Maternal anemia and adverse pregnancy outcomes
by Zhang, Qiaoyi, Ph.D., RUTGERS THE STATE UNIVERSITY OF NEW JERSEY - NEW BRUNSWICK, 2008, 146 pages; 3349607

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 1 st, 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 3 rd 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.

 
AdviserCande V. Anath
SchoolRUTGERS THE STATE UNIVERSITY OF NEW JERSEY - NEW BRUNSWICK
SourceDAI/B 70-03, May 2009
Source TypeDissertation
SubjectsObstetrics and gynecology; Epidemiology
Publication Number3349607
Adobe PDF Access the complete dissertation:
 

» Find an electronic copy at your library.
  Use the link below to access a full citation record of this graduate work:
  http://gateway.proquest.com/openurl%3furl_ver=Z39.88-2004%26res_dat=xri:pqdiss%26rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation%26rft_dat=xri:pqdiss:3349607
  If your library subscribes to the ProQuest Dissertations & Theses (PQDT) database, you may be entitled to a free electronic version of this graduate work. If not, you will have the option to purchase one, and access a 24 page preview for free (if available).

About ProQuest Dissertations & Theses
With over 2.3 million records, the ProQuest Dissertations & Theses (PQDT) database is the most comprehensive collection of dissertations and theses in the world. It is the database of record for graduate research.

The database includes citations of graduate works ranging from the first U.S. dissertation, accepted in 1861, to those accepted as recently as last semester. Of the 2.3 million graduate works included in the database, ProQuest offers more than 1.9 million in full text formats. Of those, over 860,000 are available in PDF format. More than 60,000 dissertations and theses are added to the database each year.

If you have questions, please feel free to visit the ProQuest Web site - http://www.proquest.com - or call ProQuest Hotline Customer Support at 1-800-521-3042.