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Predictors of pregnancy and postpartum haemoglobin concentrations in low-income women

Published online by Cambridge University Press:  02 January 2007

Lisa M Bodnar ,
Anna Maria Siega-Riz ,
Lenore Arab ,
Kim Chantala  and
Thad McDonald
Lisa M Bodnar*
Affiliation:
Department of Nutrition, University of North Carolina School of Public Health and School of Medicine, Chapel Hill, NC, USA Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA
Anna Maria Siega-Riz
Affiliation:
Department of Nutrition, University of North Carolina School of Public Health and School of Medicine, Chapel Hill, NC, USA Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA Department of Maternal and Child Health, University of North Carolina School of Public Health, Chapel Hill, NC, USA
Lenore Arab
Affiliation:
Department of Nutrition, University of North Carolina School of Public Health and School of Medicine, Chapel Hill, NC, USA Department of Epidemiology, University of North Carolina School of Public Health, Chapel Hill, NC, USA
Kim Chantala
Affiliation:
Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA
Thad McDonald
Affiliation:
Department of Obstetrics and Gynecology, Wake Medical Center, Raleigh, NC, USA
*
*Corresponding author: Email [email protected]
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Abstract

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Objective:

Pregnancy and postpartum iron status is of great public health importance, yet few studies have examined predictors of haemoglobin (Hb) concentration during this time. We identified predictors of Hb from 24 weeks' gestation until delivery and from 4 to 25 weeks postpartum.

Design:

Blood was drawn as many as four times during care: at the initial visit, at 24–29 weeks' gestation, at delivery and postpartum. A longitudinal, multivariable linear regression model was used to predict Hb concentration.

Setting:

A public health clinic in Raleigh, North Carolina.

Subjects:

n = 520 women who participated in the Iron Supplementation Study.

Results:

Hb concentration at the previous blood draw, short stature, non-Hispanic white ethnicity/race, > 12 years of education and smoking were positive predictors of pregnancy and postpartum Hb concentrations. Iron supplement use was a positive predictor, while inadequate weight gain and severe nausea/vomiting were negative predictors of gestational Hb. A high infant birth weight and postpartum haemorrhage were negative predictors of postpartum Hb. Pre-pregnancy body mass index had a slight positive relationship with gestational Hb, but had a strong negative relationship with postpartum Hb. The longitudinal model also confirmed the typical pattern of gestational Hb concentration. As the number of weeks between the initial visit and the 24- to 29-week visit increased, Hb at 24–29 weeks' gestation decreased. As gestational age increased from 24 weeks until delivery, Hb concentration increased as well.

Conclusions:

The predictors identified here could be used in clinical settings to target high–risk women for intervention.

Keywords

PregnancyPostpartumHaemoglobinIronLongitudinal data
Type
Research Article
Information
Public Health Nutrition , Volume 7 , Issue 6 , September 2004 , pp. 701 - 711
Copyright
Copyright © CAB International 2004

References

1Bodnar, LM, Scanlon, KS, Freedman, DS, Siega-Riz, AM, Cogswell, ME. High prevalence of postpartum anemia among low-income women in the United States. American Journal of Obstetrics and Gynecology 2001; 185: 438–43.Google Scholar
2Bodnar, LM, Cogswell, ME, Scanlon, KS. Low income postpartum women are at risk of iron deficiency. Journal of Nutrition 2002; 132: 2299–303.Google Scholar
3Centers for Disease Control and Prevention (CDC). Pregnancy Nutrition Surveillance, 1996 Full Report. Atlanta, GA: US Department of Health and Human Services, CDC, 1998.Google Scholar
4Haas, JD, Brownlie, T. Iron deficiency and reduced work capacity: a critical review of the research to determine a causal relationship. Journal of Nutrition 2001; 131: 676S–88S.Google Scholar
5Bruner, AB, Joffe, A, Duggan, AK, Casella, JF, Brandt, J. Randomised study of cognitive effects of iron supplementation in non-anaemic iron–deficient adolescent girls. Lancet 1996; 348: 992–6.Google Scholar
6Ballin, A, Berar, M, Rubinstein, U, Kleter, Y, Hershkovitz, A, Meytes, D. Iron state in female adolescents. American Journal of Diseases of Children 1992; 146: 803–5.Google Scholar
7Rasmussen, KM. Is there a causal relationship between iron deficiency or iron-deficiency anemia and weight at birth, length of gestation, and perinatal mortality? Journal of Nutrition 2001; 131: 590S–601S.Google Scholar
8Yip, R, Dallman, PR. The roles of inflammation and iron deficiency as causes of anemia. American Journal of Clinical Nutrition 1988; 48: 1295–300.Google Scholar
9Institute of Medicine, Food and Nutrition Board. Nutrition during Pregnancy. Washington, DC: National Academy Press, 1990.Google Scholar
10Taylor, DJ, Lind, T. Red cell mass during and after normal pregnancy. British Journal of Obstetrics and Gynaecology 1979; 86: 364–70.Google Scholar
11Blackburn, ST, Loper, DL. Maternal, Fetal, and Neonatal Physiology: A Clinical Perspective. Philadelphia, PA: WB Saunders, 1992.Google Scholar
12Friis, H, Gomo, E, Kæstel, P, Ndhlovu, P, Nyazema, N, Krarup, H, et al. HIV and other predictors of serum folate, serum ferritin, and hemoglobin in pregnancy: a cross–sectional study in Zimbabwe. American Journal of Clinical Nutrition 2001; 73: 1066–73.CrossRefGoogle ScholarPubMed
13Robinson, S, Godfrey, K, Denne, J, Cox, V. The determinants of iron status in early pregnancy. British Journal of Nutrition 1998; 79: 249–55.Google Scholar
14Centers for Disease Control and Prevention. Recommendations to prevent and control iron deficiency in the United States. Morbidity and Mortality Weekly Report 1998; 47(RR-3).Google Scholar
15US Department of Health and Human Services Resources. Healthy People 2010: National Health Promotion and Disease Prevention Objectives, [online]. Available at http://www.health.gov/healthypeople/Publications/. Accessed 21 January 2003.Google Scholar
16Siega-Riz, AM, Hartzema, A, Thorp, J, McDonald, T, Turnbull, C, Cogswell, ME. Selective versus universal iron supplementation during pregnancy: prevention of third-trimester anemia. FASEB Journal 2001; 15: A974.Google Scholar
17Bodnar, LM, Davidian, M, Siega-Riz, AM, Tsiatis, AA. Marginal structural models for analyzing causal effects of time-dependent treatments: an application in perinatal epidemiology. American Journal of Epidemiology 2004; in press.CrossRefGoogle Scholar
18Siega-Riz, AM, Adair, LS, Hobel, CJ. Maternal underweight status and inadequate rate of weight gain during the third trimester of pregnancy increases the risk of preterm delivery. Journal of Nutrition 1996; 126: 146–53.Google Scholar
19Zeger, SL, Liang, KY. Longitudinal data analysis for discrete and continuous outcomes. Biometrics 1986; 42: 121–30.CrossRefGoogle ScholarPubMed
20Akaike, H. Likelihood of model and information criteria. Journal of Econometrics 1981; 16: 3–14.CrossRefGoogle Scholar
21American College of Obstetricians and Gynecologists. Postpartum hemorrhage [;ACOG Educational Bulletin, No. 243, January 1998]. International Journal of Gynaecology and Obstetrics 1998; 61: 79–86.Google Scholar
22Bothwell, TH, Charlton, RW, Cook, JD, Finch, CA. Iron Metabolism in Man. Oxford: Blackwell Scientific Publications, 1979; 576.Google Scholar
23Spellacy, WN, Miller, S, Winegar, A, Peterson, PQ. Macrosomia – maternal characteristics and infant complications. Obstetrics and Gynecology 1985; 66: 158–61.Google Scholar
24Zetterstrom, J, Lopez, A, Anzen, B, Norman, M, Holstrom, B, Mellgren, A. Anal sphincter tears at vaginal delivery: risk factors and clinical outcome of primary repair. Obstetrics and Gynecology 1999; 94: 21–8.Google Scholar
25Turner, MJ, Rasmussen, MJ, Turner, ME, Boylan, PC, MacDonald, D, Stronge, JM. The influence of birth weight on labour in nulliparas. Obstetrics and Gynecology 1990; 76: 79–83.Google Scholar
26Axelsson, O. Delivery of the large fetus. Acta Obstetricia et Gynecologica Scandinavica 1990; 69: 473–4.Google Scholar
27Oppenheimer, LW, Sherriff, EA, Goodman, JD, Shah, D, James, CE. The duration of lochia. British Journal of Obstetrics and Gynaecology 1986; 93: 754–7.Google Scholar
28Paterson, JA, Davis, J, Gregory, M, Holt, SJR, Pachulski, A, Stamford, DE, et al. A study on the effects of low haemoglobin on postnatal women. Midwifery 1994; 10: 77–86.CrossRefGoogle Scholar
29Larsen, CE, Serdula, MK, Sullivan, KM. Macrosomia: influence of maternal overweight among a low–income population. American Journal of Obstetrics and Gynecology 1990; 162: 490–4.Google Scholar
30Combs, CA, Murphy, EL, Laros, RK. Factors associated with postpartum hemorrhage with vaginal birth. Obstetrics and Gynecology 1991; 77: 69–76.Google ScholarPubMed
31Crane, SS, Wojtowycz, MA, Dye, TD, Aubry, RH, Artal, R. Association between prepregnancy obesity and risk of cesarean delivery. Obstetrics and Gynecology 1997; 89: 213–6.CrossRefGoogle ScholarPubMed
32Taylor, DJ, Mallen, C, McDougall, N, Lind, T. Effect of iron supplementation on serum ferritin levels during and after pregnancy. British Journal of Obstetrics and Gynaecology 1982; 89: 1010–7.Google Scholar
33Milman, N, Agger, AO, Nielsen, OJ. Iron supplementation during pregnancy. Effect on iron status markers, serum erythropoietin and human placental lactogen. A placebo controlled study in 207 Danish women. Danish Medical Bulletin 1991; 38: 471–6.Google Scholar
34Eskeland, B, Malterud, K, Ulvik, RJ, Hunskaar, S. Iron supplementation in pregnancy: is less enough? A randomized, placebo controlled trial of low dose iron supplementation with and without heme iron. Acta Obstetricia et Gynecologica Scandinavica 1997; 76: 822–8.Google Scholar
35Preziosi, P, Prual, A, Galan, P, Daouda, H, Boureima, H, Hercberg, S. Effect of iron supplementation on the iron status of pregnant women: consequences for newborns. American Journal of Clinical Nutrition 1997; 66: 1178–82.CrossRefGoogle ScholarPubMed
36Collins, JB. Puerperium. Primary Care 1983; 10: 309–32.Google Scholar
37Bothwell, TH, Charlton, RW. Iron Deficiency in Women. Report of the International Nutritional Anemia Consultative Group. Washington, DC: The Nutrition Foundation, 1981.Google Scholar
38SAS Institute. SAS STAT. Cary, NC: SAS Institute, 2000.Google Scholar