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Maternal anemia and pediatric neurological morbidity in the offspring - Results from a population based cohort study
Tamar Wainstock1, Asnat Walfisch2, Ruslan Sergienko1
1The Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Insights
Maternal anemia increases the risk of neurological conditions in children. Even mild anemia during pregnancy is linked to higher rates of pediatric neurological hospitalizations in offspring.
Area of Science:
- Obstetrics and Gynecology
- Pediatric Neurology
- Public Health
Background:
- Maternal anemia, defined as hemoglobin <11 mg/dl, is a known risk factor for adverse fetal growth and pregnancy outcomes.
- The long-term impact of maternal anemia on offspring neurological development and morbidity remains an area of significant interest.
Purpose of the Study:
- To investigate the association between maternal anemia status and the risk of neurological morbidity in offspring.
- To analyze the long-term incidence of neurological-related hospitalizations in children based on maternal postpartum hemoglobin levels.
Main Methods:
- A population-based cohort analysis included 217,358 deliveries from 1991-2014.
- Offspring were stratified into three groups based on maternal postpartum hemoglobin: no anemia (≥11 mg/dl), mild-to-moderate anemia (11.0 > Hb ≥ 7 mg/dl), and severe anemia (<7 mg/dl).
- Kaplan-Meier curves and a multivariable Weibull hazards model were used to assess cumulative hospitalization incidence and adjust for confounding factors.
Main Results:
- Maternal anemia was categorized as severe in 0.4%, mild-to-moderate in 49.0%, and absent in 50.6% of deliveries.
- Over an 18-year follow-up, 2.1% of offspring were hospitalized for neurological diagnoses.
- Neurological hospitalization incidence was highest in the severe anemia group (2.95/1000 person-years) and lowest in the no anemia group (2.01/1000 person-years), with a significant association persisting after controlling for confounders (aHR 1.55 for severe, aHR 1.13 for mild-to-moderate).
Conclusions:
- Children born to mothers with anemia are at an elevated risk for long-term pediatric neurological morbidity.
- The findings underscore the importance of addressing maternal anemia to potentially mitigate risks for neurological health in offspring.
Objective:
Maternal anemia (Hemoglobin, <11 mg/dl) has been shown to affect fetal growth and pregnancy outcome. We aimed to study a possible association between maternal anemia and the risk for neurological morbidity in the offspring, during a follow-up period of up to 18 years.
Study Design:
A population-based cohort analysis was performed at the Soroka University Medical Center (SUMC), a single regional tertiary center comparing total and specific subtypes of neurological morbidities associated with hospitalizations among children stratified by three maternal post-partum hemoglobin categories: ≥11 mg/dl (no anemia); 11.0 mg/dl > Hb ≥ 7 mg/dl (mild-to-moderate anemia) and <7 mg/dl (severe anemia). Data on pregnancy course and outcome, and later offspring hospitalizations, were compared between the three study groups. All singleton deliveries between the years 1991-2014 were included in the analysis, and congenital malformations were excluded. A Kaplan-Meier survival curve was used to compare cumulative hospitalization incidence based on maternal anemia status, and a Weibull survival multivariable hazard model was constructed to adjust for confounding variables.
Results:
The study population included 217,358 deliveries of which 50.6% were in mothers who were not anemic, 49.0% in mothers with moderate anemia and 0.4% in mothers with severe anemia. During the follow up period (0-18 years, median 10.22 years), 2.1% of offspring were hospitalized with a neurological diagnoses. Neurological hospitalization incidence decreased from 2.95/1000 person years, in the severe anemia group, to 2.32/1000 person years and 2.01/1000 person years, among the mild-to-moderate and no anemia groups, respectively (p = 0.007). The association between maternal anemia and offspring long-term pediatric neurological morbidity remained significant in a Weibull hazards model controlled for gestational age, delivery mode, SGA and insufficient prenatal care (adjusted HR 1.55; 1.05-2.31 and adjusted HR 1.13; 1.06-1.20; among the severe and mild-to-moderate anemia, vs. no anemia, respectively).
Conclusion:
Children born to anemic mothers are at an increased risk for pediatric neurological-related hospitalizations.
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