Prediction of anemia at delivery

Enav Yefet, Avishag Yossef, Zohar Nachum, Enav Yefet, Avishag Yossef, Zohar Nachum

Abstract

We aimed to assess risk factors for anemia at delivery by conducting a secondary analysis of a prospective cohort study database including 1527 women who delivered vaginally ≥ 36 gestational weeks. Anemia (Hemoglobin (Hb) < 10.5 g/dL) was assessed at delivery. A complete blood count results during pregnancy as well as maternal and obstetrical characteristics were collected. The primary endpoint was to determine the Hb cutoff between 24 and 30 gestational weeks that is predictive of anemia at delivery by using the area under the curve (AUC) of the receiver operating characteristic curve. Independent risk factors for anemia at delivery were assessed using stepwise multivariable logistic regression. Hb and infrequent iron supplement treatment were independent risk factors for anemia at delivery (OR 0.3 95%CI [0.2-0.4] and OR 2.4 95%CI [1.2-4.8], respectively; C statistics 83%). Hb 10.6 g/dL was an accurate cutoff to predict anemia at delivery (AUC 80% 95%CI 75-84%; sensitivity 75% and specificity 74%). Iron supplement was beneficial to prevent anemia regardless of Hb value. Altogether, Hb should be routinely tested between 24 and 30 gestational weeks to screen for anemia. A flow chart for anemia screening and treatment during pregnancy is proposed in the manuscript.Trial registration: ClinicalTrials.gov Identifier: NCT02434653.

Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Hemoglobin throughout pregnancy. LOESS curve of hemoglobin levels among pregnant women with frequent (red line) and infrequent (blue line) use of iron supplements.
Figure 2
Figure 2
Suggested gestational anemia treatment flow chart based on hemoglobin values and frequency of iron supplementation use. Hb, hemoglobin; I.V intravenous.

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