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      Maternal and severe anaemia in delivering women is associated with risk of preterm and low birth weight: A cross sectional study from Jharkhand, India

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          Abstract

          Background and objectives

          Haemoglobin content is the well accepted indicator for anaemia assessment. The high prevalence of anaemia, maternal health care issues and adverse delivery outcome in Jharkhand, we investigated whether delivering women with anaemia would present a modifiable risk of preterm (PTB) and low birth weight (LBW).

          Methods

          A facility-based cross-sectional study involving pregnant women, with screening for pregnancy endpoints and haemoglobin assay, were conducted. Anaemia was classified according to World Health Organization's definition of anaemia in pregnancy. Confounding variables were adjusted in a logistic model. The adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were used for analyzing the association among maternal anaemia, PTB and LBW.

          Results

          We observed a high prevalence of anaemia (78.45%) in delivering women, whereas high prevalence of preterm birth (34.75%) and LBW (32.81%) in delivering women overall. In the adjusted analysis, overall anaemia in pregnancy was strongly associated with preterm birth (OR, 3.42; 95% CI, 1.98–5.88; P  ≤  .0001) as compared to LBW (OR, 1.12; 95% CI, 0.65–1.61; P  =  .0003). The risk of PTB and LBW were dependent on the stratification of the anaemia group, as the strongest association was observed in severe (OR, 4.86) followed by mild (OR, 3.66) and moderate (OR, 3.18) anaemia in PTB; whereas risk of LBW was found in severe (OR, 2.5) followed by moderate (OR, 1.11) and mild (OR, 0.57) anaemia. The risk of PTB and LBW across six pregnancy haemoglobin groups were compared, haemoglobin of 10–10.9 g/dl (OR, 1.25) and ≤ 8 g/dl (OR, 1.03) have shown association with PTB and LBW, respectively. However, high haemoglobin concentration was not associated with either PTB or LBW.

          Conclusions

          Anaemia in delivering women was associated with an elevated risk of PTB and LBW and the risk increased with the severity of anaemia in pregnant women.

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          Most cited references71

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          Pregnancy and pregnancy-associated hormones alter immune responses and disease pathogenesis.

          Dionne Robinson, Sabra L. Klein (2012)
          During pregnancy, it is evolutionarily advantageous for inflammatory immune responses that might lead to fetal rejection to be reduced and anti-inflammatory responses that promote transfer of maternal antibodies to the fetus to be increased. Hormones modulate the immunological shift that occurs during pregnancy. Estrogens, including estradiol and estriol, progesterone, and glucocorticoids increase over the course of pregnancy and affect transcriptional signaling of inflammatory immune responses at the maternal-fetal interface and systemically. During pregnancy, the reduced activity of natural killer cells, inflammatory macrophages, and helper T cell type 1 (Th1) cells and production of inflammatory cytokines, combined with the higher activity of regulatory T cells and production of anti-inflammatory cytokines, affects disease pathogenesis. The severity of diseases caused by inflammatory responses (e.g., multiple sclerosis) is reduced and the severity of diseases that are mitigated by inflammatory responses (e.g., influenza and malaria) is increased during pregnancy. For some infectious diseases, elevated inflammatory responses that are necessary to control and clear a pathogen have a negative consequence on the outcome of pregnancy. The bidirectional interactions between hormones and the immune system contribute to both the outcome of pregnancy and female susceptibility to disease. Copyright © 2012 Elsevier Inc. All rights reserved.
          Article 0 comments Cited 229 times – based on 0 reviews     Review now
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            Maternal anemia and risk of adverse birth and health outcomes in low- and middle-income countries: systematic review and meta-analysis.

            Md Mizanur Rahman, Sarah Krull Abe, Md. Rahman … (2016)
            Anemia is a leading cause of maternal deaths and adverse pregnancy outcomes in developing countries.
            Article 0 comments Cited 205 times – based on 0 reviews     Review now
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              Preterm delivery.

              Katie Slattery, Liam J. Morrison (2002)
              Preterm delivery and its short-term and long-term sequelae constitute a serious problem in terms of mortality, disability, and cost to society. The incidence of preterm delivery, which has increased in recent years, is associated with various epidemiological and clinical risk factors. Results of randomised controlled trials suggest that attempts to reduce these risk factors by use of drugs are limited by side-effects and poor efficacy. An improved understanding of the physiological pathways that regulate uterine contraction and relaxation in animals and people has, however, helped to define the complex processes that underlie parturition (term and preterm), and has led to new scientific approaches for myometrial modulation. The continuing elucidation of the mechanisms that regulate preterm labour, combined with rigorous clinical assessment, offer hope for future solutions.
              Article 0 comments Cited 153 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Mohammad Raziuddin
                Mohammad Sohail
                Journal
                Journal ID (nlm-ta): One Health
                Journal ID (iso-abbrev): One Health
                Title: One Health
                Publisher: Elsevier
                ISSN (Electronic): 2352-7714
                Publication date PMC-release: 19 August 2019
                Publication date Collection: December 2019
                Publication date (Electronic): 19 August 2019
                Volume: 8
                Electronic Location Identifier: 100098
                Affiliations
                [a ]Research Laboratory, University Department of Zoology, Vinoba Bhave University, Hazaribag, Jharkhand, India
                [b ]SLS, Jawaharlal Nehru University, New-Delhi, India
                [c ]University Department of Biotechnology, Vinoba Bhave University, Hazaribag, Jharkhand, India
                [d ]Department of Zoology, Ranchi University, Ranchi, Jharkhand, India
                [e ]Centre for Tribal Health and Biotechnology Foundation, New Delhi, India
                Author notes
                [* ]Correspondence to: M. Raziuddin, University Department of Zoology, Faculty of Sciences, Vinoba Bhave University, Hazaribag 825301, Jharkhand, India. mrazi.vbu@ 123456gmail.com
                [** ]Correspondence to: M. Sohail, Research Laboratory, University Department of Zoology, Faculty of Sciences, Vinoba Bhave University, Hazaribag 825301, Jharkhand, India. soh.khan@ 123456hotmail.com soh.khan@ 123456vbu.ac.in
                [1]

                Equal contributor.

                Article
                Publisher ID: S2352-7714(19)30016-3 Publisher ID: 100098
                DOI: 10.1016/j.onehlt.2019.100098
                PMC ID: 6715890
                PubMed ID: 31485474
                SO-VID: b92a2825-f91e-4bc5-8018-7a805d77e01c
                Copyright © © 2019 Published by Elsevier B.V.
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 21 February 2019
                Date revision received : 23 July 2019
                Date accepted : 23 July 2019
                Categories
                Subject: Research Paper

                Keywords: maternal anaemia,preterm birth,low birth weight,pregnancy,jharkhand
                Data availability:
                Keywords: maternal anaemia, preterm birth, low birth weight, pregnancy, jharkhand

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