Haematologic parameters and pregnancy outcome A prospective cohort study in the third trimester

doi:10.1016/0895-4356(90)90134-B

Journal of Clinical Epidemiology

Volume 43, Issue 5, 1990, Pages 461-466

https://doi.org/10.1016/0895-4356(90)90134-B Get rights and content

Abstract

The relationship between haematologic parameters and pregnancy outcome was investigated in a prospective study, taking important covariates into consideration. A questionnaire asking information about smoking, alcohol consumption and iron intake was completed by a consecutive series of 796 ambulatory singleton pregnant women at 31–32 weeks of gestation. Subsequently, haematologic parameters were measured. After delivery, birth weight, gestation length and blood pressure values during pregnancy were abstracted from the obstetricians' records. Low birth weight (< 2.500 g) and preterm birth (< 37 weeks), were significantly more frequently seen in women with high haemoglobin (⩾ 8.0 mmol/1) or high haematocrit (⩾ 38%) values, with Mantel-Haenszel odds ratios varying from 2.4 to 4.2. Also a high erythrocyte count (⩾4.5/pl) was correlated with low birth weight, while for mean corpuscular volume (MCV) no such relationships were found. Pregnancy induced hypertension was positively associated with haemoglobin, haematocrit and erythrocyte count, but could not fully explain the relationships between these parameters and adverse outcomes. Using multiple logistic regression with low birth weight and/or preterm birth as the dependent variable, the effect of haematocrit still was demonstrable after controlling for smoking, hypertension, parity, alcohol consumption and iron intake. These results are in agreement with the hypothesis that a higher blood viscosity is a risk factor for suboptimal placenta-perfusion.

References (15)

S.M. Garn et al.
Maternal haematologic levels and pregnancy outcomes
Semin Perinatol
(1981)
J.F. Murphy et al.
Relation of haemoglobin levels in first and second trimester to outcome of pregnancy
Lancet
(1986)
H. Huisjes
Het haemoglobinegehalte in de zwangerschap
Ned Tijdschr Geneesk
(1985)
A. Huisman et al.
Increased 2nd trimester haemoglobin concentration in pregnancies later complicated by hypertension and growth retardation
Acta Obstet Gynaecol Scand
(1986)
O. Koller et al.
Fetal growth retardation associated with inadequate haemodilution in otherwise uncomplicated pregnancy
Acta Obstet Gynaecol Scand
(1979)
O. Koller et al.
High haemoglobin levels during pregnancy and fetal risk
Int J Gynaecol Obstet
(1980)
F.E. Hytten et al.
Increase in plasma volume during normal pregnancy
J Obstet Gynaecol Br Commonw
(1963)

There are more references available in the full text version of this article.

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Citation Excerpt :
Pregnant women undergo drastic physiological changes during pregnancy, and are highly sensitive to environmental insults (Carvalho et al., 2016; Kupsco et al., 2019). Changes in Hemoglobin (Hb) and hematocrit (HCT) lead to altered blood viscosity (Stauffer et al., 2020), which is a risk factor for pregnancy complications (e.g., preeclampsia) and fetal growth restriction (Heilmann et al., 2004; Hobbs et al., 1982; Knottnerus et al., 1990; Stott et al., 2017). A previous cohort study of 141 pregnant women observed a positive relationship between maternal serum PFASs (including PFOA, PFOS, PFHxS, PFNA, perfluoroundecanoic acid (PFUnDA)) and Hb in the first trimester (Jiang et al., 2014).
Per- and polyfluoroalkyl substances (PFASs) are common environmental contaminants and are widely detected in humans. Previous studies have linked PFASs exposure to adverse birth outcomes. However, the association between maternal exposure to PFASs and hemoglobin (Hb) and hematocrit (HCT) remains unclear.
We aimed to explore the relationship between PFASs exposure with Hb and HCT during pregnancy.
The present birth cohort study included 1044 pregnant women from Wuhan, China. Maternal HCT and Hb were measured in the first, second and third trimesters, and 13 PFASs were detected in the cord sera. Mixed linear models and general linear regression were applied to analyze the association between each single PFASs and Hb and HCT. Weighted quantile sum (WQS) regressions were used to investigate the association between PFASs mixture and Hb and HCT during pregnancy.
In single-PFAS models, 10 PFASs were positively associated with HCT and Hb across pregnancy (a 10-fold increase in PFASs was associated with 1.47–3.54 % change in HCT and 1.46–3.20 % change in Hb (All P-FDR < 0.05). In addition, Hb and HCT were more positively related to PFASs in the second and third trimesters rather than the first trimester. The association between PFASs exposure and maternal HCT and Hb was not significant in the iron supplementation group, whereas significant in the non-iron supplementation group. A significant interaction between iron supplementation and non-iron supplementation was also detected. WQS regressions showed that perfluorononanoic acid (PFNA) and perfluorohexane sulfonate (PFHxS) contributed most to the association between PFASs and HCT and Hb in the second and third trimesters, respectively.
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Long-term exposure to mould/damp stains and mouldy odour increases low birth weight
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Citation Excerpt :
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A nationwide retrospective cohort study of 30,735 pre-schoolers in six Chinese cities was performed from 2010 to 2012. One questionnaire survey was conducted to collect information on the pre-schoolers’ birth outcomes and their maternal exposure of indoor environmental factors including new furniture, house redecoration, cooking fuels, mould/damp stains, and mouldy odour during pregnancy. Maternal exposure of traffic-related air pollutant (NO₂), industrial pollutant (SO₂), and inhalable particulate matter (PM₁₀), as well as meteorological parameters, was estimated in pregnancy. Associations of LBW, T-LBW and P-LBW with indoor environmental factors were evaluated by two-level (city-child) logistic regression models with an odds ratio (OR) and 95% confidence interval (CI).
We found that P-LBW (1.0%) and T-LBW (1.4%) prevalence were respectively associated with persistent mould/damp stains and mouldy odour exposure in utero, ORs = 1.81 (95% CI: 1.01–3.24) and 1.49 (95% CI: 1.01–2.21). Exposure to high temperature and PM_2.5 in pregnancy significantly enhanced the effect of persistent mould/damp stains and/or mouldy odour on P-LBW and LBW, ORs (95% CI) = 2.92 (1.40–6.07) and 1.78 (1.00–3.15) with significant interaction p values of 0.067 and 0.094 respectively. Sensitivity analysis suggested that raising cats and dogs significantly increased LBW risk of persistent mould/damp stains and mouldy odour exposure.
Our findings indicate that long-term exposure to indoor mould/damp stains and mouldy odour in utero plays a key role in LBW, and this association can be significantly modified by some specific personal, indoor, and outdoor factors.
Birth weight following pregnancy wildfire smoke exposure in more than 1.5 million newborns in Brazil: A nationwide case-control study
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Air pollution exposure has been associated with critical neonatal morbidities, including low birth weight (LBW). However, little is known on short-term exposure to wildfire smoke and LBW. In this study, we estimated the association between birth weight following pregnancy and wildfire smoke exposure in more than 1.5 million newborns in Brazil (considered as a very fire-prone region worldwide).
We applied a logistic regression model to estimate the percent variation in newborns with low birth weight when exposed to wildfire in different trimesters of the pregnancy.
After adjusting the model with relevant covariates, we found that an increase of 100 wildfire records in Brazil was associated with an increase in low birth weight in the Midwest region [0.98% (95%CI:0.34; 1.63)] and in the South region [18.55% (95%CI:13.66; 23.65)] when the exposure occurred in the first trimester of pregnancy.
Wildfires were associated with LBW and this should be of public health concern for policymakers.
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Maternal exposure to air pollutants may increase neonatal jaundice treatment rates for phototherapy and higher neonatal serum total bilirubin level. Higher hemoglobin levels because of higher pollutant exposures may explain our findings. The association was more obvious in male newborns.
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2022, International Journal of Hygiene and Environmental Health
Preterm birth (PTB) complications are the leading cause of death among children under 5 years of age, responsible for approximately 1 million deaths in 2015, according to the World Health Organization. Those infants born prematurely who survived the first 5 years, studies suggest that these infants are more likely to experience a range of poor health outcomes during childhood and even adulthood. Wildfire smoke has been suggested as a type of air pollution source with high toxicity for reproductive health. In this study, we estimated the association between preterm birth and wildfire periods in Brazil, a country included in the list of the 10 nations with the greatest number of preterm birth and also considered as a very fire-prone region. We applied a time-stratified case-crossover study design using conditional logistic regression models to estimate the odds ratio for preterm birth associated with wildfire-related prenatal PM_2.5, during different windows of exposure, including trimesters 1–3. After adjusting for several confounders (other air pollutants, demographics, meteorological variables, and spatiotemporal terms), we found that wildfire smoke exposure during pregnancy may be associated with preterm birth in Brazil. Southeast was the region with the highest increase in the odds of PTB (OR:1.41 (95%CI: 1.31–1.51) when the exposure occurred in the first trimester. In the North, exposure to PM_2.5 during wildfire periods in the second trimester of pregnancy was associated with increased odds of PTB (OR:1.05 (95%CI: 1.01–1.09) in preterm birth when the exposure occurred in the second trimester. This study suggests that wildfire smoke exposure during pregnancy may increase the risk for preterm birth in Brazil. This should be of great concern to the public health authorities, obstetricians, and policymakers.
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2020, EClinicalMedicine
Citation Excerpt :
This work also provides a system, at the individual level, for defining normal Hb distributions based on gestational age-specific cut-offs (<3rd centile = low Hb concentration; 3rd - 4.99th centile = high risk of low Hb concentration; 5th - 9.99th centile = moderate risk of low Hb concentration; ≥10th centile = normal Hb concentration), an approach that is well accepted in biology and medicine. In addition, previous studies have suggested that high haemoglobin concentrations may be associated with increased pregnancy risks, including antepartum stillbirth and pre-eclampsia [48,49]. However, these findings are inconsistent, and in part this may be due to using a fixed cut-offs for defining haemoconcentration despite different gestational ages at the time of blood sampling.
Anaemia in pregnancy is a global health problem with associated morbidity and mortality.
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A total of 3502 (81%) of 4321 women who delivered a live, singleton newborn with no visible congenital anomalies, contributed at least one haemoglobin value. Median haemoglobin concentrations ranged from 114.6 to 121.4 g/L, 94 to 103 g/L at the 3^rd centile, and from 135 to 141 g/L at the 97^th centile. The lowest values were seen between 31 and 32 weeks’ gestation, representing a mean drop of 6.8 g/L compared to 14 weeks’ gestation. The percentage variation in maternal haemoglobin within-site was 47% of the total variance compared to 13% between sites.
We have generated International, gestational age-specific, smoothed centiles for maternal haemoglobin concentration compatible with better pregnancy outcomes, as well as adequate neonatal and early childhood morbidity, growth and development up to 2 years of age.
Bill & Melinda Gates Foundation Grant number 49038.

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Original articleHaematologic parameters and pregnancy outcome A prospective cohort study in the third trimester

Abstract

Maternal haematologic levels and pregnancy outcomes

Semin Perinatol

Relation of haemoglobin levels in first and second trimester to outcome of pregnancy

Lancet

Het haemoglobinegehalte in de zwangerschap

Ned Tijdschr Geneesk

Increased 2nd trimester haemoglobin concentration in pregnancies later complicated by hypertension and growth retardation

Acta Obstet Gynaecol Scand

Fetal growth retardation associated with inadequate haemodilution in otherwise uncomplicated pregnancy

Acta Obstet Gynaecol Scand

High haemoglobin levels during pregnancy and fetal risk

Int J Gynaecol Obstet

Increase in plasma volume during normal pregnancy

J Obstet Gynaecol Br Commonw

Original article
Haematologic parameters and pregnancy outcome A prospective cohort study in the third trimester