背景:胎龄小(SGA)和胎龄大(LGA)出生是热门话题,因为它们对生命过程具有破坏性影响,并且也对新生儿死亡率和长期发病率负责。
目的:我们检验了以下假设:在加纳北部,妊娠每三个月的血红蛋白水平异常会增加SGA和LGA分娩的风险。
方法:2020年4月至7月进行了一项回顾性队列研究。
方法:通过系统随机抽样技术,从加纳北部的五个初级和公共卫生机构招募了422名产后母亲,这些母亲在面试日期前的最后6-8周分娩。
方法:使用INTERGROWTH-21st标准,获得SGA和LGA出生。分析了产前记录中的血红蛋白水平,以确定其对SGA和LGA出生的影响,方法是在α=0.05的显著性水平下调整社会人口统计学和产科因素后,采用多项逻辑回归。
结果:首先贫血的患病率,妊娠中期和中期为63.5%,71.3%和45.3%,分别,在相应的妊娠三个月中,红细胞增多症为5.9%,3.6%和1.7%。大约8.8%和9.2%的妇女分娩了SGA和LGA婴儿,分别。在调整了混杂因素后,妊娠晚期贫血的母亲有SGA分娩的风险增加(调整后的OR,OR5.56;95%CI1.65至48.1;p<0.001)。第一次患有红细胞增多症的母亲,妊娠中期和妊娠晚期为93%(aOR0.07;95%CI0.01-0.46;p=0.040),85%(aOR0.15;95%CI0.08至0.64;p<0.001)和88%(aOR0.12;95%CI0.07至0.15;p=0.001)免于SGA出生,分别。有趣的是,妊娠所有三个月的贫血和红细胞增多症与LGA分娩无统计学意义.
结论:妊娠早期至妊娠中期贫血增加,随后在妊娠晚期降低,而从妊娠早期至妊娠晚期红细胞增多症持续降低。与SGA婴儿相比,LGA婴儿更占优势。虽然妊娠晚期贫血增加了SGA分娩的风险,整个三个月的红细胞增多症提供了重要的保护。医疗保健提供者和利益相关者应针对在整个怀孕期间减少贫血的紧迫干预措施,特别是在妊娠晚期,以实现健康的分娩结果。
BACKGROUND: Small for gestational age (SGA) and large for gestational age (LGA) births are topical issues due to their devastating effects on the life course and are also accountable for neonatal mortalities and long-term morbidities.
OBJECTIVE: We tested the hypothesis that abnormal haemoglobin levels in each trimester of pregnancy will increase the risk of SGA and LGA deliveries in Northern Ghana.
METHODS: A retrospective cohort study was conducted from April to July 2020.
METHODS: 422 postpartum mothers who had delivered in the last 6-8 weeks before their interview dates were recruited through a systematic random sampling technique from five primary and public health facilities in Northern Ghana.
METHODS: Using the INTERGROWTH-21st standard, SGA and LGA births were obtained. Haemoglobin levels from antenatal records were analysed to determine their effect on SGA and LGA births by employing multinomial logistic regression after adjusting for sociodemographic and obstetric factors at a significance level of α=0.05.
RESULTS: Prevalence of anaemia in the first, second and third trimesters of pregnancy was 63.5%, 71.3% and 45.3%, respectively, and that of polycythaemia in the corresponding trimesters of pregnancy was 5.9%, 3.6% and 1.7%. About 8.8% and 9.2% of the women delivered SGA and LGA babies, respectively. After adjusting for confounders, anaemic mothers in the third trimester of pregnancy had an increased risk of having SGA births (adjusted OR, aOR 5.56; 95% CI 1.65 to 48.1; p<0.001). Mothers with polycythaemia in the first, second and third trimesters of pregnancy were 93% (aOR 0.07; 95% CI 0.01 to 0.46; p=0.040), 85% (aOR 0.15; 95% CI 0.08 to 0.64; p<0.001) and 88% (aOR 0.12; 95% CI 0.07 to 0.15; p=0.001) protected from having SGA births, respectively. Interestingly, anaemia and polycythaemia across all trimesters of pregnancy were not statistically significant with LGA births.
CONCLUSIONS: Anaemia during pregnancy increased from the first to the second trimester and subsequently decreased in the third trimester while polycythaemia consistently decreased from the first to the third trimester. LGA babies were more predominant compared with SGA babies. While anaemia in the third trimester of pregnancy increased the risk of SGA births, polycythaemia across the trimesters offered significant protection. Healthcare providers and stakeholders should target pressing interventions for anaemia reduction throughout pregnancy, especially during the third trimester to achieve healthy birth outcomes.