Date

April 2012

Document Type

Thesis

Degree Name

M.P.H.

Department

Dept. of Public Health and Preventive Medicine

Institution

Oregon Health & Science University

Abstract

Objective: To describe the association between gestational anemia and maternal morbidity and requirements for aggressive treatment of postpartum hemorrhage. Background: Surgical literature has shown perioperative complications with hemoglobin levels below 8g/dL, yet little is known about the impact of moderate or severe anemia on perinatal maternal morbidity. Research suggests that anemia may be a risk factor for severe obstetric hemorrhage, which is the leading cause for pregnancy related deaths in the United States. Despite this research, the specific association between prenatal anemia and maternal morbidity is not well understood. Methods: We conducted a cross-sectional study on data extracted from the State Obstetric and Pediatric Research Collaboration (STORC) obstetric electronic health record. All single, term (≥37 weeks) deliveries that occurred between 1/1/2006 and 6/1/2009 with a recorded hemoglobin level within 50 days of delivery were eligible for inclusion in this study. Odds of receiving medical, surgical or other (blood transfusion or IV iron) interventions for treatment of postpartum hemorrhage among women with mild, moderate, and severe prenatal anemia was compared to women with no prenatal anemia. Smoking, maternal age, parity, infant birth weight, and high-risk pregnancy were evaluated as potential confounders of this relationship via logistic regression models. We also evaluated the association between anemia and length of stay (as a proxy for complications) among women with and without a postpartum hemorrhage by comparing mean length of stay to women without anemia. Results: Women with anemia did not have a higher level of morbidity at the time of delivery than women without anemia. The odds of receiving treatment for postpartum hemorrhage among women with mild anemia was 1.28 (95% CI: 0.79 – 2.06) times the odds of receiving treatment in women without anemia after adjusting for advanced maternal age, high risk pregnancy and delivery mode. This was similar to moderate anemia, where the odds of receiving treatment for a postpartum hemorrhage among women with moderate anemia were 1.42 (95% CI: 0.55-2.78) times the odds for those with no anemia. The mean length of stay for women who delivered vaginally with no anemia was 1.85 (95% CI: 1.83-1.99) days, which was not significantly different from women with mild or moderate anemia (mild 1.84 days [95% CI: 1.64-2.04]; moderate 1.85 days [95% CI: 1.53-2.17]) after adjusting for advanced maternal age and high-risk pregnancy. The mean length of stay for women who delivered via cesarean section with no anemia was 4.05 (95% CI: 3.44 – 4.65) days, which was not significantly different from women with mild or moderate anemia (mild 4.01 days [95% CI: 3.66-4.43]; moderate 3.76 days [95% CI: 3.19-4.33]) after adjusting for advanced maternal age, high-risk pregnancy and diagnosis of a postpartum hemorrhage. Conclusion: Prenatal anemia was not associated with a more severe postpartum hemorrhage requiring more aggressive management. Having prenatal anemia also did not put women at a higher risk of increased length of stay compared to women without prenatal anemia.

Identifier

doi:10.6083/M48S4MWV

School

School of Medicine

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