Idan Alcalay1, Tamar Wainstock2, Eyal Sheiner3. 1. Faculty of Health Sciences, Joyce & Irving Goldman Medical School at Ben Gurion University of the Negev, Beer-Sheva, Israel. alcalay.idan@gmail.com. 2. The Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel. 3. Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Abstract
PURPOSE: To evaluate the association between prenatal maternal anemia (hemoglobin, Hb < 11 g/dl) and long-term respiratory morbidity of the offspring. METHODS: A retrospective population-based cohort analysis was performed at a single tertiary medical center. We include all singletons born between 1991-2014 and discharged alive. Offspring with congenital malformations were excluded. The 3 study groups were defined on maternal Hb levels on discharge: severe anemia (< 7.0 g/dl), mild to moderate anemia (7.0-11.0 g/dl) and unexposed (≥ 11.0 g/dl). Offspring respiratory morbidity was predefined on ICD-9 codes and recruited from the hospitalized medical records. A Kaplan-Meier survival curve was formed to compare the cumulative hospitalization and a multivariable Cox survival analysis was used to control for cofounders (gestational age, maternal age, diabetes, hypertensive disorders, post-partum hemorrhage and transfusion of blood products). RESULTS: 214,305 deliveries met the inclusion criteria: 807 (0.3%) mothers had severe anemia, 105,196 (49.1%) mothers had mild-moderate anemia, and the remaining were not anemic (108,302, 50.5%). Respiratory hospitalization was significantly higher among the offspring born to anemic mothers (6.2%; 5.3% and 5.1%; p = 0.020, in the study groups). However, association between maternal anemia and respiratory-related hospitalization remained significant only among the mild-moderate anemic group (adjusted Cox hazard ratio = 1.1; 95% CI 1.05-1.14; p < 0.01). The Kaplan-Meier survival analysis showed significant higher total respiratory hospitalizations in offspring according to maternal anemia status (Log Rank p-value = < .001). CONCLUSION: Maternal anemia was associated with long-term respiratory morbidity of the offspring.
PURPOSE: To evaluate the association between prenatal maternal anemia (hemoglobin, Hb < 11 g/dl) and long-term respiratory morbidity of the offspring. METHODS: A retrospective population-based cohort analysis was performed at a single tertiary medical center. We include all singletons born between 1991-2014 and discharged alive. Offspring with congenital malformations were excluded. The 3 study groups were defined on maternal Hb levels on discharge: severe anemia (< 7.0 g/dl), mild to moderate anemia (7.0-11.0 g/dl) and unexposed (≥ 11.0 g/dl). Offspring respiratory morbidity was predefined on ICD-9 codes and recruited from the hospitalized medical records. A Kaplan-Meier survival curve was formed to compare the cumulative hospitalization and a multivariable Cox survival analysis was used to control for cofounders (gestational age, maternal age, diabetes, hypertensive disorders, post-partum hemorrhage and transfusion of blood products). RESULTS: 214,305 deliveries met the inclusion criteria: 807 (0.3%) mothers had severe anemia, 105,196 (49.1%) mothers had mild-moderate anemia, and the remaining were not anemic (108,302, 50.5%). Respiratory hospitalization was significantly higher among the offspring born to anemic mothers (6.2%; 5.3% and 5.1%; p = 0.020, in the study groups). However, association between maternal anemia and respiratory-related hospitalization remained significant only among the mild-moderate anemic group (adjusted Cox hazard ratio = 1.1; 95% CI 1.05-1.14; p < 0.01). The Kaplan-Meier survival analysis showed significant higher total respiratory hospitalizations in offspring according to maternal anemia status (Log Rank p-value = < .001). CONCLUSION: Maternal anemia was associated with long-term respiratory morbidity of the offspring.
Authors: S Parks; M K Hoffman; S S Goudar; A Patel; S Saleem; S A Ali; R L Goldenberg; P L Hibberd; J Moore; D Wallace; E M McClure; R J Derman Journal: BJOG Date: 2019-01-24 Impact factor: 6.531