examined using multiple Cox proportional hazards regression models after adjusting for a variety of confounding factors.
Results: The overall prevalence of anemia was 32.6%, with substantial variations across trimesters (11%, 20%, and 26% in the 1st, 2nd and 3rd trimesters, respectively). Older maternal age, lower education, farm occupation, delayed prenatal care, pregnancy-induced hypertension and preeclampsia were associated with increased risk for anemia, whereas peri-conceptional folic acid use was associated with reduced risk for 1st trimester anemia. Anemia in the first half of pregnancy was associated with increased risk of stillbirth (adjusted hazard ratio (HR) 1.7, 95% confidence internal (CI) 1.1, 2.7), but not neonatal deaths. Anemia in the 1st trimester was associated with increased risk for preterm premature rupture of membranes (PROM). Women with hemoglobin ≤5 g/dL were at highest risk (HR 3.3, 95% CI 1.4, 7.7) with progressively declining risk with increasing hemoglobin levels. In contrast, anemia in the 3rd trimester was associated with reduced risk for all preterm birth and spontaneous preterm labor, potentially due to hemo-dilution. Anemia was not associated with medically indicated preterm birth.
Conclusion: Anemia in early pregnancy was associated with increased risk for stillbirth and preterm PROM. These findings underscore that early identification and treatment to alleviate anemia may help improve adverse pregnancy outcomes and related complications.
Note
(type = degree)
Ph.D.
Note
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Includes bibliographical references.
Subject
(ID = SUBJ1);
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Topic
Public Health
Subject
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Topic
Pregnancy
Subject
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Topic
Anemia
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Title
Graduate School - New Brunswick Electronic Theses and Dissertations
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rucore19991600001
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http://hdl.rutgers.edu/1782.2/rucore10001600001.ETD.17242
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ETD_672
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NjNbRU
Identifier
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doi:10.7282/T3DN45FS
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ETD doctoral
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Open
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Qiaoyi Zhang
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Rutgers University. Graduate School - New Brunswick
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Non-exclusive ETD license
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Author Agreement License
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I hereby grant to the Rutgers University Libraries and to my school the non-exclusive right to archive, reproduce and distribute my thesis or dissertation, in whole or in part, and/or my abstract, in whole or in part, in and from an electronic format, subject to the release date subsequently stipulated in this submittal form and approved by my school. I represent and stipulate that the thesis or dissertation and its abstract are my original work, that they do not infringe or violate any rights of others, and that I make these grants as the sole owner of the rights to my thesis or dissertation and its abstract. I represent that I have obtained written permissions, when necessary, from the owner(s) of each third party copyrighted matter to be included in my thesis or dissertation and will supply copies of such upon request by my school. I acknowledge that RU ETD and my school will not distribute my thesis or dissertation or its abstract if, in their reasonable judgment, they believe all such rights have not been secured. I acknowledge that I retain ownership rights to the copyright of my work. I also retain the right to use all or part of this thesis or dissertation in future works, such as articles or books.
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