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Haemoglobin trajectories during pregnancy and associated outcomes using pooled maternity and hospitalization data from two tertiary hospitals
Author(s) -
Randall Deborah A.,
Patterson Jillian A.,
Gallimore Felicity,
Morris Jonathan M.,
Simpson Judy M.,
McGee Therese M.,
Ford Jane B.
Publication year - 2019
Publication title -
vox sanguinis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.68
H-Index - 83
eISSN - 1423-0410
pISSN - 0042-9007
DOI - 10.1111/vox.12839
Subject(s) - medicine , pregnancy , logistic regression , obstetrics , blood transfusion , gestational age , singleton , pediatrics , tertiary care , emergency medicine , surgery , genetics , biology
Background and objectives This study aimed to describe how haemoglobin trajectories in pregnant Australian women were associated with subsequent postpartum haemorrhage, blood transfusion and other outcomes. Materials and methods The study was conducted in two tertiary public hospitals in Australia, using routinely collected maternity and hospital data on singleton pregnancies (2011–2015). Latent class growth modelling defined trajectories among those with at least one haemoglobin in each of three antenatal time periods (0–15, 16–30 and 31+ weeks; n = 7104). Observed over expected ratios were calculated after predicting expected outcomes with adjusted logistic regression. Results The mean minimum haemoglobin levels across the three periods were 127·9, 116·5 and 119·3 g/l. We identified seven groups of women with similar haemoglobin trajectories: five with parallel U‐shaped trajectories, one with increasing and one with decreasing trajectory. Thirty‐eight women (0.5%) had very low haemoglobin across the pregnancy and the highest adverse outcomes, including higher than expected blood transfusion risk. One hundred thirteen women (1.6%) with a progressively decreasing trajectory also had higher risk of transfusion. Women with high haemoglobin across the antenatal period had higher than expected risk of preterm birth, small for gestational age and infants transferred to higher care. Conclusions Haemoglobin trajectories across pregnancy can predict women at higher risk of requiring transfusion around birth. Women who maintain high haemoglobins across the pregnancy are worthy of increased surveillance as they carry increased risks of newborn morbidity.