Birinci Trimester Maternal Anemi ile Şiddetli Preeklampsi Gelişimi Arasındaki İlişki: Retrospektif Bir Kohort Çalışması

Öz

Amaç: Bu çalışmanın amacı, birinci trimester maternal hemoglobin düzeyleri ile preeklampsi şiddeti arasındaki ilişkiyi değerlendirmek ve erken bir öngörü belirteci olarak potansiyel rolünü araştırmaktır. Gereç ve Yöntemler: Bu retrospektif kohort çalışmaya, üçüncü basamak bir merkezde preeklampsi tanısı almış 180 gebe dahil edildi. Hastalar hafif (n=131) ve şiddetli preeklampsi (n=49) olarak sınıflandırıldı. Birinci trimester hemoglobin düzeyleri, laboratuvar parametreleri ve klinik özellikler gruplar arasında karşılaştırıldı. Şiddetli preeklampsinin bağımsız belirleyicilerini saptamak amacıyla çok değişkenli lojistik regresyon analizi 
yapıldı. Birinci trimester hemoglobin düzeylerinin prediktif performansı ROC analizi ile değerlendirildi. Bulgular:  Şiddetli preeklampsi gelişen hastalarda birinci trimester hemoglobin düzeyleri, hafif olgulara kıyasla anlamlı derecede daha düşüktü (10,9 vs 12,7 g/dL, p<0,001). Birinci trimester anemisi (Hb <11 g/dL) şiddetli grupta daha sık saptandı (%58,3 vs %23,8, p<0,001). Maternal yaş, vücut kitle indeksi, gravida, parite ve demir tedavisi için düzeltme yapıldıktan sonra da anemi, şiddetli preeklampsinin bağımsız bir prediktörü olarak kaldı (düzeltilmiş olasılık oranı 3,83, %95 güven aralığı 1,54-9,48, p=0,0038). Doğum anındaki hemoglobin düzeyleri ve gebelik boyunca hemoglobin değişimi hastalık şiddeti ile ilişkili bulunmadı. ROC analizinde orta düzeyde prediktif performans saptandı (eğri altındaki alan=0,678) ve optimal kesim değeri 11 g/dL olarak belirlendi (duyarlılık %63, özgüllük %72).
Sonuç: Birinci trimester anemisinin preeklampsi şiddeti ile ilişkili olabileceği ve doğrudan nedensel bir faktörden ziyade erken bir risk belirteci olarak işlev görebileceği düşünülmektedir. Erken dönemde hemoglobin değerlendirmesi, şiddetli hastalık açısından artmış risk taşıyan hastaların belirlenmesine yardımcı olabilir ve klinik risk sınıflamasına katkı sağlayabilir.
 

Anahtar Kelimeler

• Preeklampsi
• Hemoglobin
• Anemi
• Birinci Trimester
• Demir Eksikliği

Etik Beyan

The study protocol was approved by the institutional ethics committee (Bursa City Hospital,2025-9/3) and due to the retrospective design, the requirement for informed consent was waived.

ASSOCIATION BETWEEN FIRST-TRIMESTER MATERNAL ANEMIA AND SUBSEQUENT DEVELOPMENT OF SEVERE PREECLAMPSIA: A RETROSPECTIVE COHORT STUDY

Öz

Objective: To evaluate the association between first-trimester maternal hemoglobin levels and the severity of preeclampsia, and to determine its potential role as an early predictive marker.
Material and Methods: This retrospective cohort study included 180 pregnant women diagnosed with preeclampsia at a tertiary referral center. Patients were classified as preeclampsia without severe features (n=131) or severe preeclampsia (n=49). First-trimester hemoglobin levels, laboratory parameters, and clinical characteristics were compared between groups. Multivariable logistic regression analysis was performed to identify independent predictors of severe preeclampsia. Receiver operating characteristic (ROC) analysis was used to assess the predictive performance of first-trimester hemoglobin levels. Results: First-trimester hemoglobin levels were significantly lower in women with severe preeclampsia compared with mild cases (10.9 vs 12.7 g/dL, p<0.001). First-trimester anemia (Hb <11 g/dL) was more frequent in the severe group (58.3% vs 23.8%, p<0.001). After adjustment for maternal age, body mass index, gravida, parity, and iron replacement therapy, anemia remained an independent predictor of severe preeclampsia (adjusted odds ratio 3.83, 95% confidence interval 1.54-9.48, p=0.0038). Hemoglobin levels at delivery and hemoglobin change during pregnancy were not significantly associated with disease severity. ROC analysis demonstrated moderate predictive performance (area under the curve=0.678), with an optimal cut-off value of 11 g/dL (sensitivity 63%, specificity 72%).
Conclusion: First-trimester anemia appears to be associated with the severity of preeclampsia and may serve as an early risk marker rather than a direct causal factor. Early hemoglobin assessment may help identify patients at increased risk for severe disease and may contribute to clinical risk stratification.

Anahtar Kelimeler

• Preeclampsia
• Hemoglobin
• Anemia
• First Trimester
• Iron Deficiency

Destekleyen Kurum

The author received no financial support for the research and/or authorship of this article.

Etik Beyan

The study protocol was approved by the institutional ethics committee (Bursa City Hospital,2025-9/3) and due to the retrospective design, the requirement for informed consent was waived.

Teşekkür

None.

Kaynakça

1. Sibai B, Dekker G, Kupferminc M. Pre-eclampsia. Lancet. 2005;365(9461):785-99.
2. Martini C, Saeed Z, Simeone P, Palma S, Ricci M, Arata A, et al. Preeclampsia: Insights into pathophysiological mechanisms and preventive strategies. Am J Prev Cardiol. 2025;23:101054.
3. Ibirogba ER, Grasch J, Costantine MM. Preeclampsia trials that changed practice. Semin Perinatol. 2025;25:152210.
4. Witkowski P, Dzieński B, Stefańska K, Tomaszewicz M, Zabielska-Kaczorowska M, Wydra D. Preeclampsia: Contemporary Concepts in Pathophysiology, Risk Stratification, Prevention and Monitoring. J Clin Med. 2026;15(5):1944.
5. Constantin Dimcea DA, Petca A. New Frontiers in the Pathophysiology of Hypertensive Pregnancy Disorders: A Systematic Review of Molecular Insights into Preeclampsia. Curr Issues Mol Biol. 2026;48(3):294.
6. Anemia in Pregnancy: ACOG Practice Bulletin, Number 233. Obstet Gynecol. 2021;138(2):e55-e64
7. Karami M, Chaleshgar M, Salari N, Akbari H, Mohammadi M. Global Prevalence of Anemia in Pregnant Women: A Comprehensive Systematic Review and Meta-Analysis. Matern Child Health J. 2022; ;26(7):1473-87.
8. Stephansson O, Dickman PW, Johansson A, Cnattingius S. Maternal hemoglobin concentration during pregnancy and risk of stillbirth. JAMA. 2000;284(20):2611-7.

9. Abumohsen H, Bustami B, Almusleh A, Yasin O, Farhoud A, Safarini O et al. The Association Between High Hemoglobin Levels and Pregnancy Complications, Gestational Diabetes and Hypertension, Among Palestinian Women. Cureus. 2021;13(10):e18840.
10. Obeagu GU, Altraide BO, Obeagu EI. Iron deficiency anemia in pregnancy and related complications with specific insight in Rivers State, Nigeria: a narrative review. Ann Med Surg (Lond). 2025;87(6):3435-44.
11. Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222. Obstet Gynecol. 2020;135(6):e237-e260.
12. World Health Organization. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Vitamin and Mineral Nutrition Information System. Geneva: World Health Organization; 2011. Report No.: WHO/NMH/NHD/MNM/11.1
13. Şanlı C. Erken Gebelik Döneminde Anemi Sıklığının İncelenmesi. Gevher Nesibe Journal of Medical & Health Sciences. 2023; 8(2), 322-6.
14. Booman A, Bateman BT, Siadat S, Berube C, Igbinosa I, Leggett C, et al. Pregnancy Outcomes Associated With Anemia in the First Trimester and Anemia Resolution by Late Pregnancy. Obstet Gynecol. 2026;147(4):518-27.
15. Booman A, Bateman BT, Siadat S, Igbinosa I, Leggett C, Lyell DJ, et al. Validation of International Classification of Diseases Diagnosis Codes for Anaemia During Pregnancy. Paediatr Perinat Epidemiol. 2025;39(8):671-6.
16. Jung J, Rahman MM, Rahman MS, Swe KT, Islam MR, Rahman MO, et al. Effects of hemoglobin levels during pregnancy on adverse maternal and infant outcomes: a systematic review and meta-analysis. Ann N Y Acad Sci. 2019;1450(1):69-82.
17. Chauhan L, Pahuja N, Sachdeva G, Singh G. Maternal Anemia in Early Pregnancy: Adverse Effects on Mother and Child and the Importance of Timely Laboratory Diagnosis. Journal of Contemporary Clinical Practice. 2025;11(3):63-8.
18. Ali AA, Rayis DA, Abdallah TM, Elbashir MI, Adam I. Severe anaemia is associated with a higher risk for preeclampsia and poor perinatal outcomes in Kassala hospital, eastern Sudan. BMC Res Notes. 2011; 4:311.
19. Akdulum MFC, Alpçetin SİA, Demirdağ E, Erdem M, Erdem A. Preeclampsia development and neonatal outcomes in pregnant women who were anemic in the first trimester. J Surg Med. 2022;6(12):1004-6.
20. Young MF, Oaks BM, Rogers HP, Tandon S, Martorell R, Dewey KG, et al. Maternal low and high hemoglobin concentrations and associations with adverse maternal and infant health outcomes: an updated global systematic review and meta-analysis. BMC Pregnancy Childbirth. 2023;23(1):264.
21. Ali NT. Mean Corpuscular Volume (MCV) and Mean Platelet Volume (MPV) as early diagnostic markers for preeclampsia, gestational diabetes, and anemia: a systematic review of clinical evidence and mechanisms. BMC Pregnancy Childbirth. 2025;25(1):722.
22. Yang X, Wei J, Sun L, Zhong Q, Zhai X, Chen Y, et al. Causal relationship between iron status and preeclampsia-eclampsia: a Mendelian randomization analysis. Clin Exp Hypertens. 2024;46(1):2321148.
23. Buciu VB, Ciurescu S, Șerban DM, Novacescu D, Nicoleta N, Tomescu L, et al. The Compounded Risk of Maternal Anemia and Preeclampsia: Neonatal Outcomes and Predictive Modeling in a Low-Resource Tertiary Center. J Clin Med. 2025;14(14):5051.
24. Nanda AW, Semarawisma A. Association between anemia and preeclampsia: a case control study in Gorontalo region, Indonesia. Int J Res Med Sci 2022;10:31-5.
25. Darukaradhya TB, Bhateja A, Siwatch S, Shamim MA, Satapathy P, Gandhi AP. Association Between the Anemia During Pregnancy and Maternal Intensive Care Unit Admissions: A Systematic Review and Meta-Analysis. Indian J Hematol Blood Transfus. 2025;41(2):274-85.