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Justiina Ronkainen, Estelle Lowry, Anni Heiskala, Iida Uusitalo, Peppi Koivunen, Eero Kajantie, Marja Vääräsmäki, Marjo-Riitta Järvelin, Sylvain Sebert, Maternal hemoglobin associates with preterm delivery and small for gestational age in two Finnish birth cohorts, European Journal of Obstetrics & Gynecology and Reproductive Biology, Volume 238, 2019, Pages 44-48, ISSN 0301-2115, https://doi.org/10.1016/j.ejogrb.2019.04.045

Maternal hemoglobin associates with preterm delivery and small for gestational age in two Finnish birth cohorts

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Author: Ronkainen, Justiina1,2; Lowry, Estelle1,2; Heiskala, Anni1,2;
Organizations: 1Center for Life Course Health Research, University of Oulu, Oulu, Finland
2Biocenter Oulu, University of Oulu, Oulu, Finland
3Faculty of Biochemistry and Molecular Medicine, University of Oulu, Oulu, Finland
4Oulu Center for Cell-Matrix Research, University of Oulu, Oulu, Finland
5PEDEGO Research Unit, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
6Public Health Promotion Unit, Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
7Hospital for Children and Adolescents, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
8Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
9Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
10MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom
11Department for Genomics of Common Diseases, School of Medicine, Imperial College London, London, United Kingdom
Format: article
Version: accepted version
Access: open
Online Access: PDF Full Text (PDF, 0.3 MB)
Persistent link: http://urn.fi/urn:nbn:fi-fe2019061119971
Language: English
Published: Elsevier, 2019
Publish Date: 2020-05-04
Description:

Abstract

Objective: To test whether maternal hemoglobin during pregnancy associates with offspring perinatal outcomes in a developed country. Changes in maternal hemoglobin concentration during pregnancy are partly physiological phenomena reflecting alterations of maternal blood volume. Especially hemoglobin measures outside the physiological range may influence maternal health and fetal growth with long-lasting consequences.

Study design: We studied an unselected sample drawn from two regional birth cohorts born 20 years apart: The Northern Finland Birth Cohorts 1966 and 1986. These are two mother-and-child population-based birth cohorts together comprising 21,710 mothers and their children. After exclusions, the sample size of the current study was 20,554. Concentrations of maternal hemoglobin at first and last antenatal visits were categorized as low (lowest 10%), medium (reference) or high (highest 10%). Multinomial logistic regression analyses for categories of maternal hemoglobin and perinatal outcomes such as preterm delivery and full-term small and large for gestational age were conducted with adjustments for maternal cofactors.

Results: Low maternal hemoglobin at early pregnancy associated with decreased risk of full-term small for gestational age (adjusted OR 0.73, 95% CI [0.58, 0.93], p = 0.010). At late pregnancy, low maternal hemoglobin associated with increased risk of preterm delivery (adjusted OR 1.60, 95% CI [1.26, 2.02], p < 0.0005) whereas high maternal hemoglobin associated with increased risk of full-term small for gestational age (adjusted OR 1.29, 95% CI [1.07, 1.56], p = 0.009). Maternal hemoglobin did not show constant association with risk of large for gestational age.

Conclusion: The results from this study support evidence that both low and high maternal hemoglobin associate with adverse perinatal outcomes. Low maternal hemoglobin associated with preterm delivery and high with full-term small for gestational age. Association was mainly present when maternal hemoglobin was measured during the third trimester. These results indicate that it is important to monitor both extremes of maternal hemoglobin throughout the pregnancy.

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Series: European journal of obstetrics & gynecology and reproductive biology
ISSN: 0301-2115
ISSN-E: 1872-7654
ISSN-L: 0301-2115
Volume: 238
Pages: 44 - 48
DOI: 10.1016/j.ejogrb.2019.04.045
OADOI: https://oadoi.org/10.1016/j.ejogrb.2019.04.045
Type of Publication: A1 Journal article – refereed
Field of Science: 3142 Public health care science, environmental and occupational health
Subjects:
Intrauterine growth restriction
Large for gestational age
Maternal hemoglobin
Preterm delivery
Small for gestational age
Article
Funding: This work was supported by the European Union's Horizon 2020 research and innovation program under grant agreement No. 633595 (DynaHEALTH), and grant agreement No. 733206 (LifeCycle); the academy of Finland EGEA-project (285547) and the Biocenter Oulu.
EU Grant Number: (733206) LIFECYCLE - Early-life stressors and LifeCycle health
(633595) DYNAHEALTH - Understanding the dynamic determinants of glucose homeostasis and social capability to promote Healthy and active aging
Academy of Finland Grant Number: 285547
Detailed Information: 285547 (Academy of Finland Funding decision)
Copyright information: © 2019. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/.
  https://creativecommons.org/licenses/by-nc-nd/4.0/