Relationship between maternal hemoglobin and birthweight in Antioquia, Colombia

this was an analytical, cross-sectional observational study that included the prenatal records of494 pregnant women who delivered live newborns in the Department of Antioquia. The maternal health data collected included HbM and BW, and gynecological and obstetric, anthropometric, and maternal health-related data. The Mann-Whitney U test was applied, supplemented by effect size (ES) to compare the study groups.

Results:

HbMin the third trimester was significantly associated with BW (p=0.029).It showed a significant effect size on BW as follows: first trimester: ES=0.44 (CI95%= 0.183-0.697); second trimester: ES=0.49 (CI95%= 0.187-0.79); and third trimester: ES=0.43 (CI95% = 0.202-0.658). Maternal anemia was 4.2%>, 11.2%, and 21.4%> in the first, second, and third trimester, respectively.

Conclusions:

as it is an inexpensive indicator and easy to determine, the timely monitoring and assessment of HbM is required owing to its importance in maternal and neonatal health, quality of life, and human capital development.

Key words:
Birth weight; Anemia; Maternal hemoglobin; Pregnancy; Prenatal

Pregnant woman	N=494	Frequency % (CI95%)
Age in years		Me: 22 (19; 27)^a a Data are shown in Me: median (lower quartile; upper quartile);
Educational level (years of study)
None	38	7.7% ( 5.5-10.1)
From 1 to 5	71	14.4% ( 11.3-17.8)
From 6 to 11	351	71.1% (66.6-74.9)
More than 12	34	6.9% (4.9-9.3)
Residence area
Urban	415	84.0% (80.8-87.0)
Rural	79	16.0% (13.0-19.2)
Ethnicity
Mixed race	256	51.8% (47.2-56.3)
Black	19	3.8% (2.2-5.7)
Indigenous	4	0.8% (0.2-1.8)
Other	215	43.5% (39.3-48.2)
Marital status
Common law marriage	266	53.8% (49.4 -58.1)
Single	178	36.0% (31.6-40.5)
Married	43	8.7% (6.3-11.3)
Other	7	1.4% (0.4-2.6)
Health regime
Subsidized	426	86.2% (83.0-89.3)
Uninsured	55	11.1% (8.3-14.0)
Contributive	13	2.6% (1.4-4.0)
SISBEN^b b Health beneficiary identification system; level
Level 0	8	1.6% (0.6-2.8)
Level 1	382	77.3% (73.7-81.4)
Level 2	78	15.8% (12.6-19.2)
Level 3	25	5.1% (3.2-7.1)
Level 4	1	0.2% (0.0-0.6)
Gynecology and obstetrics
Previous pregnancies	273	55.3% (50.8-59.5)
Previous abortions	86	17.4% (14.4-20.6)
Previous deliveries	231	46.8% (42.1-51.2)
Planned pregnancy	134	27.1% (23.1-31.2)
Birth interval	101	20.4% (16.8-23.9)
Cesarean	145	29.4% (25.3-33.4)
Treated UTI^c c Urinary tract infection;	21	4.3% (2.4-6.1)
Anthropometrics
Pregestational BMI^d d Body mass index.	494	Me: 23.2 (21.7; 24.9)^a a Data are shown in Me: median (lower quartile; upper quartile);
Pregestational height (cm)	494	Me: 157 (153; 162)^a a Data are shown in Me: median (lower quartile; upper quartile);
Pregestational weight (kg)	494	Me: 58 (53; 63)^a a Data are shown in Me: median (lower quartile; upper quartile);
BMI^d at last prenatal examination	494	Me: 27.2 (25.8; 29.0)^a a Data are shown in Me: median (lower quartile; upper quartile);

Newborn	N=494	Frequency % (CI95%)
Anthropometric data
Weight (g)		3225.5 ± 409,2^a a Data are shown as arithmetic mean ± standard deviation;
Head circumference (cm)		Me: 34 (33; 35)^b b Data are shown in Me: median (lower quartile; upper quartile);
Height (cm)		Me: 50 (49; 51)^b b Data are shown in Me: median (lower quartile; upper quartile);
Gender
Female	231	46.8% (42.5-51.0)
Male	263	53.2% (49.0-57.5)
Weight classification WHO^c c World Health Organization; ,^d d Based on the Public Health Surveillance Protocol, low birth weight at term code 110, 2016.4;
Low birthweight	15	3.0% (1.6-4.7)
Insufficient weight	116	23.5% (19.6-27.5)
Normal	348	70.5% (66.0-74.3)
Macrosomic	15	3.0% (1.6-4.7)
Fenton classification^e e Based on the Fenton classification.18
Adequate	15	83.3% (62.5-100)
Large for gestational age	3	16.7% (0.0-36.3)
Gestational age	494	Me: 39 (38; 40)^b b Data are shown in Me: median (lower quartile; upper quartile);

	Weight <3000 (g) (N=131)	Weight 3000-4000 (g) (N=348)	p ^a a Mann-Whitney U;	^b b Effect size: probability of superiority (PS). Effect size (CI95%)
HbM in first trimester (g/dL)	13.0 (1.1) n=79	12.8 (1.4) n = 224	0.093	0.44 (0.183-0.697)
HbM second trimester (g/dL)	11.8 (1.1) n = 60	11.9 (1.6) n = 138	0.855	0.49 (0.187-0.793)
HbM third trimester (g/dL)	12.1 (1.2) n = 103	11.8 (1.6) n = 262	0.029	0.43 (0.202-0.658)
HbM DELTA first trimester vs third (g/dL)	0.85 (1.2) n = 62	0.9 (1.3) n = 165	0.930	0.50 (0.208-0.792)

	Weight <3000 (g)	Weight 3000-4000 (g)	Value p adjusted^a a Poisson regression of multivariate robust variance; (PR: CI95%)	Effect size Eta squared^b b Effect size for a multiple linear regression model (dependent variable birthweight in grams);
HbM first trimester^c c Median (Interquartile range); (g/dL)	13.0 (1.1)	12.8 (1.3)	0.494 (1.08: 0.87-1.33)	0.0023
HbM third trimester^c c Median (Interquartile range); (g/dL)	12.1 (1.2)	11.8 (1.6)	0.164 (1.18: 0.93-1.50)	0.0007
Agec (years)	21 (7)	22 (8)	0.255 (0.97: 0.91-1.02)	0.0004
BMI^d d Body mass index; pregestational^c c Median (Interquartile range);	22.8 (3.1)	23.3 (3.2)	0.043 (0.90: 0.81-0.99)	0.0287
BMI^d d Body mass index; from the last prenatal examination^c c Median (Interquartile range);	27.3 (3.3)	27.2 (3.1)	0.497 (0.96: 0.87-1.07)	0.0045
Previous pregnancies n (%)	67 (25.6%)	195 (74.4%)	0.908 (0.95: 0.40-2.25)	0.0038
Previous history of abortions n (%)	27 (32.1%)	57 (67.9%)	0.232 (1.55: 0.75-3.20)	0.0052
Previous deliveries n (%)	54 (24.4%)	167 (75.6%)	0.988 (0.99: 0.44-2.22)	0.0036
UTI n (%)^e e Urinary tract infection.	9 (45.0%)	11 (55.0%)	0.011 (2.53: 1.24-5.18)	0.0014

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E-mail: revista@imip.org.br

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[1] Author’s contribution

Madrid-Pérez C: conception, final writing, revision, methodology, research, administration. Restrepo-Mesa SL: revision, research. Ospina AC: revision. Tirado JA: methodology, research. Sierra DCL: methodology, research. Parra-Sosa BE: conception, final writing, revision, methodology, research. All authors approved the final version of the article.