Risk Factors And Perinatal Outcomes Of Anemia During Pregnancy In Mainland China

Objective To provide a basis for better management of anemia during pregnancy by studying the prevalence and perinantal outcomes of anemia during pregnancy in mainland China in recent years.Methods Hospitalized obstetrical cases from 19 tertiary and 20 secondary hospitals in 14 provinces(nationally representative) during the period January 1,2011 to December 31,2011 were randomly selected. The general conditions, pregnancy complications and perinatal outcomes of anemia during pregnancy and without anemia were compared. Risk factors for neonatal death and maternal severe adverse events of anemia during pregnancy were analyzed.Results Collect first trimester pregnancy cases 37372 cases, second trimester 50852 cases of pregnancy, before delivery 100769 cases, 71734 cases of postpartum. As Hb normal maternal pregnancy to control group, we analysis the risk factors and perinatal outcome of first trimester, second trimester, before birth and postpartum anemia. Maternal pregnancy in first trimester in our country the incidence of anemia was 8.09%, the incidence of anemia during second trimester was 20.42%, in the incidence of anemia was 33.27% before delivery, the incidence of postpartum anemia was 61.25%. Each pregnancy weeks age ≤20 years old has higher incidence of anemia(P < 0.0001), the incidence of anemia pregnant women drinking is higher, the pregnant woman blood type A higher incidence of anemia(P < 0.0001), the lower BMI before progestation, the higher the incidence of anemia(P < 0.0001), multiple pregnancy anemia occurred more(P < 0.0001). Pregnant time ≥2 is the risk factor of anemia in first trimester(OR > 1, P < 0.05). Pregnancy weight gain during pregnancy in < 7 kg, the higher the incidence of anemia in second trimester(P < 0.0001), and at times ≥4 times higher incidence of anemia, multipara than first-time mothers are more likely to occur second trimester anemia(P < 0.0001). Lower than the junior middle school education level has a higher incidence of anemia pregnant women(P < 0.0001), weight gain during pregnancy < 7 kg and > 18 kg anemia incidence were higher, the more times pregnancy the higher the incidence of anemia, multiparas are more likely to happen anemia before delivery. HBs Ag, HBe Ag positive for HBV higher incidence of anemia(P < 0.0001), pregnancy with placenta previa is a higher incidence of anemia. Lower than junior middle school has higher incidence of postpartum anemia pregnant women, weight gain during pregnancy > 18 kg higher incidence of postpartum anemia. Multiparas are more likely to happen postpartum maternal anemia, HBs Ag, HBe Ag positive for HBV higher incidence of anemia(P < 0.05), placenta previa, placenta implantation and placenta adhesion of maternal postpartum were higher incidence of anemia. For perinatal outcome, in first trimester, moderate anemia group FGR incidence is higher than normal group OR 3.15(1.16 8.57), and higher incidence of postpartum hemorrhage OR 1.86(1.00 3.47), the placenta weight light in all anemia group compared with normal group. Pregnancy in moderate anemia group increased incidence of PPROM, severe anemia group has high incidence of HDCP and its complications. Significantly higher incidence of FGR in severe anemia group. Mild-to-moderate anemia group were higher incidence of postpartum hemorrhage, the placenta weight light in anemia groups. Moderate anemia group has a high incidence of neonatal Apgar score ≤7 at 1 minute, 5 minutes, 10 minutes than normal group, the incidence of low birth weight is also high,. Before delivery light moderately severe anemia group compared with normal group, premature birth,and PPROM incidence are higher. HDCP and its complications incidence in moderate-to-severe anemia group are high. Significantly higher incidence of FGR in severe anemia group. Moderate-to-severe anemia group increased the incidence of placental abruption, incidence of postpartum hemorrhage, is high in all anemia groups compared with normal group and the placenta weight are lower. The neonatal Apgar score ≤7 at 1 minute, 5 minutes, 10 minutes is higher in moderate-to-severe anemia group, the incidence of low birth weight and neonatal adverse outcomes is also high. Cesarean section rate inanemia groups are higher than normal group.ConclusionsThe incidence of anemia during pregnancy in mainland China is higher than that in developed countries, and it increases with the increasing of gestational weeks. Age, cultural degree, alcohol drinking, history of gestation, maternal BMI before pregnancy, weight gain during pregnancy,the fetus number,ABO blood group and placenta previa, placentaincreta, placenta adh esion are associated with anemia occurred. Anemia can cause premature delivery, PROM, HDCP,postpartumhemorrhage, weight reduction of placenta, abnormal amniotic fluid volume, cesarean section rate increasing and FGR, low birth weight and neonatal Apgar score at1 minute ≤7 and Apgar score at 5 minutes≤7.