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. 2016 Jun 3;16(1):135.
doi: 10.1186/s12884-016-0924-x.

Maternal haemoglobin concentrations before and during pregnancy and stillbirth risk: a population-based case-control study

Siavash Maghsoudlou  1   2 , Sven Cnattingius  3 , Olof Stephansson  3   4 , Mohsen Aarabi  5 , Shahriar Semnani  6 , Scott M Montgomery  3   7   8 , Shahram Bahmanyar  6   9
Affiliations

Maternal haemoglobin concentrations before and during pregnancy and stillbirth risk: a population-based case-control study

Siavash Maghsoudlou et al. BMC Pregnancy Childbirth. .

Abstract

Background: Results of previous studies on the association between maternal haemoglobin concentration during pregnancy and stillbirth risk are inconclusive. It is not clear if haemoglobin concentration before pregnancy has a role. Using prospectively collected information from pre-pregnancy and antenatal visits, we investigated associations of maternal haemoglobin concentrations before and during pregnancy and haemoglobin dilution with stillbirth risk.

Methods: In a population-based case-control study from rural Golestan, a province in northern Iran, we identified 495 stillbirths (cases) and randomly selected 2,888 control live births among antenatal health-care visits between 2007 and 2009. Using logistic regression, we estimated associations of maternal haemoglobin concentrations, haemoglobin dilution at different stages of pregnancy, with stillbirth risk.

Results: Compared with normal maternal haemoglobin concentration (110-120 g/l) at the end of the second trimester, high maternal haemoglobin concentration (≥140 g/l) was associated with a more than two-fold increased stillbirth risk (OR = 2.31, 95 % CI [1.30-4.10]), while low maternal haemoglobin concentration (<110 g/l) was associated with a 37 % reduction in stillbirth risk. Haemoglobin concentration before pregnancy was not associated with stillbirth risk. Decreased haemoglobin concentration, as measured during pregnancy (OR = 0.61, 95 % CI [0.46, 0.80]), or only during the second trimester (OR = 0.75, 95 % CI [0.62, 0.90]), were associated with reduced stillbirth risk. The associations were essentially similar for preterm and term stillbirths.

Conclusions: Haemoglobin concentration before pregnancy is not associated with stillbirth risk. High haemoglobin level and absence of haemoglobin dilution during pregnancy could be considered as indicators of a high-risk pregnancy.

Keywords: Adverse pregnancy outcome; Haemoglobin concentration; Haemoglobin dilution; Maternal anaemia; Stillbirth.

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