Maternal anemia and severe maternal morbidity in a united states cohort


Maternal Fetal Medicine, Advocate Medical Group


BACKGROUND: Maternal anemia is a common pregnancy complication and often leads to additional treatments and interventions. Identifying the frequency with which women with antenatally diagnosed anemia experience severe morbidity at the time of labor and delivery admission will guide future recommendations regarding screening and interventions for anemia in pregnancy.

OBJECTIVE: The objective of this study was to evaluate the association of antenatally diagnosed anemia with severe maternal morbidity (SMM) as defined by the Center for Disease Control in a large, contemporary United States cohort. Neonatal outcomes were also examined.

STUDY DESIGN: This was a secondary analysis of the Consortium on Safe Labor database from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, which collected data on 228,438 deliveries in 19 U.S. hospitals from 2002 to 2008. This analysis included women with viable, singleton gestations with exclusion of stillbirth and severe congenital anomalies. Women with a diagnosis of antenatal anemia were compared to those without. Diagnosis of antenatal anemia was obtained via electronic medical record abstraction and international classification of disease coding per each hospital protocol within the CSL. The primary maternal outcome consisted of a composite of SMM as defined by the CDC including: maternal death, eclampsia, thrombosis, transfusion, hysterectomy, and maternal intensive care unit (ICU) admission. The primary neonatal outcome was a composite that included 5 minute Apgar

RESULTS: A total of 166,566 women met inclusion criteria. 56,734 women could not be analyzed due to an unknown diagnosis of anemia. Of those included, 10,217 (6.1%) were diagnosed with anemia during the pregnancy. Women with anemia were more likely to be younger, non-Hispanic Black, single, multiparous, and have higher pre-pregnancy body mass index compared to those without anemia. The frequency of the primary maternal composite outcome, the neonatal composite outcome, and other secondary outcomes including the SMM composite not including transfusion, maternal death, transfusion in labor and postpartum, hysterectomy, postpartum hemorrhage, infectious morbidity, cesarean delivery, and preterm delivery were more common in women with anemia (p

CONCLUSION: Women with antepartum anemia experience increased rates of SMM and other serious adverse outcomes. Diagnosis and treatment of anemia during the antepartum period may lead to identification and treatment of women at higher risk of maternal morbidity and mortality.

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