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Anemia and adverse outcomes in pregnancy: subgroup analysis of the CLIP cluster-randomized trial in India

2022; BioMed Central; Volume: 22; Issue: 1 Linguagem: Inglês

10.1186/s12884-022-04714-y

1471-2393

Jeffrey N. Bone, Mrutyunjaya Bellad, Shivaprasad S. Goudar, Ashalata Mallapur, Umesh Charantimath, Umesh Y Ramadurg, Geetanjali Katageri, Maria Lesperance, Mai‐Lei Woo Kinshella, Raiya Suleman, Marianne Vidler, Sumedha Sharma, Richard J. Derman, Laura A. Magee, Peter von Dadelszen, Shashidhar G Bannale, Keval S Chougala, Vaibhav B Dhamanekar, Anjali Joshi, Namdev A Kamble, Gudadayya S Kengapur, Uday S Kudachi, Sphoorthi S Mastiholi, Geetanjali I Mungarwadi, Esperança Sevene, Khátia Munguambe, Charfudin Sacoor, Eusébio Macete, Helena Boene, Felizarda Amose, Orvalho Augusto, Cassimo Bique, Ana Ilda Biz, Rogério Chiaú, Silvestre Cutana, Paulo Filimone, Emília Gonçálves, Marta Macamo, Salésio Macuácua, Sónia Maculuve, Ernesto Mandlate, Analisa Matavele, Sibone Mocumbi, Dulce Mulungo, Zefanias Nhamirre, Ariel Nhancolo, Cláudio Nkumbula, Vivalde Nobela, Rosa Pires, Corsino Tchavana, Anifa Valá, Faustino Vilanculo, Rahat Qureshi, Sana Sheikh, Zahra Hoodbhoy, Imran Ahmed, Amjad Hussain, Javed Memon, Farrukh Raza, Olalekan O. Adetoro, John Sotunsa, Sharla Drebit, Chirag Kariya, Mansun Lui, Diane Sawchuck, Ugochi V Ukah, Mai‐Lei Woo Kinshella, Shafik Dharamsi, Guy A. Dumont, Tabassum Firoz, Ana Pilar Betrán, Susheela Engelbrecht, Véronique Filippi, William A. Grobman, Marian Knight, Ana Langer, Simon Lewin, Gwyneth Lewis, Craig Mitton, Nadine Schuurman, Jim Thornton, France Donnay, Romano Byaruhanga, Brian A. Darlow, Eileen K. Hutton, Mario Merialdi, Lehana Thabane, Kelly Pickerill, Avinash Kavi, Chandrashekhar Karadiguddi, Sangamesh Rakaraddi, Amit Revankar,

Child Nutrition and Water Access

Abstract Background Iron-deficiency anemia is a known risk factor for several adverse perinatal outcomes, but data on its impact on specific maternal morbidities is less robust. Further, information on associations between anemia in early pregnancy and subsequent outcomes are understudied. Methods The study population was derived from the Community Level Interventions for Pre-eclampsia (CLIP) trial in Karnataka State, India (NCT01911494). Included were women who were enrolled in either trial arm, delivered by trial end date, and had a baseline measure of hemoglobin (Hb). Anemia was classified by WHO standards into four groups: none (Hb ≥ 11 g/dL), mild (10.0 g/dL ≤ Hb < 11.0 g/dL), moderate (7.0 g/dL ≤ Hb < 10.0 g/dL) and severe (Hb < 7.0 g/dL). Targeted maximum likelihood estimation was used to estimate confounder-adjusted associations between anemia and a composite (and its components) of adverse maternal outcomes, including pregnancy hypertension. E-values were calculated to assess robustness to unmeasured confounding. Results Of 11,370 women included, 10,066 (88.5%) had anemia, that was mild (3690, 32.5%), moderate (6023, 53.0%), or severe (68, 0.6%). Almost all women (> 99%) reported taking iron supplements during pregnancy. Blood transfusions was more often administered to those with anemia that was mild (risk ratio [RR] 2.16, 95% confidence interval [CI] 1.31–3.56), moderate (RR 2.37, 95% CI 1.56–3.59), and severe (RR 5.70, 95% CI 3.00–10.85). No significant association was evident between anemia severity and haemorrhage (antepartum or postpartum) or sepsis, but there was a U-shaped association between anemia severity and pregnancy hypertension and pre-eclampsia specifically, with the lowest risk seen among those with mild or moderate anemia. Conclusion In Karnataka State, India, current management strategies for mild-moderate anemia in early pregnancy are associated with similar rates of adverse maternal or perinatal outcomes, and a lower risk of pregnancy hypertension and preeclampsia, compared with no anemia in early pregnancy. Future research should focus on risk mitigation for women with severe anemia, and the potential effect of iron supplementation for women with normal Hb in early pregnancy.