Haemoglobin trajectories during pregnancy and associated outcomes using pooled maternity and hospitalization data from two tertiary hospitals.
Adult
Australia
Blood Transfusion
/ statistics & numerical data
Female
Hemoglobins
/ analysis
Hospitalization
/ statistics & numerical data
Humans
Infant, Newborn
Morbidity
Postpartum Hemorrhage
/ epidemiology
Pregnancy
/ blood
Pregnancy Outcome
/ epidemiology
Tertiary Care Centers
/ statistics & numerical data
blood transfusion
haemoglobins
postpartum haemorrhage
pregnancy
prenatal care
Journal
Vox sanguinis
ISSN: 1423-0410
Titre abrégé: Vox Sang
Pays: England
ID NLM: 0413606
Informations de publication
Date de publication:
Nov 2019
Nov 2019
Historique:
received:
12
02
2019
revised:
26
06
2019
accepted:
29
07
2019
pubmed:
28
8
2019
medline:
15
2
2020
entrez:
28
8
2019
Statut:
ppublish
Résumé
This study aimed to describe how haemoglobin trajectories in pregnant Australian women were associated with subsequent postpartum haemorrhage, blood transfusion and other outcomes. The study was conducted in two tertiary public hospitals in Australia, using routinely collected maternity and hospital data on singleton pregnancies (2011-2015). Latent class growth modelling defined trajectories among those with at least one haemoglobin in each of three antenatal time periods (0-15, 16-30 and 31+ weeks; n = 7104). Observed over expected ratios were calculated after predicting expected outcomes with adjusted logistic regression. The mean minimum haemoglobin levels across the three periods were 127·9, 116·5 and 119·3 g/l. We identified seven groups of women with similar haemoglobin trajectories: five with parallel U-shaped trajectories, one with increasing and one with decreasing trajectory. Thirty-eight women (0.5%) had very low haemoglobin across the pregnancy and the highest adverse outcomes, including higher than expected blood transfusion risk. One hundred thirteen women (1.6%) with a progressively decreasing trajectory also had higher risk of transfusion. Women with high haemoglobin across the antenatal period had higher than expected risk of preterm birth, small for gestational age and infants transferred to higher care. Haemoglobin trajectories across pregnancy can predict women at higher risk of requiring transfusion around birth. Women who maintain high haemoglobins across the pregnancy are worthy of increased surveillance as they carry increased risks of newborn morbidity.
Sections du résumé
BACKGROUND AND OBJECTIVES
OBJECTIVE
This study aimed to describe how haemoglobin trajectories in pregnant Australian women were associated with subsequent postpartum haemorrhage, blood transfusion and other outcomes.
MATERIALS AND METHODS
METHODS
The study was conducted in two tertiary public hospitals in Australia, using routinely collected maternity and hospital data on singleton pregnancies (2011-2015). Latent class growth modelling defined trajectories among those with at least one haemoglobin in each of three antenatal time periods (0-15, 16-30 and 31+ weeks; n = 7104). Observed over expected ratios were calculated after predicting expected outcomes with adjusted logistic regression.
RESULTS
RESULTS
The mean minimum haemoglobin levels across the three periods were 127·9, 116·5 and 119·3 g/l. We identified seven groups of women with similar haemoglobin trajectories: five with parallel U-shaped trajectories, one with increasing and one with decreasing trajectory. Thirty-eight women (0.5%) had very low haemoglobin across the pregnancy and the highest adverse outcomes, including higher than expected blood transfusion risk. One hundred thirteen women (1.6%) with a progressively decreasing trajectory also had higher risk of transfusion. Women with high haemoglobin across the antenatal period had higher than expected risk of preterm birth, small for gestational age and infants transferred to higher care.
CONCLUSIONS
CONCLUSIONS
Haemoglobin trajectories across pregnancy can predict women at higher risk of requiring transfusion around birth. Women who maintain high haemoglobins across the pregnancy are worthy of increased surveillance as they carry increased risks of newborn morbidity.
Substances chimiques
Hemoglobins
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
842-852Subventions
Organisme : Australian Research Council
ID : 120100069
Organisme : National Blood Authority
ID : National Blood Sector Research and Development Gra
Organisme : National
ID : 105
Organisme : Blood Sector Research and Development Grant
ID : 105
Informations de copyright
© 2019 International Society of Blood Transfusion.
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