Association of hemoglobin values at booking with adverse maternal outcomes among Peruvian populations living at different altitudes

• Published in: International journal of gynecology and obstetrics 2012-05, Vol.117 (2), p.134-139
• Main Authors: Gonzales, Gustavo F, Tapia, Vilma, Gasco, Manuel, Carrillo, Carlos E, Fort, Alfredo L
• Format: Article
• Language: English
• Subjects: Adult; Altitude; Anemia; Anemia - epidemiology; Anemia - etiology; Anemias. Hemoglobinopathies; Biological and medical sciences; Cohort Studies; Databases, Factual; Delivery. Postpartum. Lactation; Diseases of mother, fetus and pregnancy; Diseases of red blood cells; Disorders; Female; Fetal Membranes, Premature Rupture - epidemiology; Fetal Membranes, Premature Rupture - etiology; Gynecology. Andrology. Obstetrics; Hematologic and hematopoietic diseases; Hemoglobin; Hemoglobins - metabolism; Humans; Maternal Mortality; Medical sciences; Obstetrics and Gynecology; Peru - epidemiology; Postpartum hemorrhage; Postpartum Hemorrhage - epidemiology; Postpartum Hemorrhage - etiology; Pre-eclampsia; Pre-Eclampsia - epidemiology; Pre-Eclampsia - etiology; Pregnancy; Pregnancy Outcome - epidemiology; Pregnancy. Fetus. Placenta; Premature rupture of membranes; Retrospective Studies; Risk Factors; Young Adult
• ISSN: 0020-7292; 1879-3479
• DOI: 10.1016/j.ijgo.2011.11.024

Abstract Objective To determine hemoglobin values associated with adverse maternal outcomes among Peruvian populations at different altitudes. Methods A retrospective cohort study was conducted using data from the Perinatal Information System. Adverse maternal outcomes were assessed. Results Risk of pre-eclampsia increased at maternal hemoglobin levels above 14.5 g/dL (OR 1.27; 95% CI, 1.18–1.36) or below 7.0 g/dL (OR 1.52; CI 95%, 1.08–2.14). Altitude above 2000 m reduced risk (OR 0.65; 95% CI 0.62–0.68). Risk of postpartum hemorrhage (PPH) increased with moderate/severe anemia (OR 6.15; 95% CI, 3.86–9.78) and at moderate altitudes (OR 1.26; 95% CI, 1.12–1.43). Mild anemia at any altitude was associated with reduced risk of pre-eclampsia (OR 0.85, 95% CI, 0.81–0.89) and PPH (OR 1.01; 95% CI, 0.88–1.15). Risk of premature rupture of membranes was reduced at high hemoglobin values. Maternal mortality increased at hemoglobin levels below 9.0 g/dL (OR 5.68; 95% CI, 2.97–10.80) and above 14.5 g/dL (OR 2.18; 95% CI, 1.22–3.91). Maternal mortality increased at moderate altitudes (OR 29.2; 95% CI, 2.62–324.60) and high altitudes (OR 66.4; 95% CI, 6.65–780.30) when hemoglobin levels were below 9.0 g/dL. Conclusion Elevated altitude and hemoglobin levels influence maternal outcomes.