Reference intervals for hemoglobin and hematocrit in a low-risk pregnancy cohort

implications of racial differences

Giuseppe Chiossi, Stefano Palomba, Maged Costantine, Angela I. Falbo, Hassan Harirah, George Saade, Giovanni B. La Sala

Research output: Contribution to journalArticle

Abstract

Objective: As anemia in pregnancy is associated with adverse perinatal outcomes, we sought to define the mean and the fifth percentile of Hb and Ht using a contemporary multiethnic large cohort of low-risk pregnancies, and assess potential racial differences. Methods: We conducted a retrospective cohort study on women who delivered between 1 January 2008 and 31 December 2013 in Reggio Emilia County, Italy. Linear mixed effects models were used to describe changes in mean Hb and Ht, while quantile regression with matrix-design bootstrap defined changes in the fifth percentile of Hb and Ht, controlling for race, maternal age, smoking, and pregnancy number. Results: We analyzed 23,657 hemograms from 7318 pregnancies and 6870 women. Multivariate analysis showed that when compared to Caucasians’, African women’s mean Hb and Ht were respectively 0.24 (95%CI 0.3–0.17) g/dl and 0.7 (95%CI 0.8–0.5) % lower, while Asian mothers’ were 0.11 (95%CI 0.19–0.03) g/dl and 0.3 (95%CI 0.5–0.1) % inferior. Similarly, both African and Asian women had lower fifth Ht percentiles (−1, 95%CI −1.3 to −0.6, and −0.4, 95%CI −0.7 to −0.04) than Caucasians, while African mothers also had lower fifth Hb percentile (0.3, 95%CI 0.5–0.1). The fifth percentile for Hb and Ht were, respectively, 11.3 (95%CI 11–11.5) g/dl and 32.8 (95%CI 32.3–33.4) % in the first trimester, 10.4 (95%CI 10.1–10.6) g/dl and 30.2 (95%CI 29.6–30.8) % in the second trimester, 10.1 (95%CI 9.8–10.3) g/dl and 30.6 (95%CI 30–31.1) % in the third trimester. Conclusions: We provided contemporary references to define anemia in pregnancy, and we confirmed that even in pregnancy, African and Asian women have lower Hb and Ht than Caucasian. Racial and population-specific references may have significant clinical and public health implication for more accurate disease diagnosis and appropriate treatment.

Original languageEnglish (US)
Pages (from-to)1-8
Number of pages8
JournalJournal of Maternal-Fetal and Neonatal Medicine
DOIs
StateAccepted/In press - Mar 23 2018

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Hematocrit
Hemoglobins
Pregnancy
Anemia
Mothers
Maternal Age
Third Pregnancy Trimester
Second Pregnancy Trimester
First Pregnancy Trimester
Italy
Cohort Studies
Multivariate Analysis
Retrospective Studies
Public Health
Smoking
Population

Keywords

  • hematocrit
  • Hemoglobin
  • low-risk pregnancy
  • maternal race

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology

Cite this

Reference intervals for hemoglobin and hematocrit in a low-risk pregnancy cohort : implications of racial differences. / Chiossi, Giuseppe; Palomba, Stefano; Costantine, Maged; Falbo, Angela I.; Harirah, Hassan; Saade, George; La Sala, Giovanni B.

In: Journal of Maternal-Fetal and Neonatal Medicine, 23.03.2018, p. 1-8.

Research output: Contribution to journalArticle

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abstract = "Objective: As anemia in pregnancy is associated with adverse perinatal outcomes, we sought to define the mean and the fifth percentile of Hb and Ht using a contemporary multiethnic large cohort of low-risk pregnancies, and assess potential racial differences. Methods: We conducted a retrospective cohort study on women who delivered between 1 January 2008 and 31 December 2013 in Reggio Emilia County, Italy. Linear mixed effects models were used to describe changes in mean Hb and Ht, while quantile regression with matrix-design bootstrap defined changes in the fifth percentile of Hb and Ht, controlling for race, maternal age, smoking, and pregnancy number. Results: We analyzed 23,657 hemograms from 7318 pregnancies and 6870 women. Multivariate analysis showed that when compared to Caucasians’, African women’s mean Hb and Ht were respectively 0.24 (95{\%}CI 0.3–0.17) g/dl and 0.7 (95{\%}CI 0.8–0.5) {\%} lower, while Asian mothers’ were 0.11 (95{\%}CI 0.19–0.03) g/dl and 0.3 (95{\%}CI 0.5–0.1) {\%} inferior. Similarly, both African and Asian women had lower fifth Ht percentiles (−1, 95{\%}CI −1.3 to −0.6, and −0.4, 95{\%}CI −0.7 to −0.04) than Caucasians, while African mothers also had lower fifth Hb percentile (0.3, 95{\%}CI 0.5–0.1). The fifth percentile for Hb and Ht were, respectively, 11.3 (95{\%}CI 11–11.5) g/dl and 32.8 (95{\%}CI 32.3–33.4) {\%} in the first trimester, 10.4 (95{\%}CI 10.1–10.6) g/dl and 30.2 (95{\%}CI 29.6–30.8) {\%} in the second trimester, 10.1 (95{\%}CI 9.8–10.3) g/dl and 30.6 (95{\%}CI 30–31.1) {\%} in the third trimester. Conclusions: We provided contemporary references to define anemia in pregnancy, and we confirmed that even in pregnancy, African and Asian women have lower Hb and Ht than Caucasian. Racial and population-specific references may have significant clinical and public health implication for more accurate disease diagnosis and appropriate treatment.",
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AU - Chiossi, Giuseppe

AU - Palomba, Stefano

AU - Costantine, Maged

AU - Falbo, Angela I.

AU - Harirah, Hassan

AU - Saade, George

AU - La Sala, Giovanni B.

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N2 - Objective: As anemia in pregnancy is associated with adverse perinatal outcomes, we sought to define the mean and the fifth percentile of Hb and Ht using a contemporary multiethnic large cohort of low-risk pregnancies, and assess potential racial differences. Methods: We conducted a retrospective cohort study on women who delivered between 1 January 2008 and 31 December 2013 in Reggio Emilia County, Italy. Linear mixed effects models were used to describe changes in mean Hb and Ht, while quantile regression with matrix-design bootstrap defined changes in the fifth percentile of Hb and Ht, controlling for race, maternal age, smoking, and pregnancy number. Results: We analyzed 23,657 hemograms from 7318 pregnancies and 6870 women. Multivariate analysis showed that when compared to Caucasians’, African women’s mean Hb and Ht were respectively 0.24 (95%CI 0.3–0.17) g/dl and 0.7 (95%CI 0.8–0.5) % lower, while Asian mothers’ were 0.11 (95%CI 0.19–0.03) g/dl and 0.3 (95%CI 0.5–0.1) % inferior. Similarly, both African and Asian women had lower fifth Ht percentiles (−1, 95%CI −1.3 to −0.6, and −0.4, 95%CI −0.7 to −0.04) than Caucasians, while African mothers also had lower fifth Hb percentile (0.3, 95%CI 0.5–0.1). The fifth percentile for Hb and Ht were, respectively, 11.3 (95%CI 11–11.5) g/dl and 32.8 (95%CI 32.3–33.4) % in the first trimester, 10.4 (95%CI 10.1–10.6) g/dl and 30.2 (95%CI 29.6–30.8) % in the second trimester, 10.1 (95%CI 9.8–10.3) g/dl and 30.6 (95%CI 30–31.1) % in the third trimester. Conclusions: We provided contemporary references to define anemia in pregnancy, and we confirmed that even in pregnancy, African and Asian women have lower Hb and Ht than Caucasian. Racial and population-specific references may have significant clinical and public health implication for more accurate disease diagnosis and appropriate treatment.

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