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Randomized Controlled Trial
. 2022 Feb 18;14(4):858.
doi: 10.3390/nu14040858.

Maternal Hemoglobin Concentrations and Birth Weight, Low Birth Weight (LBW), and Small for Gestational Age (SGA): Findings from a Prospective Study in Northwest China

Danmeng Liu  1 , Shanshan Li  2 , Binyan Zhang  1 , Yijun Kang  1 , Yue Cheng  3 , Lingxia Zeng  1 , Fangyao Chen  1 , Baibing Mi  1 , Pengfei Qu  4 , Doudou Zhao  4 , Zhonghai Zhu  1 , Hong Yan  1   5   6 , Duolao Wang  7 , Shaonong Dang  1
Affiliations
Randomized Controlled Trial

Maternal Hemoglobin Concentrations and Birth Weight, Low Birth Weight (LBW), and Small for Gestational Age (SGA): Findings from a Prospective Study in Northwest China

Danmeng Liu et al. Nutrients. .

Abstract

Birth weight and related outcomes have profound influences on life cycle health, but the effect of maternal hemoglobin concentration during pregnancy on birth weight is still unclear. This study aims to reveal the associations between maternal hemoglobin concentrations in different trimesters of pregnancy and neonatal birth weight, LBW, and SGA. This was a prospective study based on a cluster-randomized controlled trial conducted from July 2015 to December 2019 in rural areas of Northwest China. Information on maternal socio-demographic status, health-related factors, antenatal visits, and neonatal birth outcomes were collected. A total of 3748 women and their babies were included in the final analysis. A total of 65.1% and 46.3% of the participants had anemia or hemoglobin ≥ 130 g/L during pregnancy. In the third trimester, maternal hemoglobin concentration was associated with birth weight in an inverted U-shaped curve and with the risks of LBW and SGA in extended U-shaped curves. The relatively higher birth weight and lower risks for LBW and SGA were observed when hemoglobin concentration was 100-110 g/L. When maternal hemoglobin was <70 g/L or >130 g/L, the neonatal birth weight was more than 100 g lower than that when the maternal hemoglobin was 100 g/L. In conclusion, both low and high hemoglobin concentrations in the third trimester could be adverse to fetal weight growth and increase the risks of LBW and SGA, respectively. In addition to severe anemia, maternal hemoglobin >130 g/L in the third trimester should be paid great attention to in the practice of maternal and child health care.

Keywords: LBW; SGA; maternal hemoglobin concentration; neonatal birth weight; nonlinear association; prospective study.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Study flowchart.
Figure 2
Figure 2
Dose-response relationships between maternal hemoglobin concentrations in the third trimester and (a) birth weight, (b) LBW, and (c) SGA. The associations were estimated using restricted cubic spline functions with four knots (including hemoglobin at 70, 100, 110, 130 g/L). Models were adjusted for socio-demographic characteristics (including maternal age, education, occupation, and per capita annual household income) and health-related characteristics (including parity, BMI at enrolment, gestational age at enrolment, number of antenatal visits, and micronutrient supplementation). When estimating the associations between maternal hemoglobin concentrations and birth weight/LBW, models were additionally adjusted for neonatal gender and gestational age at delivery. For birth weight, hemoglobin at 110 g/L was set as the reference value, and for LBW and SGA, the minimum value of hemoglobin was set as the reference value. Dashed lines represent the 95% CIs, and knots were displayed by dots. The horizontal dashed green line represents whether the difference in birth weight was 0 g or the RR for LBW/SGA was 1.00.
Figure 2
Figure 2
Dose-response relationships between maternal hemoglobin concentrations in the third trimester and (a) birth weight, (b) LBW, and (c) SGA. The associations were estimated using restricted cubic spline functions with four knots (including hemoglobin at 70, 100, 110, 130 g/L). Models were adjusted for socio-demographic characteristics (including maternal age, education, occupation, and per capita annual household income) and health-related characteristics (including parity, BMI at enrolment, gestational age at enrolment, number of antenatal visits, and micronutrient supplementation). When estimating the associations between maternal hemoglobin concentrations and birth weight/LBW, models were additionally adjusted for neonatal gender and gestational age at delivery. For birth weight, hemoglobin at 110 g/L was set as the reference value, and for LBW and SGA, the minimum value of hemoglobin was set as the reference value. Dashed lines represent the 95% CIs, and knots were displayed by dots. The horizontal dashed green line represents whether the difference in birth weight was 0 g or the RR for LBW/SGA was 1.00.
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