Eric O Ohuma1, Melissa F Young2, Reynaldo Martorell2, Leila Cheikh Ismail3,4, Juan Pablo Peña-Rosas5, Manorama Purwar6, Maria Nieves Garcia-Casal5, Michael G Gravett7, Mercedes de Onis5, QingQing Wu8, Maria Carvalho9, Yasmin A Jaffer10, Ann Lambert4,11, Enrico Bertino12, Aris T Papageorghiou4,11, Fernando C Barros13, Zulfiqar A Bhutta14, Stephen H Kennedy4,11, Jose Villar4,11. 1. Maternal, Adolescent, Reproductive and Child Health (MARCH) Centre, London School of Hygiene and Tropical Medicine (LSHTM), London, UK. 2. Hubert Department of Global Health, Emory University, Atlanta, Georgia. 3. Clinical Nutrition and Dietetics Department, University of Sharjah, Sharjah, United Arab Emirates. 4. Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK. 5. Department of Nutrition and Food Safety, World Health Organization, Geneva, Switzerland. 6. Nagpur INTERGROWTH-21st Research Centre, Ketkar Hospital, Nagpur, India. 7. Departments of Obstetrics and Gynecology and of Global Health, University of Washington, Seattle, WA, USA. 8. Department of Ultrasound, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China. 9. Department of Obstetrics and Gynaecology, Faculty of Health Sciences, Aga Khan University Hospital, Nairobi, Kenya. 10. Department of Family and Community Health, Ministry of Health, Muscat, Oman. 11. Oxford Maternal and Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK. 12. Unit of the University, AOU City of Health and Science of Turin, Turin, Italy. 13. Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, Pelotas, Brazil. 14. Center for Global Child Health, Hospital for Sick Children, Toronto, Canada.
Abstract
BACKGROUND: Anaemia in pregnancy is a global health problem with associated morbidity and mortality. METHODS: A secondary analysis of prospective, population-based study from 2009 to 2016 to generate maternal haemoglobin normative centiles in uncomplicated pregnancies in women receiving optimal antenatal care. Pregnant women were enrolled <14 weeks' gestation in the Fetal Growth Longitudinal Study (FGLS) of the INTERGROWTH-21st Project which involved eight geographically diverse urban areas in Brazil, China, India, Italy, Kenya, Oman, United Kingdom and United States. At each 5 ± 1 weekly visit until delivery, information was collected about the pregnancy, as well as the results of blood tests taken as part of routine antenatal care that complemented the study's requirements, including haemoglobin values. FINDINGS: 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 3rd centile, and from 135 to 141 g/L at the 97th 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. INTERPRETATION: 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. FUNDING: Bill & Melinda Gates Foundation Grant number 49038.
BACKGROUND: Anaemia in pregnancy is a global health problem with associated morbidity and mortality. METHODS: A secondary analysis of prospective, population-based study from 2009 to 2016 to generate maternal haemoglobin normative centiles in uncomplicated pregnancies in women receiving optimal antenatal care. Pregnant women were enrolled <14 weeks' gestation in the Fetal Growth Longitudinal Study (FGLS) of the INTERGROWTH-21st Project which involved eight geographically diverse urban areas in Brazil, China, India, Italy, Kenya, Oman, United Kingdom and United States. At each 5 ± 1 weekly visit until delivery, information was collected about the pregnancy, as well as the results of blood tests taken as part of routine antenatal care that complemented the study's requirements, including haemoglobin values. FINDINGS: 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 3rd centile, and from 135 to 141 g/L at the 97th 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. INTERPRETATION: 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. FUNDING: Bill & Melinda Gates Foundation Grant number 49038.
Authors: Aris T Papageorghiou; Stephen H Kennedy; Laurent J Salomon; Douglas G Altman; Eric O Ohuma; William Stones; Michael G Gravett; Fernando C Barros; Cesar Victora; Manorama Purwar; Yasmin Jaffer; Julia A Noble; Enrico Bertino; Ruyan Pang; Leila Cheikh Ismail; Ann Lambert; Zulfiqar A Bhutta; José Villar Journal: Am J Obstet Gynecol Date: 2018-02 Impact factor: 8.661
Authors: José Villar; Aris T Papageorghiou; Ruyan Pang; Eric O Ohuma; Leila Cheikh Ismail; Fernando C Barros; Ann Lambert; Maria Carvalho; Yasmin A Jaffer; Enrico Bertino; Michael G Gravett; Doug G Altman; Manorama Purwar; Ihunnaya O Frederick; Julia A Noble; Cesar G Victora; Zulfiqar A Bhutta; Stephen H Kennedy Journal: Lancet Diabetes Endocrinol Date: 2014-07-06 Impact factor: 32.069
Authors: Filomena Gomes; Rina Agustina; Robert E Black; Parul Christian; Kathryn G Dewey; Klaus Kraemer; Anuraj H Shankar; Emily R Smith; Andrew Thorne-Lyman; Alison Tumilowicz; Megan W Bourassa Journal: Ann N Y Acad Sci Date: 2022-02-25 Impact factor: 6.499