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

Kaynakça

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