Anemia before pregnancy and risk of preterm birth, low birth weight and small-for-gestational-age birth in Korean women

Abstract

Background/objectives: Maternal prepregnancy hemoglobin concentration has rarely been explored as a risk of poor birth outcomes. This study examined whether women with anemia before pregnancy would be at higher risk of preterm birth, low birth weight (LBW) and small-for-gestational-age (SGA) birth.

Subjects/methods: This retrospective cohort study was conducted on 70,895 Korean women who delivered a singleton in 1999, with their prepregnancy hemoglobin concentration measured at health examinations in 1997-1999. A logistic model was used to adjust for confounding variables and calculate odds ratios (ORs) and 95% confidence intervals (CIs).

Results: In adjusted analysis, moderate-to-severe anemia (hemoglobin <100 g/l) before pregnancy was associated with preterm birth (OR, 1.53; 95% CI, 1.05-2.23; P=0.027), LBW (OR, 1.81; 95% CI, 1.24-2.64; P=0.002) and SGA (OR, 1.71; 95% CI, 1.35-2.17; P<0.001) when compared with prepregnancy hemoglobin of 120-149 g/l. Mild anemia (hemoglobin of 100-119 g/l) was also associated with LBW (OR, 1.21; 95% CI, 1.06-1.39; P=0.005) and SGA (OR, 1.15; 95% CI, 1.06-1.25; P=0.001). The risk of preterm birth, LBW and SGA across 11 prepregnancy hemoglobin groups depended on the severity of anemia (P for trend=0.042, 0.019, and 0.001, respectively). A high hemoglobin concentration (≥150 g/l), however, was not associated with adverse birth outcomes.

Conclusions: Anemia, not high hemoglobin concentration, before pregnancy was associated with an elevated risk of preterm birth, LBW and SGA, and the risk increased with the severity of anemia in Korean women.