بررسی میزان سطح هموگلوبین مادران باردار، تعیین cut off point هموگلوبین و ارتباط با زایمان زودرس و وزن کم نوزاد در هنگام تولد

نوع مقاله : اصیل پژوهشی

نویسندگان

1 دستیار تخصصی زنان و مامایی، کمیته تحقیقات دانشجویی، دانشکده پزشکی، دانشگاه علوم پزشکی بابل، بابل، ایران.

2 دانشیار گروه زنان و مامایی، مرکز تحقیقات بهداشت باروری و ناباروری، پژوهشکده سلامت، واحد توسعه تحقیقات بیمارستان آیت‌الله روحانی، دانشکده پزشکی، دانشگاه علوم پزشکی بابل، بابل، ایران.

3 استاد گروه زنان و مامایی، مرکز تحقیقات بهداشت باروری و ناباروری، پژوهشکده سلامت، واحد توسعه تحقیقات بیمارستان آیت‌الله روحانی، دانشکده پزشکی، دانشگاه علوم پزشکی بابل، بابل، ایران.

4 استادیار گروه آمار و اپیدمیولوژی، مرکز تحقیقات بهداشت باروری و ناباروری، پژوهشکده سلامت، دانشگاه علوم پزشکی بابل، بابل، ایران.

چکیده

مقدمه: کم‌خونی، خطر پیامدهای زیان‌بار بارداری از جمله زایمان زودرس و وزن کم هنگام تولد را افزایش می‌دهد. مطالعه حاضر با هدف بررسی ارتباط بین شدت آنمی با زایمان زودرس و وزن کم نوزاد هنگام تولد و سطحی از هموگلوبین که باعث بروز این پیامدها می‌شود، انجام شد.
روشکار: این مطالعه مقطعی در سال 99-۱۳۹۸ بر روی ۷۳۷ زن باردار مراجعه­کننده به بیمارستان آیت‌الله روحانی بابل که تحت زایمان قرار گرفتند، انجام شد. اطلاعات دموگرافیک، میزان هموگلوبین مادران، سن بارداری، نوع زایمان، وزن، قد، دور سر و آپگار نوزاد هنگام تولد در چک‌لیست ثبت گردید. تجزیه و تحلیل داده‌ها با استفاده از نرم‌افزار آماری SPSS (نسخه 25) و آزمون‌های تک‌متغیره آنووا، تی‌تست، کای دو و ضریب همبستگی انجام شد.
یافته ­ها: شیوع آنمی در مادران باردار ۱۵/۲۴% برآورد گردید. با اختلاف معنی‌دار، سن بارداری، وزن، قد، دور سر و آپگار نوزاد در گروه آنمیک کمتر بود (۰۰۱/۰>p). با تقسیم مادران به دو گروه ترم و پره‌ترم، اختلاف معنی‌داری در میزان هموگلوبین آن‌ها وجود نداشت (۱۱/۰=p)؛ اما با تقسیم مادران پره‌ترم به دو گروه پره‌ترم زودهنگام و دیرهنگام، هموگلوبین در مادران پره‌ترم زودهنگام پایین‌تر گزارش شد (۰۰۴/۰=p). مشخص شد که هموگلوبین کمتر از ۷/۱۱ گرم بر دسی‌لیتر در مادر باردار، باعث افزایش خطر زایمان پره‌ترم زودهنگام (کمتر از ۳۴ هفته) و وزن کمتر از ۲۵۰۰ گرم در هنگام تولد می‌شود.
نتیجه ­گیری: به‌نظر می‌رسد با وجود رساندن هموگلوبین به میزان حداقل نرمال، هنوز هم احتمال بروز پیامدهای نامطلوب نوزادی به میزان قابل‌توجهی وجود دارد، لذا باید سعی شود که میزان هموگلوبین بالاتر از حداقل نرمال نگه ‌داشته شود.

کلیدواژه‌ها


عنوان مقاله [English]

The level of hemoglobin in pregnant mothers, the cut-off point of hemoglobin and its relationship with preterm delivery and low birth weight

نویسندگان [English]

  • Fakhri Khalighi 1
  • Shahnaz Barat 2
  • Shahla Yazdani 3
  • Soraya Khafri 4
1 Resident, Department of Obstetrics and Gynecology, Student Research Committee, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran.
2 Associate Professor, Department of Obstetrics and Gynecology, Reproductive Health and Infertility Research Center, Health Research Institute, Research Development Unit of Ayatollah Rouhani Hospital, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran.
3 Professor, Department of Obstetrics and Gynecology, Reproductive Health and Infertility Research Center, Health Research Institute, Research Development Unit of Ayatollah Rouhani Hospital, School of Medicine, Babol University of Medical Sciences, Babol, Iran.
4 Assistant Professor, Department of Statistics and Epidemiology, Fertility and Infertility Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran.
چکیده [English]

Introduction: Anemia increases the risk of adverse pregnancy outcomes including preterm delivery and low birth weight. This study was performed with aim to determine the relationship between the severity of anemia with preterm delivery and low birth weight and the level of hemoglobin which causes these consequences.
Methods: This cross-sectional study was conducted in 2019-2020 on 737 pregnant women referred to Ayatollah Rouhani Hospital in Babol who underwent delivery. Demographic information, hemoglobin level of mothers, gestational age, type of delivery, weight, height, head circumference and Apgar of the newborn were recorded in the checklist. Data were analyzed by SPSS (version 25) and univariate ANOVA, t-test, Chi-square and correlation coefficient tests.
Results: The prevalence of anemia in pregnant mothers was estimated at 24.15%. Gestational age, weight, height, head circumference, and Apgar of the newborn were significantly lower in the anemic group (p<0.001). By dividing the mothers into two groups of term and pre-term, there was no significant difference in their hemoglobin level (p=0.11); however, by dividing preterm mothers into early and late preterm groups, hemoglobin was reported to be lower in early preterm mothers (p=0.004). It was found that hemoglobin less than 11.7 g/dL in a pregnant mother increases the risk of preterm delivery (less than 34 weeks) and birth weight less than 2500 g.
Conclusion: It seems that despite reaching the hemoglobin to the minimum normal level, there is still a significant possibility of adverse outcomes in the newborn, so one should try to keep the hemoglobin level above the minimum normal level.

کلیدواژه‌ها [English]

  • Anemia
  • Gestational age
  • Infant low birth weight
  • Premature birth
  1. Sohail M, Shakeel S, Kumari S, Bharti A, Zahid F, Anwar S, et al. Prevalence of malaria infection and risk factors associated with anaemia among pregnant women in semiurban community of Hazaribag, Jharkhand, India. BioMed research international 2015; 2015.
  2. Lee AI, Okam MM. Anemia in pregnancy. Hematology/Oncology Clinics 2011; 25(2):241-59.
  3. Anlaakuu P, Anto F. Anaemia in pregnancy and associated factors: a cross sectional study of antenatal attendants at the Sunyani Municipal Hospital, Ghana. BMC research notes 2017; 10(1):1-8.
  4. Sayehmiri K, Darvishi Z, Azami M, Qavam S. The prevalence of anemia in first, second and third trimester of pregnancy in Iran: a systematic review and meta-analysis. Iran J Obstet Gynecol Infertil 2015; 18(168):7-15.
  5. Bora R, Sable C, Wolfson J, Boro K, Rao R. Prevalence of anemia in pregnant women and its effect on neonatal outcomes in Northeast India. The Journal of Maternal-Fetal & Neonatal Medicine 2014; 27(9):887-91.
  6. Suryanarayana R, Chandrappa M, Santhuram AN, Prathima S, Sheela SR. Prospective study on prevalence of anemia of pregnant women and its outcome: A community based study. Journal of family medicine and primary care 2017; 6(4):739.
  7. Cunningham FG, Leveno KJ, Bloom SL, Dashe JS, Hoffman BL, Casey BM, et al. Williams Obstetrics. 25nd , section 56. New York: McGraw-Hill Education; 2018.
  8. Figueiredo AC, Gomes-Filho IS, Silva RB, Pereira PP, Mata FA, Lyrio AO, et al. Maternal anemia and low birth weight: a systematic review and meta-analysis. Nutrients 2018; 10(5):601.
  9. Rahman MM, Abe SK, Rahman MS, Kanda M, Narita S, Bilano V, et al. Maternal anemia and risk of adverse birth and health outcomes in low-and middle-income countries: systematic review and meta-analysis, 2. The American journal of clinical nutrition 2016; 103(2):495-504.
  10. Wirth JP, Woodruff BA, Engle-Stone R, Namaste SM, Temple VJ, Petry N, et al. Predictors of anemia in women of reproductive age: Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project. The American journal of clinical nutrition 2017; 106(suppl_1):416S-27S.
  11. Cunningham FG, Leveno KJ, Bloom SL, Dashe JS, Hoffman BL, Casey BM, et al. Williams Obstetrics. 25nd ,section 42. New York: McGraw-Hill Education; 2018.
  12. WHO CM. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Geneva, Switz World Heal Organ 2011: 1-6.
  13. Azami M, Darvishi Z, Borji M, Sayehmiri K. The prevalence of anemia among pregnant women in Iran (2005-2016): a systematic review and meta-analysis study. Journal of School of Public Health and Institute of Public Health Research 2016; 14(1):15-30.
  14. Barooti E, Rezazadehkermani M, Sadeghirad B, Motaghipisheh S, Tayeri S, Arabi M, et al. Prevalence of iron deficiency anemia among Iranian pregnant women; a systematic review and meta-analysis. Journal of reproduction & infertility 2010; 11(1):17.
  15. Stevens GA, Finucane MM, De-Regil LM, Paciorek CJ, Flaxman SR, Branca F, et al. Global, regional, and national trends in haemoglobin concentration and prevalence of total and severe anaemia in children and pregnant and non-pregnant women for 1995–2011: a systematic analysis of population-representative data. The Lancet Global Health 2013; 1(1):e16-25.
  16. Rahmati S, Azami M, Badfar G, Parizad N, Sayehmiri K. The relationship between maternal anemia during pregnancy with preterm birth: a systematic review and meta-analysis. The Journal of Maternal-Fetal & Neonatal Medicine 2020; 33(15):2679-89.
  17. Rahbar N, Ghorbani R, Rezaei Ahvanoei F. Prevalence of iron deficiency anemia and its complications in pregnant women referred to medical-health centers in Semnan. Iran J Obstet Gynecol Infertil 2014; 17(128):12-7.
  18. Phaloprakarn C, Tangjitgamol S. Impact of high maternal hemoglobin at first antenatal visit on pregnancy outcomes: a cohort study. Journal of perinatal medicine 2008; 36(2):115-9.
  19. Pakniat H, Soofizadeh N, Dabbaghi Ghale T. The relationship between hemoglobin level in the first trimester of pregnancy and preterm delivery. Scientific Journal of Kurdistan University of Medical Sciences 2016; 21(5):60-8.
  20. Afzal Aghai M, Musa Farkhani E, Beygi B, Eftekhari Gol R, Eslami V, Bahrami HR. Maternal Anemia during pregnancy and birth outcomes: a population based cross sectional study Maternal Anemia and birth outcomes. Journal of Sabzevar University of Medical Sciences 2021; 28(1):809-16.
  21. Badi NE, Almoula HA, Idris NI, Hamadalnil Y, Handady SO. Relation Ship of Maternal Haemoglobin Concentration Measured in Labour with Neonatal Outcome among Sudanese Women. Open Journal of Obstetrics and Gynecology 2021; 11(2):131-9.
  22. Çağlayan EK, Küçük Ö, Göçmen AY, Seçkin L, Aktulay A, Üstün YE. Sixth-month perinatal outcomes of anemic pregnancies. Gynecology Obstetrics & Reproductive Medicine 2014; 20(2):68-72.
  23. Sekhavat L, Davar R, Hosseinidezoki S. Relationship between maternal hemoglobin concentration and neonatal birth weight. Hematology 2011; 16(6):373-6.
  24. Veghari G, Kazemi S, Bemani M, Shabdin M. Hemoglobin concentration level during pregnancy and its association with birth weight. British Journal of Medicine and Medical Research 2015; 8(11):988-92.
  25. Kidanto HL, Mogren I, Lindmark G, Massawe S, Nystrom L. Risks for preterm delivery and low birth weight are independently increased by severity of maternal anaemia. South African Medical Journal 2009; 99(2):98-102.
  26. Kumari S, Garg N, Kumar A, Guru PK, Ansari S, Anwar S, et al. Maternal and severe anaemia in delivering women is associated with risk of preterm and low birth weight: A cross sectional study from Jharkhand, India. One Health 2019; 8:100098.
  27. Akbari TA, Aghdam A, Najafi NI, Zare R. The relationship between maternal hemoglobin level and birth weight in the 523rd Army Hospital of the Islamic Republic of Iran in Urmia in 2019. Journal of Nurse And Physician Within War 2020; 7(25):19-23.
  28. Sukrat B, Wilasrusmee C, Siribumrungwong B, McEvoy M, Okascharoen C, Attia J, et al. Hemoglobin concentration and pregnancy outcomes: a systematic review and meta-analysis. BioMed research international 2013; 2013.
  29. Gonzales GF, Steenland K, Tapia V. Maternal hemoglobin level and fetal outcome at low and high altitudes. American Journal of Physiology-Regulatory, Integrative and Comparative Physiology 2009; 297(5):R1477-85.