Steer P, Alam MA, Wadsworth J, Welch A. Relation between maternal haemoglobin concentration and birth weight in different ethnic groups. BMJ 310, 489-491

Academic Department of Obstetrics and Gynaecology, Charing Cross and Westminster Medical School, Chelsea and Westminster Hospital, London.
BMJ Clinical Research (Impact Factor: 14.09). 02/1995; 310(6978):489-91. DOI: 10.1016/0020-7292(95)96757-L
Source: PubMed


To assess the relation of the lowest haemoglobin concentration in pregnancy with birth weight and the rates of low birth weight and preterm delivery in different ethnic groups.
Retrospective analysis of 153,602 pregnancies with ethnic group and birth weight recorded on a regional pregnancy database during 1988-91. The haemoglobin measurement used was the lowest recorded during pregnancy.
North West Thames region.
115,262 white women, 22,206 Indo-Pakistanis, 4570 Afro-Caribbeans, 2642 mediterraneans, 3905 black Africans, 2351 orientals, and 2666 others.
Birth weight and rates of low birth weight (< 2500 g) and preterm delivery (< 37 completed weeks).
Maximum mean birth weight in white women was achieved with a lowest haemoglobin concentration in pregnancy of 85-95 g/l; the lowest incidence of low birth weight and preterm labour occurred with a lowest haemoglobin of 95-105 g/l. A similar pattern occurred in all ethnic groups.
The magnitude of the fall in haemoglobin concentration in pregnancy is related to birth weight; failure of the haemoglobin concentration to fall below 105 g/l indicates an increased risk of low birth weight and preterm delivery. This phenomenon is seen in all ethnic groups. Some ethnic groups have higher rates of low birth weight and preterm delivery than white women, and they also have higher rates of low haemoglobin concentrations. This increased rate of "anaemia," however, does not account for their higher rates of low birth weight, which occurs at all haemoglobin concentrations.

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    • "Thus, the difference between the LNS and IFA groups in mean maternal Hb, ZPP and TfR concentrations needs to be weighed against the difference (in the opposite direction) in birth outcomes. In two sets of analyses (Garn et al. 1981; Steer et al. 1995) each involving a large number of pregnant women, the lowest risk of adverse birth outcomes including low birth weight was seen in women with Hb ~95–105 g/L (Steer et al. 1995) or Hb ~100–110 g/L (Garn et al. 1981). Appropriate cut-offs for ZPP and TfR in pregnancy are not well documented, particularly with respect to functional outcomes. "
    [Show abstract] [Hide abstract] ABSTRACT: We examined hemoglobin (Hb, g/L), iron status (zinc protoporphyrin, ZPP, µmol/mol heme, and transferrin receptor, TfR, mg/L) and inflammation (C-reactive protein, CRP and alpha-1 glycoprotein, AGP) in pregnant Ghanaian women who participated in a randomized controlled trial. Women (n = 1320) received either 60 mg Fe + 400-µg folic acid (IFA); 18 micronutrients including 20-mg Fe (MMN) or small-quantity lipid-based nutrient supplements (SQ-LNS, 118 kcal/d) with the same micronutrient levels as in MMN, plus four additional minerals (LNS) daily during pregnancy. Intention-to-treat analysis included 349, 354 and 354 women in the IFA, MMN and LNS groups, respectively, with overall baseline mean Hb and anemia (Hb <100) prevalence of 112 and 13.3%, respectively. At 36 gestational weeks, overall Hb was 117, and anemia prevalence was 5.3%. Compared with the IFA group, the LNS and MMN groups had lower mean Hb (120 ± 11 vs. 115 ± 12 and 117 ± 12, respectively; P < 0.001), higher mean ZPP (42 ± 30 vs. 50 ± 29 and 49 ± 30; P = 0.010) and TfR (4.0 ± 1.3 vs. 4.9 ± 1.8 and 4.6 ± 1.7; P < 0.001), and greater prevalence of anemia (2.2% vs. 7.9% and 5.8%; P = 0.019), elevated ZPP (>60) [9.4% vs. 18.6% and 19.2%; P = 0.003] and elevated TfR (>6.0) [9.0% vs. 19.2% and 15.1%; P = 0.004]. CRP and AGP concentrations did not differ among groups. We conclude that among pregnant women in a semi-urban setting in Ghana, supplementation with SQ-LNS or MMN containing 20 mg iron resulted in lower Hb and iron status but had no impact on inflammation, when compared with iron (60 mg) plus folic acid (400 µg). The amount of iron in such supplements that is most effective for improving both maternal Hb/iron status and birth outcomes requires further evaluation. This trial was registered at as: NCT00970866.
    Full-text · Article · Feb 2016 · Maternal and Child Nutrition
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    • "Pour Allen [22], l'anémie augmenterait d'un facteur 3,1 le risque de bas poids de naissance. Ce risque est également retrouvé par Steer et al [23] dans différents groupes ethniques, par Bondevik [24] au Népal, par Hamalainen et al en Finlande [25], par Kalenga et al au Zaïre [26] et par Singla et al en Inde [27]. À l'inverse, Gaspar et al [28 ] ne retrouve pas cette association dans une population hispanique. "
    [Show abstract] [Hide abstract] ABSTRACT: The objective of this study is to identify the constitutional, obstetrical, nutritional, pathological and socioeconomic factors associated with the birth of newborns small weight at the maternity hospital Sharif Idrissi in the region of Gharb chrarda Bni Hssen. retrospective study was based on the recording of the data collected from the records established systematically after each delivery over a period of 01/04/2011 to 30/09/2011. risk factors that were found significantly associated with hypotrophy: the age below 21 years (43% vs 12%), less than the 155 cm size (21% vs 10.5%), antenatal care (18% vs 8%), hypertension (30% vs 10%), malnutrition (30% vs 11%), anemia (27% vs 11%), from the rural (33% vs 11.5 %), birth interval less than 18 months and the birth interval greater than 60 months (13%, 38% vs 5%), the term imprecise (42% vs 9% is attained). Finally the below 21 years age were mostly primiparous women. Against by the higher age than or equal to 35 were multiparous, compared to the reference class (age between 21 and 34 years). The risk factors identified in this study should be sustained in the prevention of delayed intrauterine growth control. Overall, the improvement of living conditions and proper monitoring of pregnancy coupled with better health and nutrition education is the guarantee of a regression of this situation to the Gharb region. KEYWORDS: Intrauterine growth restriction, risk factor, region of Gharb chrarda Bni Hssen.
    Full-text · Article · Aug 2014
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    • "The association between maternal haemoglobin and neonatal outcomes has already been studied in the general population of neonates and seems to follow a U-shaped distribution with adverse outcomes at both ends of the haemoglobin range largely mediated through preterm birth and low birth weight.[7], [8], [17] However, as our study was dealing only with preterm neonates, the effect of preterm birth could not be taken into account. In our very preterm population, we did not find a U-shaped distribution: preterm neonates whose mothers had low haemoglobin concentration value (Q1) had a poorer short-term outcome but no difference was found in terms of outcome in infants whose mothers had the highest haemoglobin concentration value (Q4). "
    [Show abstract] [Hide abstract] ABSTRACT: To determine whether there is a significant association between maternal haemoglobin measured before delivery and short-term neonatal outcome in very preterm neonates. We included prospectively all live births occurring from 25 to 32+6 weeks of gestation in a tertiary care centre between January 1(st) 2009 and December 31(st) 2011. Outborn infants and infants presenting with lethal malformations were excluded. Three hundred and thirty-nine mothers and 409 infants met the inclusion criteria. For each mother-infant pair a prospective record of epidemiologic data was performed and maternal haemoglobin concentration recorded within 24 hours before delivery was retrospectively researched. Maternal haemoglobin was divided into quartiles with the second and the third one regarded as reference as they were composed of normal haemoglobin values. Short-term outcome was defined as poor in case of death during hospital stay and/or grades III/IV intraventricular haemorrhage and/or periventricular leukomalacia and/or necessity of ventriculoperitoneal shunt. The global rate of poor short-term neonatal outcome was 11.4% and was significantly associated with low maternal haemoglobin values. This association remained significant after adjustment for antenatal corticosteroids therapy, gestational age, parity, mechanism of preterm birth, mode of delivery and birth weight (aOR = 2.97 CI 95% [1.36-6.47]). There was no relation between short-term neonatal outcome and high maternal haemoglobin concentration values. We show that low maternal haemoglobin concentration at delivery is an independent risk factor for poor short-term neonatal outcome in very preterm neonates. This study is one of the first to show such an association within the preterm population.
    Full-text · Article · Feb 2014 · PLoS ONE
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