Anemia and adverse outcomes in pregnancy: subgroup analysis of the CLIP cluster-randomized trial in India
Abstract Background Iron-deficiency anemia is a known risk factor for several adverse perinatal outcomes, but data on its impact on specific maternal morbidities is less robust. Further, information on associations between anemia in early pregnancy and subsequent outcomes are understudied. Methods T...
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| Format: | Article |
| Language: | English |
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BMC
2022-05-01
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| Series: | BMC Pregnancy and Childbirth |
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| Online Access: | https://doi.org/10.1186/s12884-022-04714-y |
| _version_ | 1817988330780884992 |
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| author | Jeffrey N. Bone Mrutyunjaya Bellad Shivaprasad Goudar Ashalata Mallapur Umesh Charantimath Umesh Ramadurg Geetanjali Katageri Maria Lesperance Mai-Lei Woo Kinshella Raiya Suleman Marianne Vidler Sumedha Sharma Richard Derman Laura A. Magee Peter von Dadelszen the CLIP working group |
| author_facet | Jeffrey N. Bone Mrutyunjaya Bellad Shivaprasad Goudar Ashalata Mallapur Umesh Charantimath Umesh Ramadurg Geetanjali Katageri Maria Lesperance Mai-Lei Woo Kinshella Raiya Suleman Marianne Vidler Sumedha Sharma Richard Derman Laura A. Magee Peter von Dadelszen the CLIP working group |
| author_sort | Jeffrey N. Bone |
| collection | DOAJ |
| description | Abstract Background Iron-deficiency anemia is a known risk factor for several adverse perinatal outcomes, but data on its impact on specific maternal morbidities is less robust. Further, information on associations between anemia in early pregnancy and subsequent outcomes are understudied. Methods The study population was derived from the Community Level Interventions for Pre-eclampsia (CLIP) trial in Karnataka State, India (NCT01911494). Included were women who were enrolled in either trial arm, delivered by trial end date, and had a baseline measure of hemoglobin (Hb). Anemia was classified by WHO standards into four groups: none (Hb ≥ 11 g/dL), mild (10.0 g/dL ≤ Hb < 11.0 g/dL), moderate (7.0 g/dL ≤ Hb < 10.0 g/dL) and severe (Hb < 7.0 g/dL). Targeted maximum likelihood estimation was used to estimate confounder-adjusted associations between anemia and a composite (and its components) of adverse maternal outcomes, including pregnancy hypertension. E-values were calculated to assess robustness to unmeasured confounding. Results Of 11,370 women included, 10,066 (88.5%) had anemia, that was mild (3690, 32.5%), moderate (6023, 53.0%), or severe (68, 0.6%). Almost all women (> 99%) reported taking iron supplements during pregnancy. Blood transfusions was more often administered to those with anemia that was mild (risk ratio [RR] 2.16, 95% confidence interval [CI] 1.31–3.56), moderate (RR 2.37, 95% CI 1.56–3.59), and severe (RR 5.70, 95% CI 3.00–10.85). No significant association was evident between anemia severity and haemorrhage (antepartum or postpartum) or sepsis, but there was a U-shaped association between anemia severity and pregnancy hypertension and pre-eclampsia specifically, with the lowest risk seen among those with mild or moderate anemia. Conclusion In Karnataka State, India, current management strategies for mild-moderate anemia in early pregnancy are associated with similar rates of adverse maternal or perinatal outcomes, and a lower risk of pregnancy hypertension and preeclampsia, compared with no anemia in early pregnancy. Future research should focus on risk mitigation for women with severe anemia, and the potential effect of iron supplementation for women with normal Hb in early pregnancy. |
| first_indexed | 2024-04-14T00:32:57Z |
| format | Article |
| id | doaj.art-4c56547801574d188d8daaeb67062593 |
| institution | Directory Open Access Journal |
| issn | 1471-2393 |
| language | English |
| last_indexed | 2024-04-14T00:32:57Z |
| publishDate | 2022-05-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pregnancy and Childbirth |
| spelling | doaj.art-4c56547801574d188d8daaeb670625932022-12-22T02:22:29ZengBMCBMC Pregnancy and Childbirth1471-23932022-05-0122111110.1186/s12884-022-04714-yAnemia and adverse outcomes in pregnancy: subgroup analysis of the CLIP cluster-randomized trial in IndiaJeffrey N. Bone0Mrutyunjaya Bellad1Shivaprasad Goudar2Ashalata Mallapur3Umesh Charantimath4Umesh Ramadurg5Geetanjali Katageri6Maria Lesperance7Mai-Lei Woo Kinshella8Raiya Suleman9Marianne Vidler10Sumedha Sharma11Richard Derman12Laura A. Magee13Peter von Dadelszen14the CLIP working groupDepartment of Obstetrics and Gynaecology, University of British ColumbiaKLE Academy of Higher Education and Research’s J N Medical CollegeKLE Academy of Higher Education and Research’s J N Medical CollegeS Nijalingappa Medical College and Hanagal Shree Kumareshwar Hospital and Research CenterKLE Academy of Higher Education and Research’s J N Medical CollegeS Nijalingappa Medical College and Hanagal Shree Kumareshwar Hospital and Research CenterS Nijalingappa Medical College and Hanagal Shree Kumareshwar Hospital and Research CenterRichmond Division of Family Practice, Vancouver Coastal HealthDepartment of Obstetrics and Gynaecology, University of British ColumbiaFaculty of Medicine, University of British ColumbaDepartment of Obstetrics and Gynaecology, University of British ColumbiaDepartment of Obstetrics and Gynaecology, University of British ColumbiaGlobal Affairs, Thomas Jefferson UniversityDepartment of Women and Children’s Health, School of Life Course Sciences, Faculty of Life Science and Medicine, Kings College LondonDepartment of Women and Children’s Health, School of Life Course Sciences, Faculty of Life Science and Medicine, Kings College LondonAbstract Background Iron-deficiency anemia is a known risk factor for several adverse perinatal outcomes, but data on its impact on specific maternal morbidities is less robust. Further, information on associations between anemia in early pregnancy and subsequent outcomes are understudied. Methods The study population was derived from the Community Level Interventions for Pre-eclampsia (CLIP) trial in Karnataka State, India (NCT01911494). Included were women who were enrolled in either trial arm, delivered by trial end date, and had a baseline measure of hemoglobin (Hb). Anemia was classified by WHO standards into four groups: none (Hb ≥ 11 g/dL), mild (10.0 g/dL ≤ Hb < 11.0 g/dL), moderate (7.0 g/dL ≤ Hb < 10.0 g/dL) and severe (Hb < 7.0 g/dL). Targeted maximum likelihood estimation was used to estimate confounder-adjusted associations between anemia and a composite (and its components) of adverse maternal outcomes, including pregnancy hypertension. E-values were calculated to assess robustness to unmeasured confounding. Results Of 11,370 women included, 10,066 (88.5%) had anemia, that was mild (3690, 32.5%), moderate (6023, 53.0%), or severe (68, 0.6%). Almost all women (> 99%) reported taking iron supplements during pregnancy. Blood transfusions was more often administered to those with anemia that was mild (risk ratio [RR] 2.16, 95% confidence interval [CI] 1.31–3.56), moderate (RR 2.37, 95% CI 1.56–3.59), and severe (RR 5.70, 95% CI 3.00–10.85). No significant association was evident between anemia severity and haemorrhage (antepartum or postpartum) or sepsis, but there was a U-shaped association between anemia severity and pregnancy hypertension and pre-eclampsia specifically, with the lowest risk seen among those with mild or moderate anemia. Conclusion In Karnataka State, India, current management strategies for mild-moderate anemia in early pregnancy are associated with similar rates of adverse maternal or perinatal outcomes, and a lower risk of pregnancy hypertension and preeclampsia, compared with no anemia in early pregnancy. Future research should focus on risk mitigation for women with severe anemia, and the potential effect of iron supplementation for women with normal Hb in early pregnancy.https://doi.org/10.1186/s12884-022-04714-yAnemia in pregnancyHypertensionGlobal health |
| spellingShingle | Jeffrey N. Bone Mrutyunjaya Bellad Shivaprasad Goudar Ashalata Mallapur Umesh Charantimath Umesh Ramadurg Geetanjali Katageri Maria Lesperance Mai-Lei Woo Kinshella Raiya Suleman Marianne Vidler Sumedha Sharma Richard Derman Laura A. Magee Peter von Dadelszen the CLIP working group Anemia and adverse outcomes in pregnancy: subgroup analysis of the CLIP cluster-randomized trial in India BMC Pregnancy and Childbirth Anemia in pregnancy Hypertension Global health |
| title | Anemia and adverse outcomes in pregnancy: subgroup analysis of the CLIP cluster-randomized trial in India |
| title_full | Anemia and adverse outcomes in pregnancy: subgroup analysis of the CLIP cluster-randomized trial in India |
| title_fullStr | Anemia and adverse outcomes in pregnancy: subgroup analysis of the CLIP cluster-randomized trial in India |
| title_full_unstemmed | Anemia and adverse outcomes in pregnancy: subgroup analysis of the CLIP cluster-randomized trial in India |
| title_short | Anemia and adverse outcomes in pregnancy: subgroup analysis of the CLIP cluster-randomized trial in India |
| title_sort | anemia and adverse outcomes in pregnancy subgroup analysis of the clip cluster randomized trial in india |
| topic | Anemia in pregnancy Hypertension Global health |
| url | https://doi.org/10.1186/s12884-022-04714-y |
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