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  Maternal low and high hemoglobin concentrations and associations with adverse maternal and infant health outcomes: an updated global systematic review and meta-analysis

Young, M. F., Oaks, B. M., Rogers, H. P., Tandon, S., Martorell, R., Dewey, K. G., Wendt, A. (2023): Maternal low and high hemoglobin concentrations and associations with adverse maternal and infant health outcomes: an updated global systematic review and meta-analysis. - BMC Pregnancy and Childbirth, 23, 264.
https://doi.org/10.1186/s12884-023-05489-6

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 Creators:
Young, Melissa F.1, Author
Oaks, Brietta M.1, Author
Rogers, Hannah Paige1, Author
Tandon, Sonia1, Author
Martorell, Reynaldo1, Author
Dewey, Kathryn G.1, Author
Wendt, Amanda2, Author              
Affiliations:
1External Organizations, ou_persistent22              
2Potsdam Institute for Climate Impact Research, ou_persistent13              

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Free keywords: Hemoglobin, anemia, Pregnancy, Review, Birth outcomes
 Abstract: Background: Growing evidence suggests low and high maternal hemoglobin (Hb) concentrations may have adverse consequences for maternal and child health. There remain questions on specific Hb thresholds to define anemia and high Hb as well as how cutoffs may vary by anemia etiology and timing of assessment. - Methods: We conducted an updated systematic review (using PubMed and Cochrane Review) on low (< 110 g/L) and high (≥ 130 g/L) maternal Hb concentrations and associations with a range of maternal and infant health outcomes. We examined associations by timing of Hb assessment (preconception; first, second, and third trimesters, as well as at any time point in pregnancy), varying cutoffs used for defining low and high hemoglobin concentrations and performed stratified analyses by iron-deficiency anemia. We conducted meta-analyses to obtain odds ratios (OR) and 95% confidence intervals. Results: The updated systematic review included 148 studies. Low maternal Hb at any time point in pregnancy was associated with: low birthweight, LBW (OR (95% CI) 1.28 (1.22–1.35)), very low birthweight, VLBW (2.15 (1.47–3.13)), preterm birth, PTB (1.35 (1.29–1.42)), small-for-gestational age, SGA (1.11 (1.02–1.19)), stillbirth 1.43 (1.24–1.65)), perinatal mortality (1.75 (1.28–2.39)), neonatal mortality (1.25 (1.16–1.34), postpartum hemorrhage (1.69 (1.45–1.97)), transfusion (3.68 (2.58–5.26)), pre-eclampsia (1.57 (1.23–2.01)), and prenatal depression (1.44 (1.24–1.68)). For maternal mortality, the OR was higher for Hb < 90 (4.83 (2.17–10.74)) than for Hb < 100 (2.87 (1.08–7.67)). High maternal Hb was associated with: VLBW (1.35 (1.16–1.57)), PTB (1.12 (1.00-1.25)), SGA (1.17 (1.09–1.25)), stillbirth (1.32 (1.09–1.60)), maternal mortality (2.01 (1.12–3.61)), gestational diabetes (1.71 (1.19–2.46)), and pre-eclampsia (1.34 (1.16–1.56)). Stronger associations were noted earlier in pregnancy for low Hb and adverse birth outcomes while the role of timing of high Hb was inconsistent. Lower Hb cutoffs were associated with greater odds of poor outcomes; for high Hb, data were too limited to identify patterns. Information on anemia etiology was limited; relationships did not vary by iron-deficiency anemia. - Conclusion: Both low and high maternal Hb concentrations during pregnancy are strong predictors of adverse maternal and infant health outcomes. Additional research is needed to establish healthy reference ranges and design effective interventions to optimize maternal Hb during pregnancy.

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Language(s): eng - English
 Dates: 2022-08-222023-03-022023-04-192023-04-19
 Publication Status: Finally published
 Pages: 16
 Publishing info: -
 Table of Contents: -
 Rev. Type: Peer
 Identifiers: DOI: 10.1186/s12884-023-05489-6
Organisational keyword: RD2 - Climate Resilience
PIKDOMAIN: RD2 - Climate Resilience
Working Group: Climate Change and Health
MDB-ID: No data to archive
Research topic keyword: Health
Regional keyword: Global
Model / method: Quantitative Methods
OATYPE: Gold Open Access
 Degree: -

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Title: BMC Pregnancy and Childbirth
Source Genre: Journal, SCI, Scopus, oa
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Pages: - Volume / Issue: 23 Sequence Number: 264 Start / End Page: - Identifier: CoNE: https://publications.pik-potsdam.de/cone/journals/resource/1471-2393
Publisher: BioMed Central (BMC)