Abstract
Purpose
To determine if correction of cut-offs of haemoglobin levels to define anaemia at high altitudes affects rates of adverse perinatal outcomes.
Methods
Data were obtained from 161,909 mothers and newborns whose births occurred between 1,000 and 4,500 m above sea level (masl). Anaemia was defined with or without correction of haemoglobin (Hb) for altitude as Hb <11 g/dL. Correction of haemoglobin per altitude was performed according to guidelines from the World Health Organization. Rates of stillbirths and preterm births were also calculated.
Results
Stillbirth and preterm rates were significantly reduced in cases of anaemia calculated after correction of haemoglobin for altitude compared to values obtained without Hb correction. At high altitudes (3,000–4,500 masl), after Hb correction, the rate of stillbirths was reduced from 37.7 to 18.3 per 1,000 live births (p < 0.01); similarly, preterm birth rates were reduced from 13.1 to 8.76 % (p < 0.01). The odds ratios for stillbirths and for preterm births were also reduced after haemoglobin correction.
Conclusion
At high altitude, correction of maternal haemoglobin should not be performed to assess the risks for preterm birth and stillbirth. In fact, using low altitude Hb cut-off is associated with predicting those at risk.
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Acknowledgments
The authors appreciate the collaboration of the Ministry of Health and their representatives from different public hospitals in Peru. We acknowledge technical assistance from Dr. Carlos Carrillo, MPH Leopoldo Bejarano and Lic. Vanessa Vasquez. The study was supported by a grant from the UNDP/UNFPA/WHO/WORLD BANK Special Programme of Research, Development and Research Training in Human Reproduction at the World Health Organization. The funding sources had no involvement in the design, analysis or conclusions of this study.
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Gonzales, G.F., Tapia, V. & Gasco, M. Correcting haemoglobin cut-offs to define anaemia in high-altitude pregnant women in Peru reduces adverse perinatal outcomes. Arch Gynecol Obstet 290, 65–74 (2014). https://doi.org/10.1007/s00404-014-3182-z
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DOI: https://doi.org/10.1007/s00404-014-3182-z