The association between maternal anaemia and pregnancy outcomes: a cohort study in Assam, India.
Manisha Nair (NPEU)
Marian Knight (NPEU)
Severe maternal morbidity and mortality
John Fell OUP Research Fund, Oxford
Studies show that anaemia (particularly iron deficiency anaemia) during pregnancy is associated with adverse maternal and infant outcomes such as maternal sepsis, postpartum haemorrhage, perterm birth, small-for-gestational age and low birth weight.
UK antenatal guidance (NICE, 2008) defines anaemia as haemoglobin concentration of <110g/l in the first trimester and <105g/l in the second or third trimester.
In additoin to haemoglobin concentration, there are other diagnostic tests for iron deficiency anaemia such as serum ferritin levels, mean corpuscular volume (MCV) and mean corpuscular haemoglobin concentration (MCHC), however, the cut-off levels amongh pregnant women at which these are associated with adverse maternal and infant outcomes are uncertain.
Moreover, iron deficiency anaemia is only one end of the spectrum of iron deficiency during pregnancy, the range being from depleted iron stores without low Hb concentration (or without clinically classified anaemia) to overt anaemia.
In order to intitate timely and adequate management of iron deficiency anaemia and non-anaemic iron deficiency, it is important to understand the individual associated between maternal haemoglobin, serum ferritin, MCV and MCHC levels and adverse maternal and infant outcomes, and explore various permutation and combinations of these indicators that could predict adverse outcomes.
The objectives of this study are to examine the association of maternal haemoglobin, serum ferritin, MCV and MCHC levels at booking and 28 weeks of gestation with adverse maternal and infant outcomes, and to explore prediciton of adverse maternal and infant outcomes using combinations of haemoglobin, serum ferritin, MCV and MCHC cut-off levels at booking and 28 weeks of gestation.
This study will use anonymised data from the hospital records of 10,000 pregnant women who gave birth in the New Cross hospital during 2011-12 to calculate th eincidenc of maternal iron deficiency anaemia and non-anaemic iron deficiency, and statistical modelling to examine the association between iron deficiency anaemia and non-anaemic iron deficiency and adverse maternal and infant outcomes.