Maternal and neonatal outcomes of antenatal anemia in a Scottish population: a retrospective cohort study

Ruramayi Rukuni, Sohinee Bhattacharya, Michael F. Murphy, David Roberts, Simon J. Stanworth, Marian Knight

Research output: Contribution to journalArticle

Abstract

Introduction Antenatal anemia is a major public health problem in the UK, yet there is limited high quality evidence for associated poor clinical outcomes. The objectives of this study were to estimate the incidence and clinical outcomes of antenatal anemia in a Scottish population. Material and methods A retrospective cohort study of 80 422 singleton pregnancies was conducted using data from the Aberdeen Maternal and Neonatal Databank between 1995 and 2012. Antenatal anemia was defined as haemoglobin ≤10 g/dl during pregnancy. Incidence was calculated with 95% confidence intervals and compared over time using a chi‐squared test for trend. Multivariable logistic regression was used to adjust for confounding variables. Results are presented as adjusted odds ratios with 95% confidence interval. Results The overall incidence of antenatal anemia was 9.3 cases/100 singleton pregnancies (95% confidence interval 9.1–9.5), decreasing from 16.9/100 to 4.1/100 singleton pregnancies between 1995 and 2012 (p < 0.001). Maternal anemia was associated with antepartum hemorrhage (adjusted odds ratio 1.26, 95% confidence interval 1.17–1.36), postpartum infection (adjusted odds ratio 1.89, 95% confidence interval 1.39–2.57), transfusion (adjusted odds ratio 1.87, 95% confidence interval 1.65–2.13) and stillbirth (adjusted odds ratio 1.42, 95% confidence interval 1.04–1.94), reduced odds of postpartum hemorrhage (adjusted odds ratio 0.92, 95% confidence interval 0.86–0.98) and low birthweight (adjusted odds ratio 0.77, 95% confidence interval 0.69–0.86). No other outcomes were statistically significant. Conclusions This study shows the incidence of antenatal anemia is decreasing steadily within this Scottish population. However, given that anemia is a readily correctable risk factor for major causes of morbidity and mortality in the UK, further work is required to investigate appropriate preventive measures.
Original languageEnglish
Pages (from-to)555-564
Number of pages10
JournalActa Obstetricia et Gynecologica Scandinavica
Volume95
Issue number5
Early online date1 Mar 2016
DOIs
Publication statusPublished - May 2016

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Anemia
Cohort Studies
Retrospective Studies
Mothers
Confidence Intervals
Odds Ratio
Population
Pregnancy
Incidence
Postpartum Hemorrhage
Confounding Factors (Epidemiology)
Stillbirth
Postpartum Period
Hemoglobins
Public Health
Logistic Models
Databases
Hemorrhage
Morbidity
Mortality

Keywords

  • Anemia
  • pregnancy outcome
  • neonatal outcome
  • hemorrhage
  • postpartum infection

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Maternal and neonatal outcomes of antenatal anemia in a Scottish population : a retrospective cohort study. / Rukuni, Ruramayi; Bhattacharya, Sohinee; Murphy, Michael F.; Roberts, David; Stanworth, Simon J.; Knight, Marian.

In: Acta Obstetricia et Gynecologica Scandinavica, Vol. 95, No. 5, 05.2016, p. 555-564.

Research output: Contribution to journalArticle

Rukuni, Ruramayi ; Bhattacharya, Sohinee ; Murphy, Michael F. ; Roberts, David ; Stanworth, Simon J. ; Knight, Marian. / Maternal and neonatal outcomes of antenatal anemia in a Scottish population : a retrospective cohort study. In: Acta Obstetricia et Gynecologica Scandinavica. 2016 ; Vol. 95, No. 5. pp. 555-564.
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abstract = "Introduction Antenatal anemia is a major public health problem in the UK, yet there is limited high quality evidence for associated poor clinical outcomes. The objectives of this study were to estimate the incidence and clinical outcomes of antenatal anemia in a Scottish population. Material and methods A retrospective cohort study of 80 422 singleton pregnancies was conducted using data from the Aberdeen Maternal and Neonatal Databank between 1995 and 2012. Antenatal anemia was defined as haemoglobin ≤10 g/dl during pregnancy. Incidence was calculated with 95{\%} confidence intervals and compared over time using a chi‐squared test for trend. Multivariable logistic regression was used to adjust for confounding variables. Results are presented as adjusted odds ratios with 95{\%} confidence interval. Results The overall incidence of antenatal anemia was 9.3 cases/100 singleton pregnancies (95{\%} confidence interval 9.1–9.5), decreasing from 16.9/100 to 4.1/100 singleton pregnancies between 1995 and 2012 (p < 0.001). Maternal anemia was associated with antepartum hemorrhage (adjusted odds ratio 1.26, 95{\%} confidence interval 1.17–1.36), postpartum infection (adjusted odds ratio 1.89, 95{\%} confidence interval 1.39–2.57), transfusion (adjusted odds ratio 1.87, 95{\%} confidence interval 1.65–2.13) and stillbirth (adjusted odds ratio 1.42, 95{\%} confidence interval 1.04–1.94), reduced odds of postpartum hemorrhage (adjusted odds ratio 0.92, 95{\%} confidence interval 0.86–0.98) and low birthweight (adjusted odds ratio 0.77, 95{\%} confidence interval 0.69–0.86). No other outcomes were statistically significant. Conclusions This study shows the incidence of antenatal anemia is decreasing steadily within this Scottish population. However, given that anemia is a readily correctable risk factor for major causes of morbidity and mortality in the UK, further work is required to investigate appropriate preventive measures.",
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author = "Ruramayi Rukuni and Sohinee Bhattacharya and Murphy, {Michael F.} and David Roberts and Stanworth, {Simon J.} and Marian Knight",
note = "Acknowledgrments The authors thank Alastair Coutts for extracting the data from the AMND. Funding RR has an academic clinical fellowship supported by the National Institute of Health Research (NIHR). MK is funded by an NIHR Research Professorship. The views expressed in this publication are those of the author(s),and not necessarily those of the NHS, the NIHR, or the Department of Health. The funder had no role in the study design, data collection and analysis, decision to publish, or preparation of the article.",
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T1 - Maternal and neonatal outcomes of antenatal anemia in a Scottish population

T2 - a retrospective cohort study

AU - Rukuni, Ruramayi

AU - Bhattacharya, Sohinee

AU - Murphy, Michael F.

AU - Roberts, David

AU - Stanworth, Simon J.

AU - Knight, Marian

N1 - Acknowledgrments The authors thank Alastair Coutts for extracting the data from the AMND. Funding RR has an academic clinical fellowship supported by the National Institute of Health Research (NIHR). MK is funded by an NIHR Research Professorship. The views expressed in this publication are those of the author(s),and not necessarily those of the NHS, the NIHR, or the Department of Health. The funder had no role in the study design, data collection and analysis, decision to publish, or preparation of the article.

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N2 - Introduction Antenatal anemia is a major public health problem in the UK, yet there is limited high quality evidence for associated poor clinical outcomes. The objectives of this study were to estimate the incidence and clinical outcomes of antenatal anemia in a Scottish population. Material and methods A retrospective cohort study of 80 422 singleton pregnancies was conducted using data from the Aberdeen Maternal and Neonatal Databank between 1995 and 2012. Antenatal anemia was defined as haemoglobin ≤10 g/dl during pregnancy. Incidence was calculated with 95% confidence intervals and compared over time using a chi‐squared test for trend. Multivariable logistic regression was used to adjust for confounding variables. Results are presented as adjusted odds ratios with 95% confidence interval. Results The overall incidence of antenatal anemia was 9.3 cases/100 singleton pregnancies (95% confidence interval 9.1–9.5), decreasing from 16.9/100 to 4.1/100 singleton pregnancies between 1995 and 2012 (p < 0.001). Maternal anemia was associated with antepartum hemorrhage (adjusted odds ratio 1.26, 95% confidence interval 1.17–1.36), postpartum infection (adjusted odds ratio 1.89, 95% confidence interval 1.39–2.57), transfusion (adjusted odds ratio 1.87, 95% confidence interval 1.65–2.13) and stillbirth (adjusted odds ratio 1.42, 95% confidence interval 1.04–1.94), reduced odds of postpartum hemorrhage (adjusted odds ratio 0.92, 95% confidence interval 0.86–0.98) and low birthweight (adjusted odds ratio 0.77, 95% confidence interval 0.69–0.86). No other outcomes were statistically significant. Conclusions This study shows the incidence of antenatal anemia is decreasing steadily within this Scottish population. However, given that anemia is a readily correctable risk factor for major causes of morbidity and mortality in the UK, further work is required to investigate appropriate preventive measures.

AB - Introduction Antenatal anemia is a major public health problem in the UK, yet there is limited high quality evidence for associated poor clinical outcomes. The objectives of this study were to estimate the incidence and clinical outcomes of antenatal anemia in a Scottish population. Material and methods A retrospective cohort study of 80 422 singleton pregnancies was conducted using data from the Aberdeen Maternal and Neonatal Databank between 1995 and 2012. Antenatal anemia was defined as haemoglobin ≤10 g/dl during pregnancy. Incidence was calculated with 95% confidence intervals and compared over time using a chi‐squared test for trend. Multivariable logistic regression was used to adjust for confounding variables. Results are presented as adjusted odds ratios with 95% confidence interval. Results The overall incidence of antenatal anemia was 9.3 cases/100 singleton pregnancies (95% confidence interval 9.1–9.5), decreasing from 16.9/100 to 4.1/100 singleton pregnancies between 1995 and 2012 (p < 0.001). Maternal anemia was associated with antepartum hemorrhage (adjusted odds ratio 1.26, 95% confidence interval 1.17–1.36), postpartum infection (adjusted odds ratio 1.89, 95% confidence interval 1.39–2.57), transfusion (adjusted odds ratio 1.87, 95% confidence interval 1.65–2.13) and stillbirth (adjusted odds ratio 1.42, 95% confidence interval 1.04–1.94), reduced odds of postpartum hemorrhage (adjusted odds ratio 0.92, 95% confidence interval 0.86–0.98) and low birthweight (adjusted odds ratio 0.77, 95% confidence interval 0.69–0.86). No other outcomes were statistically significant. Conclusions This study shows the incidence of antenatal anemia is decreasing steadily within this Scottish population. However, given that anemia is a readily correctable risk factor for major causes of morbidity and mortality in the UK, further work is required to investigate appropriate preventive measures.

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KW - pregnancy outcome

KW - neonatal outcome

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KW - postpartum infection

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