Top

BMC Pregnancy and Childbirth

Published in:

Open Access 01-12-2018 | Research article

Hemoglobin levels during the first trimester of pregnancy are associated with the risk of gestational diabetes mellitus, pre-eclampsia and preterm birth in Chinese women: a retrospective study

Authors: Chen Wang, Li Lin, Rina Su, Weiwei Zhu, Yumei Wei, Jie Yan, Hui Feng, Boya Li, Shuang Li, Huixia Yang

Published in: BMC Pregnancy and Childbirth | Issue 1/2018

Abstract

Background

Hemoglobin (Hb) measurement is a standard test among pregnant women during the first perinatal visit that is used to evaluate physical status and anemia. However, studies focusing on Hb levels and pregnancy outcomes are scarce. This study aimed to determine whether Hb levels in early pregnancy were associated with the risk of gestational diabetes mellitus (GDM), pre-eclampsia (PE) and preterm birth.

Methods

A hospital-based retrospective study was conducted among 21,577 singleton, non-smoking pregnancies between June 2013 and January 2015. The demographic data and medical information of each participant were collected individually through questionnaires and patient medical records. Odds ratios were generated using a multivariate logistic regression analysis to evaluate the relative risk of GDM, PE and preterm birth continuously and across different hemoglobin ranges in the overall population and in women from different pre-pregnancy body mass index (BMI) categories, respectively. The level of statistical significance was set at 0.05.

Results

(1) For women who were underweight, normal-weight, overweight and obese, early pregnancy Hb levels were 127.8 ± 10.1 g/L, 129.6 ± 9.7 g/L, 132.2 ± 9.5 g/L and 133.4 ± 9.4 g/L, respectively. (2) Women with GDM and PE had significantly increased Hb levels during early pregnancy compared with controls, whereas women with preterm birth processed significantly decreased Hb levels. (3) After adjusting for confounders, the risks for GDM and PE increased with high maternal Hb (OR: 1.27 for Hb 130–149; OR: 2.06 for Hb ≥ 150 g/L), and the risk for preterm birth decreased with high maternal Hb (OR: 1.30 for Hb 130–149; OR: 2.38 for Hb ≥ 150 g/L) and increased with low maternal Hb (OR: 1.41 for Hb < 110 g/L). Among women whose BMI was < 24 kg/m², high GDM (OR: 1.27 for Hb 130–149; OR: 1.84 for Hb ≥ 150 g/L) and low preterm rates (OR: 0.77 for Hb 130–149; OR: 0.23 for Hb ≥ 150 g/L) were observed with high Hb, whereas in women whose BMI was ≥24 kg/m², only high GDM rates were observed with Hb > 150 g/L (OR: 2.33).

Conclusion

These findings suggest that Hb levels during early pregnancy play a role in predicting the risk of GDM, PE and preterm birth.

Vogel JP, Souza JP, Mori R, Morisaki N, Lumbiganon P, Laopaiboon M, et al. Maternal complications and perinatal mortality: findings of the World Health Organization multicountry survey on maternal and newborn health. BJOG. 2014;121(Suppl 1):76–88. https://doi.org/10.1111/1471-0528.12633.CrossRefPubMed

Hod M, Kapur A, Sacks DA, Hadar E, Agarwal M, Di Renzo GC, et al. The International Federation of Gynecology and Obstetrics (FIGO) initiative on gestational diabetes mellitus: a pragmatic guide for diagnosis, management, and care. Int J Gynaecol Obstet. 2015;131(Suppl 3):S173–211. https://doi.org/10.1016/S0020-7292(15)30007-2.CrossRefPubMed

Umesawa M, Kobashi G. Epidemiology of hypertensive disorders in pregnancy: prevalence, risk factors, predictors and prognosis. Hypertens Res. 2016; https://doi.org/10.1038/hr.2016.126.

Sacks DA, Hadden DR, Maresh M, Deerochanawong C, Dyer AR, Metzger BE, et al. Frequency of gestational diabetes mellitus at collaborating centers based on IADPSG consensus panel-recommended criteria: the hyperglycemia and adverse pregnancy outcome (HAPO) study. Diabetes Care. 2012;35:526–8. https://doi.org/10.2337/dc11-1641.CrossRefPubMedPubMedCentral

Blencowe H, Cousens S, Oestergaard MZ, Chou D, Moller AB, Narwal R, et al. National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. Lancet. 2012;379:2162–72. https://doi.org/10.1016/S0140-6736(12)60820-4.CrossRefPubMed

Rogers LK, Velten M. Maternal inflammation, growth retardation, and preterm birth: insights into adult cardiovascular disease. Life Sci. 2011;89:417–21. https://doi.org/10.1016/j.lfs.2011.07.017.CrossRefPubMed

Nutritional anaemias. Report of a WHO group of experts. WHO Tech Rep Ser. 1972;503:1–29.

Annamraju H, Pavord S. Anaemia in pregnancy. Br J Hosp Med. 2016;77:584–8. https://doi.org/10.12968/hmed.2016.77.10.584.CrossRef

Huisman A, Aarnoudse JG. Increased 2nd trimester hemoglobin concentration in pregnancies later complicated by hypertension and growth retardation. Early evidence of a reduced plasma volume. Acta Obstet Gynecol Scand. 1986;65:605–8. https://doi.org/10.3109/00016348609158396.CrossRefPubMed

10.

Phaloprakarn C, Tangjitgamol S. Impact of high maternal hemoglobin at first antenatal visit on pregnancy outcomes: a cohort study. J Perinat Med. 2008;36:115–9. https://doi.org/10.1515/JPM.2008.018.CrossRefPubMed

11.

Tarim E, Kilicdag E, Bagis T, Ergin T. High maternal hemoglobin and ferritin values as risk factors for gestational diabetes. Int J Gynaecol Obstet. 2004;84:259–61. https://doi.org/10.1016/S0020-7292(03)00341-2.CrossRefPubMed

12.

Rasmussen S, Bergsjø P, Jacobsen G, Haram K, Bakketeig LS. Haemoglobin and serum ferritin in pregnancy--correlation with smoking and body mass index. Eur J Obstet Gynecol Reprod Biol. 2005;123:27–34. https://doi.org/10.1016/j.ejogrb.2005.02.012.CrossRefPubMed

13.

Zhou B. Coorperative meta-analysis group of China obesity task force. [Predictive values of body mass index and waist circumference to risk factors of related diseases in Chinese adult population]. Zhonghua Liu Xing Bing Xue Za Zhi. 2002;23:5–10.PubMed

14.

Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy. A World Health Organization guideline. Diabetes Res Clin Pract. 2014;103:341–63. https://doi.org/10.1016/j.diabres.2013.10.012.CrossRef

15.

WHO. WHO: recommended definitions, terminology and format for statistical tables related to the perinatal period and use of a new certificate for cause of perinatal deaths. Modifications recommended by FIGO as amended October 14, 1976. Acta Obstet Gynecol Scand. 1977;56:247–53.

16.

Lao TT, Chan LY, Tam KF, Ho LF. Maternal hemoglobin and risk of gestational diabetes mellitus in Chinese women. Obstet Gynecol. 2002;99:807–12.PubMed

17.

Murphy JF, O’Riordan J, Newcombe RG, Coles EC, Pearson JF. Relation of haemoglobin levels in first and second trimesters to outcome of pregnancy. Lancet. 1986;1:992–5. https://doi.org/10.1016/S0140-6736(86)91269-9.CrossRefPubMed

18.

Mehrabian F, Hosseini SM. Comparison of gestational diabetes mellitus and pre-eclampsia in women with high hemoglobin in the first trimester of pregnancy: a longitudinal study. Pak J Med Sci. 2013;29:986–90. https://doi.org/10.12669/pjms.294.4012.CrossRefPubMedPubMedCentral

19.

Bowers K, Yeung E, Williams MA, Qi L, Tobias DK, Hu FB, et al. A prospective study of prepregnancy dietary iron intake and risk for gestational diabetes mellitus. Diabetes Care. 2011;34:1557–63. https://doi.org/10.2337/dc11-0134.CrossRefPubMedPubMedCentral

20.

Liu Q, Sun L, Tan Y, Wang G, Lin X, Cai L. Role of iron deficiency and overload in the pathogenesis of diabetes and diabetic complications. Curr Med Chem. 2009;16:113–29. https://doi.org/10.2174/092986709787002862.CrossRefPubMed

21.

Cho YI, Cho DJ. Hemorheology and microvascular disorders. Korean Circ J. 2011;41:287–95. https://doi.org/10.4070/kcj.2011.41.6.287.CrossRefPubMedPubMedCentral

22.

Treuer AV, Gonzalez DR. Nitric oxide synthases, S-nitrosylation and cardiovascular health: from molecular mechanisms to therapeutic opportunities (review). Mol Med Rep. 2015;11:1555–65. https://doi.org/10.3892/mmr.2014.2968.CrossRefPubMed

23.

Tsemakhovich VA, Bamm VV, Shaklai M, Shaklai N. Vascular damage by unstable hemoglobins: the role of heme-depleted globin. Arch Biochem Biophys. 2005;436:307–15. https://doi.org/10.1016/j.abb.2005.02.006.CrossRefPubMed

24.

Levy A, Fraser D, Katz M, Mazor M, Sheiner E. Maternal anemia during pregnancy is an independent risk factor for low birthweight and preterm delivery. Eur J Obstet Gynecol Reprod Biol. 2005;122:182–6. https://doi.org/10.1016/j.ejogrb.2005.02.015.CrossRefPubMed

25.

Gonzales GF, Tapia V, Gasco M, Carrillo CE. Maternal hemoglobin concentration and adverse pregnancy outcomes at low and moderate altitudes in Peru. J Matern Fetal Neonatal Med. 2012;25:1105–10. https://doi.org/10.3109/14767058.2011.623200.CrossRefPubMed

26.

Masukume G, Khashan AS, Kenny LC, Baker PN, Nelson G, SCOPE Consortium. Risk factors and birth outcomes of anaemia in early pregnancy in a nulliparous cohort. PLoS One. 2015;10:e0122729. https://doi.org/10.1371/journal.pone.0122729.CrossRefPubMedPubMedCentral

27.

Lu ZM, Goldenberg RL, Cliver SP, Cutter G, Blankson M. The relationship between maternal hematocrit and pregnancy outcome. Obstet Gynecol. 1991;77:190–4. https://doi.org/10.1097/00006250-199102000-00005.CrossRefPubMed

28.

Scholl TO, Hediger ML, Fischer RL, Shearer JW. Anemia vs iron deficiency: increased risk of preterm delivery in a prospective study. Am J Clin Nutr. 1992;55:985–8.CrossRefPubMed

29.

Rawal S, Hinkle SN, Bao W, Zhu Y, Grewal J, Albert PS, et al. A longitudinal study of iron status during pregnancy and the risk of gestational diabetes: findings from a prospective, multiracial cohort. Diabetologia. 2017;60:249–57. https://doi.org/10.1007/s00125-016-4149-3.CrossRefPubMed

Title: Hemoglobin levels during the first trimester of pregnancy are associated with the risk of gestational diabetes mellitus, pre-eclampsia and preterm birth in Chinese women: a retrospective study
Authors: Chen Wang
Li Lin
Rina Su
Weiwei Zhu
Yumei Wei
Jie Yan
Hui Feng
Boya Li
Shuang Li
Huixia Yang
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: BMC Pregnancy and Childbirth / Issue 1/2018
Electronic ISSN: 1471-2393
DOI: https://doi.org/10.1186/s12884-018-1800-7

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Hemoglobin levels during the first trimester of pregnancy are associated with the risk of gestational diabetes mellitus, pre-eclampsia and preterm birth in Chinese women: a retrospective study

Abstract

Background

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2018

Iron supplementation in pregnant sicklers: an opinion

Development of a tailored strategy to improve postpartum hemorrhage guideline adherence

The effect of advanced maternal age on perinatal outcomes in nulliparous singleton pregnancies

Women suffer more from disrespectful and abusive care than from the labour pain itself: a qualitative study from Women’s perspective

Arterial/venous thrombosis, fetal loss and stillbirth in pregnant women with systemic lupus erythematosus versus primary and secondary antiphospholipid syndrome: a systematic review and meta-analysis

Comparison of the effect of breast pump stimulation and oxytocin administration on the length of the third stage of labor, postpartum hemorrhage, and anemia: a randomized controlled trial