İlk trimester hemoglobin değerinin olumsuz gebelik sonuçları üzerine etkileri

Öz

Amaç: Literatürde yapılan çalışmalarda farklı hemoglobin (Hb) düzeylerinin postpartum hemoraji, gebelik ile indüklenen hipertansiyon, intrauterin gelişme geriliği, gestasyonel diabetes mellitus ve perinatal mortalite gibi olumsuz gebelik sonuçları ile ilişkisi gösterilmiştir. Bu çalışmanın amacı gebeliğin ilk üç ayında ölçülen hemoglobin (Hb) düzeylerinin gebelik sonuçları üzerindeki etkilerini araştırmak ve Hb'nin olumsuz gebelik sonuçları üzerindeki prediktif değerini belirlemektir. Yöntemler: Bu tek merkezli, retrospektif çalışma, kadın hastalıkları ve jinekoloji kliniğimizde teşhis, takip ve doğumları yapılan toplam 8.916 gebeyi kapsamaktadır. Hastalar Hb düzeylerine göre anemik (Hb<11 g/dL, n=1.846), normal (Hb 11-12,5 g/dL, n=4.898) ve yüksek (Hb ≥12,5 g/dL, n=2.172) olmak üzere üç gruba ayrıldı. Hastaların demografik ve klinik özellikleri hastane kayıtlarından elde edilerek olumsuz gebelik sonuçları kaydedildi. Bulgular: Hastaların ortalama yaşı 27,50 (4,45) yıl ve vücut kitle indeksi değeri (VKİ) değeri 25,03 (3,39) kg/m2 idi. Ortalama Hb düzeyi 11,83 (0,88) g/dL ve ortalama hematokrit değeri %36 (%2,75)'ti. Hemoglobin seviyelerinden bağımsız olarak tüm çalışma grubunda gebelik kaybı %6,5, bozulmuş glukoz toleransı %4,9, gestasyonel diabetes mellitus %5,1, gebelik ile indüklenen hipertansiyon %7,4, erken doğum %3,8, yenidoğan yoğun bakım ünitesine duyulan ihtiyaç %3,5, düşük APGAR skorları %3,8, plasenta previa %2,4, plasental ablasyon %1,3, sezaryen (C/S) doğum %39,3, düşük doğum ağırlığı %5,9 ve erken membran rüptürü %9,7 oranında saptandı. Hemoglobin seviyeleri ve olumsuz gebelik sonuçlarını oluşturan değişkenler açısından anlamlı bir fark yoktu (Tümü için P>0,05). Sonuç: Çalışmamızda ilk trimesterde ölçülen Hb konsantrasyonlarına göre ayrılan gruplar arasında olumsuz gebelik sonuçları açısından anlamlı bir farklılık saptanmadı.

Anahtar Kelimeler

• Anemi
• İlk trimester
• Hemoglobin
• Gebelik sonuçları

The effects of first-trimester hemoglobin on adverse pregnancy outcomes

Abstract

Aim: Previous studies have demonstrated that variable hemoglobin levels are associated with adverse pregnancy outcomes such as postpartum hemorrhage, pregnancy-induced hypertension, intrauterine growth restriction, gestational diabetes mellitus and perinatal mortality. Here, we aimed to investigate the effects of hemoglobin (Hb) levels measured in the first trimester of pregnancy on pregnancy outcomes and identify the predictive value of Hb on adverse pregnancy outcomes. Methods: This single-center, retrospective study included a total of 8,916 pregnant women who were diagnosed, followed, and delivered their babies in our Obstetrics and Gynecology clinic. The patients were divided into three groups according to their Hb levels as anemic (Hb <11 g/dL, n=1,846), normal (Hb <12.5 g/dL, n=4,898), and elevated (Hb ≥12.5 g/dL, n=2,172). Demographic and clinical features of the patients were obtained from hospital records. Adverse pregnancy outcomes were also noted. Results: The mean age of the patients was 27.50 (4.45) years and BMI value was 25.03 (3.39) kg/m2. The mean Hb level was 11.83 (0.88) g/dL and the mean hematocrit value was 36.004 (2.75%). Irrespective of Hb levels, among all patients, rate of pregnancy loss was 6.5%, rate of impaired glucose tolerance, 4.9%, gestational diabetes mellitus, 5.1%, pregnancy-induced hypertension, 7.4%, preterm birth 3.8%. The rate of newborns in need of neonatal intensive care unit was 3.5%, while 3.8% were born with low APGAR scores. Placenta previa was observed in 2.4% of patients, and placental abruption was seen in 1.3%. About 39.3% had a cesarean-section (C/S) delivery, 5.9% gave birth to low birth-weight neonates, and premature rupture of membranes was observed in 9.7% patients. There were no significant differences with respect to adverse pregnancy outcomes between the three groups (P>0.05 for all). Conclusion: Our study results showed no significant differences between the three groups categorized by Hb concentrations measured in the first trimester in terms of adverse pregnancy outcomes.

Keywords

• anemia
• first trimester
• hemoglobin
• pregnancy outcome

References

1. 1. Horowitz KM, Ingardia CJ, Borgida AF. Anemia in Pregnancy. Clin Lab Med. 2013;33(2):281-91.
2. 2. Moeller SL, Schmiegelow C, Larsen LG, Nielsen K, Msemo OA, Lusingu JPA, et al. Anemia in Late Pregnancy Induces an Adaptive Response in Fetoplacental Vascularization. Placenta. 2019;80:49-58.
3. 3. Tran K, Mc Cormack S. Screening and Treatment of Obstetric Anemia: A Review of Clinical Effectiveness, Cost-Effectiveness, and Guidelines. Ottawa (ON): CADTH. 2019
4. 4. Global Health Observatory Data Repository. Prevalence of anemia in pregnant women. Estimates by WHO region2018.
5. 5. Smith C, Teng F, Branch E, Chu S, Joseph KS. Maternal and Perinatal Morbidity and Mortality Associated With Anemia in Pregnancy. Obstet Gynecol. 2019;134:1234–44.
6. 6. Scanlon KS, Yip R, Schieve LA, Cogswell ME. High and low hemoglobin levels during pregnancy: differential risks for preterm birth and SGA. Obstet Gynecol. 2000;96:741–7.
7. 7. Kumar KJ, Asha N, Murthy DS, Sujatha MS, Manjunath VG. Maternal anemia in various trimesters and its effect on newborn weight and maturity: an observational study. Int J Preven Med. 2013;4(2):193-9.
8. 8. Badfar G, Shohani M, SoleymanA, Azami M. Maternal anemia during pregnancy and small for gestational age: a systematic review and meta-analysis. J Matern Fetal Neonatal Med. 2019;32(10):1728-34.

9. 9. Pena Rozas JB, De-Regil LM, Malave HG, Flores-Urrutia MC, Dowswell T. Intermittent Oral Iron Supplementation During Pregnancy Cochrane Database Syst Rev. 2015;19;2015(10):CD009997.
10. 10. Vural T, Toz E, Ozcan A, Biler A, İleri A, Inan AH. Can anemia predict perinatal outcomes in different stages of pregnancy? Pak J Med Sci. 2016;32:1354-9.
11. 11. Suryanarayana R, Chandrappa M, Santhuram AN, Prathima S, Sheela S R. Prospective study on prevalence of anemia of pregnan two menandits outcome: A community based study. J Family Med Prim Care. 2017;6:739-43.
12. 12. Sacks BD, Arnold B, Bakris GL, Brunns DE, Horward AE, Kirkman SE, et al. Guidelines and recommendations for labaratory analysis in the diagnosis and management of diabetes mellitus. Clin Chem. 2011,57(6):1-47.
13. 13. Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Böhm M, et al. 2013 ESC/ESC guidelines for the management of arteriel hypertension of the European Society of Hpertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2013;34:2159-219.
14. 14. Asıcıoğlu O, Sahbaz A, Gungorduk K, Yıldırım G, Asıcıoğlu BB, Ülker V. Maternal and perinatal outcomes in women with placenta praevia and accreta in teaching hospitals in Western Turkey. J Obstet Gynaecol. 2014;34:462–6.
15. 15. Bencaiova G,Breymann C. Mild Anemia and Pregnancy Outcome in a Swiss Collective. J Pregnancy. 2014;2014:307535.
16. 16. Çakmak BD, Türker ÜA, Öztaş S, Arık M, Üstünyurt E. The effect of first trimester hemoglobin levels on pregnancy outcomes. Turk J Obstet Gynecol. .2018;15:165-70.
17. 17. Randall DA, Patterson JA, Gallimore F, Morris JM, McGee TM, Ford JB, et al. The association between haemoglobin levels in the first 20 weeks of pregnancy and pregnancy outcomes. PLoS ONE. 2019;14(11):e0225123.
18. 18. Hamalainen H, Hakkarainen, K and Heinonen S. Anaemia in the first but not in these condor third trimester is a risk factor for low birth weight. Clinic Nutr. 2003;22(3):271–5.
19. 19. Hercberg S, Preziosi P and Galan P. Iron deficiency in Europe. Public Health Nutr. 2001;4(2B):537–45.
20. 20. Levy A, Fraser D, Katz M, Mazor M, Sheiner E. Maternal anemia during pregnancy is an independent risk factor for low birth weight and preterm delivery. Eur J Obstet Gynecol Reprod Biol. 2005;122:182-6.
21. 21. Sehgal R, Kriplani A, Vanamail P, Maiti L, Kandpal S, Kumar N. Assessment and comparison of pregnancy outcome among anaemic and nonanaemic primigravida mothers. Indian J Public Health. 2016;60:188-94.
22. 22. Wang C, Lin L, Su R, Zhu W, Wei Y, Yan J, et al. Hemoglobin levels during the first trimester of pregnancy are associated with the risk of gestational diabetes mellitus, pre-eclampsia and preterm birth in Chinese women: retrospective study. BMC Pregnancy and Childbirth. 2018;18(1):263.
23. 23. Aghamohammadi A, Zafari M, Tofighi M. High maternal hemoglobin concentration in first trimester as risk factor for pregnancy induced hypertension. Caspian J Intern Med. 2011;2:194-7.
24. 24. Zhu B, Liang C, Xia X, Huang K, Yan S, Hao J et al. Iron-Related Factors in Early Pregnancy and Subsequent Risk of Gestational Diabetes Mellitus: the Ma’anshan Birth Cohort (MABC) Biol Trace Elem Res. 2019;191(1):45-53.
25. 25. Casanueva E, Viteri FE. Iron and oxidative stress in pregnancy. J Nutr 2003;133(2):1700-8.
26. 26. Fernandez-Real JM, Penarroja G, Castro A, Garcia-Bragado F, Hernandez-Aguado I, Ricart W. Blood letting in high ferritin type 2 diabetes: effects on insulin sensitivity and beta-cell function. Diabetes. 2002;51(4):1000–4.
27. 27. Gao CJ, Huang XM, Chen ZP, Sheng L, Xu J, Li Y, et al. High Level of Hemoglobin During the First Trimester of Pregnancy Associated With the Risk of Gestational Diabetes Mellitus. Zhonghua Fu Chan KeZaZhi. 2019;54(10):654-9.
28. 28. Pena-Rosas JP, De-Regil LM, Garcia-Casal MN, Dowswell T. Daily oral iron supplementation during pregnancy. Cochrane Database Syst Rev. 2015;(7).
29. 29. Bakacak M, Avci F,Ercan Ö, Köstü B, Serin S, Kiran G, et al. The effect of maternal hemoglobin concentration on fetal birth weight according to trimesters. J Matern Fetal Neonatal Med. 2015;28(17):2106-10.