Hemoglobin Evaluation in Hypertensive Disorders of Pregnancy
Keywords:
Anemia, Haemoglobin (Hb), Eclampsia (Ec), Pre-eclampsia (PE)Abstract
Objective: To evaluate the maternal hemoglobin (Hb) concentration and its levels in hypertensive pregnant patients during the third trimester of gestation.
Methods: A prospective cross-sectional study was conducted in an Obstetrics and Gynecology department of teaching hospital affiliated to The University of Lahore from November 2017 to June 2018. All pregnant women aged 18-40 years having third trimester of gestation, who came for antenatal check up or admitted to hospital were consecutively included. The demographic characteristics of pregnant women were documented and Hb concentration was assayed in the hematology laboratory and evaluated in pregnant females with hypertension (Hypertensive pregnant group) and healthy normotensive pregnant women. Hypertensive pregnant group were further categorized as pregnancy induced hypertensive (PIH), pre-eclampsia, and eclampsia.
Results: Of 78 pregnant women (62 hypertensive and 16 normotensive), the median age was 25 (23–29) years. Of 62 hypertensive women, PIH was observed in 33 (42.3%) women, pre-eclampsia in 17 (21.8%), and eclampsia in 12 (15.4%). The median HB level was observed in 11.5 (10-12) g/dL. The median Hb level in normotensive pregnant women was significantly higher as compared to hypertensive pregnant women, i.e., 11.9 (11.6-12.0) vs. 11.0 (9.5-12.0) respectively (p-value 0.006). Furthermore, among hypertensive women, the median Hb level was insignificantly higher in eclamptic women [11.5 (11.1-12.0)] as compared to PIH [10.7 (9.4-12.2)] and pre-eclamptic women [9.9 (9.5-11.7)] (p-value 0.079).
Conclusion: In the present study, the evaluation of Hb shows a statistically significant deterioration in Hb levels among hypertensive pregnant patients as compared to normotensive pregnant women.
Downloads
References
2. Brown MA, Magee LA, Kenny LC, Karumanchi SA, McCarthy FP, Saito S, et al. Hypertensive disorders of pregnancy: ISSHP classification, diagnosis and management recommendations for international practice. Hypertension 2018; 72:24-43. doi:10.1161/hypertensionaha.117.10803
3. March MI, Geahchan C, Wenger J, Raghuraman N, Berg A, Haddow H, et al. Circulating angiogenic factors and the risk of adverse outcomes among Haitian women with Preeclampsia. PLoS One 2015; 10:e0126815. doi.org/10.1371/journal.pone.0126815
4. Sandvik MK, Leirgul E, Nygard O, Ueland PM, Berg A, Svarstad E, et al. Preeclampsia in healthy women and endothelial dysfunction 10 years later. Am J Obstet Gynecol 2013 ; 209:569 e1–569 e10. doi:10.1016/j.ajog.2013.07.024
5. Means RT. Iron Deficiency and Iron Deficiency Anemia: Implications and impact in pregnancy, fetal development, and early childhood parameters. Nutrients 2020; 12:447. doi:10.3390/nu12020447
6. Selim NA, Al-Mass M, Al-Kuwari M, Ismail MS. Assessment of Anemia, IDA and ID among pregnants in Qatar: Cross sectional survey. SMJ Public Health Epidemiol 2016; 2:1035.
7. Roberfroid D, Huybregts L, Habicht JP. Randomized controlled trial of prenatal iron supplements: is there a dose-response relation with maternal hemoglobin? Am J Clin Nutr 2011; 93:1012-doi.org/10.3945/ajcn.110.006239
8. Riu DS, Mappaware NA, Fujiyanto, Asmi MN, Tansil AR. Maternal hemoglobin concentration and birth weight; a report from mother and child tertiary hospital child tertiary hospital. Enferm Clin. 2020; 30:92-5. doi:10.1016/j.enfcli.2019.07.042
9. Bakacak M, Avci F, Ercan O, Kostu B, Serin S, Kiran G, et al. The effect of maternal hemoglobin concentration on fetal birth weight according to trimesters. J Matern Fetal Neonatal Med 2015; 28:2106-10. doi:10.3109/14767058.2014.979149
10. Smith C, Teng F, Branch E, Chu S, Joseph KS. Maternal and perinatal morbidity and mortality associated with anemia in pregnancy. Obstet Gynecol 2019; 134:1234-44. doi:10.1097/AOG.0000000000003557
11. Un Nisa S, Shaikh AA, Kumar R. Maternal and Fetal Outcomes of Pregnancy-related Hypertensive Disorders in a Tertiary Care Hospital in Sukkur, Pakistan. Cureus 2019 ; 11:e5507. doi: 10.7759/cureus.5507
12. Toker E, Kabalcioglu F, Sonmez M, Arslan OF. Evaluation the anemia status among preeclamptic pregnants in hospital inpatients from Sanlıurfa, Turkey. Int J Med Sci 2016; 5:813-20. doi:10.5455/medscience.2016.05.8450
13. Noreen S, Nouroz F , Ahmad S, Khan S, Aslam A, Bukhari Z. Prevalence of Anemia in Pregnant Women of District Abbottabad, Pakistan. Pak J Clinc Biomed Res 2014; 2:12-6.
14. Unamba BC, Rosemary NO. The relationship between haemoglobin concentration and pregnancy outcomes in women with pre-eclampsia in a tertiary hospital in South-Southern, Nigeria. J Gynecol Women’s Health 2017; 7:555713. doi: 10.19080/jgwh.2017.07.555713
15. Lin L, Wei Y, Zhu W, Wang C, Su R, Feng H, et al. Prevalence, risk factors and associated adverse pregnancy outcomes of anaemia in Chinese pregnant women: a multicentre retrospective study. BMC Pregnancy Childbirth 2018; 18:111. doi: 10.1186/s12884-018-1739-8
16. Mtali YS , Lyimo MA, Luzzatto L and Massawe SN .Hypertensive disorders of pregnancy are associated with an inflammatory state: evidence from hematological findings and cytokine levels. BMC Pregnancy Childbirth 2019; 19:237. doi.org/10.1186/s12884-019-2383-7
17. Gupta G. A case control study to evaluate correlation of anemia with severe pre-eclampsia. Int J Reprod Contracept Obstet Gynecol 2018l; 7:2773-7. doi.org/10.18203/2320-1770.ijrcog20182879
18. Enaruna NO, Sodje JD. Early-onset severe preeclampsia in Nigerian women: determining a balance between maternal wellbeing and fetal survival in a resource-limited setting. British J Med Med Res 2015; 10:1-9. doi: 10.9734/BJMMR/2015/19217
19. Perveen S. Frequency and impact of hypertensive disorders of pregnancy. J Ayub Med Coll Abbottabad 2014; 26:518-21.
20. Seshan V, Alkhasawneh E, Al Kindi S, Al Simadi FA, Arulappan J. Can gestational anemia be alleviated with increased awareness of its causes and management strategies? Implications for health care services. Oman Med J 2018; 33:322-30. doi: 10.5001/omj.2018.59
21. Kavak EÇ, Kavak SB. The association between anemia prevalence, maternal age and parity in term pregnancies in our city. Perinatal J 2017; 25:6–10. doi:10.2399/prn.17.0251002
22. Gajjar K, Gajjar A, Shah H. Association of hemoglobin during first trimester and its relation to pregnancy-induced hypertension in Indian Women. Int J Clin Exp Physiol 2020; 7:73-6. doi: 10.5530/ijcep.2020.7.2.18
23. Haider BA, Olofin I, Wang M , Spiegelman D, Ezzati M, Fawzi WW. Anaemia, prenatal iron use, and risk of adverse pregnancy outcomes: systematic review and meta-analysis. BMJ 2013; f3443:346. doi: 10.1136/bmj.f3443
24. Endeshaw M, Abebe F, Bedimo M, Asart A. Diet and pre-eclampsia: a prospective multi-centre case control study in Ethiopia. Midwifery 2015; 31:617-24. doi: 10.1016/j.midw.2015.03.003
25. Mahmood T, Rehman A, Tserenpil G, Siddiqui F, Ahmed M, Siraj F, et al. The association between iron-deficiency anemia and adverse pregnancy outcomes:a retrospective report from Pakistan. Cureus 2019; 11: e5854. doi:10.7759/cureus.585
26. Young MF, Oaks BM, Tandon S, Martorell R, Dewey KG, Wendt AS. Maternal hemoglobin concentrations across pregnancy and maternal and child health: a systematic review and meta-analysis. Ann N Y Acad Sci 2019; 1450:47-68. doi:10.1111/nyas.14093
27. Randall DA, Patterson JA, Gallimore F, Morris JM, McGee TM, Ford JB, et al. The association between haemoglobin levels in the first 20 weeks of pregnancy and pregnancy outcomes. PLoS One 2019; 14:e0225123. doi.org/10.1371/journal.pone.0225123
28. Wang C, Lin L, Rina Su, Wei Y, Feng H, Li B, et al. Hemoglobin levels during the first trimester of pregnancy are associated with the risk of gestational diabetes mellitus, pre-eclampsia and preterm birth in Chinese women:a retrospective study. BMC Pregnancy Childbirth 2018; 18:263. doi.org/10.1186/s12884-018-1800-7
Downloads
Published
Versions
- 2022-01-15 (2)
- 2021-04-06 (1)
How to Cite
Issue
Section
License
Copyright (c) 2021 Ahsan Rabia Muhammad, Ghazal Mansoor, Sana Qanber Abbasi, Qurat ul ain, Sana Javid, Nazish Jamil
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Articles published in the Journal of Dow University of Health Sciences are distributed under the terms of the Creative Commons Attribution Non-Commercial License https://creativecommons.org/ licenses/by-nc/4.0/. This license permits use, distribution and reproduction in any medium; provided the original work is properly cited and initial publication in this journal. 
