Severity of Anemia during Pregnancy and Adverse Maternal and Fetal Outcomes
JAMA Network
Anemia is the most widespread nutritional deficiency among pregnant females in the world. A total of 40.05% of pregnant females worldwide had anemia during pregnancy, with the highest prevalence (48.15%) in Southeast Asia. Because of the high prevalence of anemia, any adverse maternal and fetal outcomes associated with anemia during pregnancy would have a great public health impact.
Despite numerous studies on anemia, evidence is limited about the association of severity of anemia with maternal and fetal health.
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In this retrospective cohort study, the association between the severity of anemia during pregnancy and maternal and fetal outcomes was evaluated among pregnant women in China. Of 18, 948, 443 pregnant women, 17.78% were diagnosed with anemia during pregnancy, of whom 0.21% had severe anemia.
Anemia severity was associated with placental abruption, preterm birth, severe postpartum hemorrhage, shock, admission to the ICU, and maternal mortality.
This study suggests an association between anemia during pregnancy and maternal and fetal health outcomes. Severe anemia during pregnancy was associated with placenta-related morbidity; mild anemia was associated with decreased maternal and fetal mortality.
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Objective
To investigate the association between severity of anemia during pregnancy and risk of maternal and fetal adverse outcomes.
Design, Setting, and Participants
This retrospective cohort study used data from China's Hospital Quality Monitoring System from January 1, 2016, to December 31, 2019, for pregnant females aged 15 to 49 years with birth outcomes reported at 1508 hospitals with maternity services in mainland China.
Exposures
Anemia of varying severity during pregnancy was identified from daily standardized electronic inpatient discharge records using corresponding codes of the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision. Mild anemia was defined as a hemoglobin concentration of 100 to 109 g/L (to convert g/L to g/dL, divide by 10.0); moderate anemia, as 70 to 99 g/L; and severe anemia, as less than 70 g/L.
Main Outcomes and Measures
The main outcomes included 6 maternal outcomes (placental abruption, preterm birth, severe postpartum hemorrhage, shock, admission to the intensive care unit [ICU], and maternal mortality) and 3 neonatal outcomes (fetal growth restriction, malformation, and stillbirth).
Results
Among 18 948 443 pregnant females aged 15 to 49 years (mean [SD] age, 29.42 [4.87] years), 17.78% were diagnosed with anemia during pregnancy, including 9.04% with mild anemia, 2.62% with moderate anemia, 0.21% with severe anemia, and 5.90% with anemia of unknown severity. Compared with no anemia, anemia severity during pregnancy was associated with increased risks of placental abruption. Compared with no anemia, moderate or severe anemia were associated with increased risks of maternal shock, ICU admission, maternal death, fetal growth restriction and stillbirth and mild anemia was associated with decreased risks (maternal shock, ICU admission, maternal death, fetal growth restriction, stillbirth after adjusting for socio demographic characteristics and other complications during pregnancy.
Conclusions and Relevance
The findings suggest that anemia during pregnancy is associated with maternal and fetal health outcomes and that mild anemia is associated with improved maternal and fetal survival and fetal growth. Further work is needed to validate the concentration of hemoglobin at which optimal maternal and fetal health are achieved.
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