The Impact of Maternal Anemia on Perinatal Mortality: A Population-based, Prospective Cohort Study in China
Received 30 December 2008; accepted 12 June 2009. published online 03 August 2009.
Purpose
To evaluate whether anemia during pregnancy is associated with increased risk of stillbirth and neonatal death.
Methods
A prospective cohort study, using data from a population-based pregnancy-monitoring system in 13 counties in East China (1993–1996) was conducted. Singleton live births (n=163,313) and stillbirths (n=1,354) delivered at 20 to 44 weeks to women with one or more hemoglobin measures during pregnancy were included. Stillbirth and neonatal mortality rates by anemia status in each trimester were estimated. Multivariable Cox proportional hazards regression models were used to evaluate the association between hemoglobin levels and mortality risk.
Results
The stillbirth rates were 6.2 and 9.2 per 1,000 births in women with and without anemia (hemoglobin <10g/dL), respectively. The protective effect of anemia was mainly in the third trimester. Hemoglobin of 9g/dL in the third trimester was associated with reduced risk (hazard ratio [HR], 0.8; 95% confidence interval [CI], 0.7–0.97). Maternal anemia was not associated with neonatal mortality.
Conclusions
Although maternal anemia was not associated with increased risk of mortality in the neonatal period, women with anemia during the third trimester had lower risk of stillbirth.
bDivision of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Medicine and Dentistry of New Jersey (UMDNJ)–Robert Wood Johnson Medical School, New Brunswick
cDepartment of Epidemiology, UMDNJ-School of Public Health, Beijing, China
dInstitute of Reproductive and Child Health, Peking University Health Science Center, Beijing, China
Address correspondence and reprint requests to: Cande V. Ananth, PhD, MPH, Division of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology, and Reproductive Sciences, UMDNJ-Robert Wood Johnson Medical School, 125 Paterson St, New Brunswick, NJ 08901-1977. Tel: (732) 235-7940. Fax: (732) 235-6627.
Funding for the original study was obtained from the U.S. Centers for Disease Control and Prevention and Beijing Medical University, China.
ABSTRACT