妊娠中の母親のヘモグロビン濃度と死産のリスク
O Stephansson1, P W Dickman, A Johansson
1Department of Medical Epidemiology, Karolinska Institutet, PO Box 281, SE-171 77, Stockholm, Sweden. olof.stephansson@mep.ki.se
JAMA
|November 22, 2000
まとめ
妊娠中の母親のヘモグロビン濃度の高さは,死産の危険性,特に早産および妊娠年齢に対して小さい死産 (SGA) と関連しています. この研究では,低ヘモグロビン (貧血) は死産リスクと有意に関連していません.
科学分野:
- 産婦人科と産婦人科を担当しています.
- 妊産婦・胎児医学について
- 妊娠中の血液学
背景:
- 母親のヘモグロビン濃度の高低は,妊娠期に比べて小さめの出産 (SGA) のリスクの増加と関連しています.
- SGAの出産は死産の予測要因として知られています.
- 母親のヘモグロビン濃度と死産リスクの正確な関係は不明である.
研究 の 目的:
- 最初の胎児前測定における母親のヘモグロビン濃度と死産のリスクとの関連性を調査する.
- 妊娠中のヘモグロビン濃度の変化が死産リスクに与える影響を調べる.
- これらの関連性を,様々な死産分類 (変形,出産前,出産内,早産,SGA) に関して分析する.
主な方法:
- スウェーデンでは,人口ベースのマッチングした症例対照研究が行われました.
- 生後死産 (妊娠28週以上) をした702人の女性,生児を産んだ702人の女性を含む.
- 母親のヘモグロビンのレベルは,最初の産前測定と週間の変化を分析し,母親の年齢,BMI,喫煙などの共変数に調整しました.
主要な成果:
- 最初の胎児前測定において,母親のヘモグロビン濃度の高さ (≥146g/L) は,死産のリスクの増加と関連していた (OR,1.8;95%CI,1.0-3.3).
- この関連性は,特に早産およびSGA症例 (4.2までのORs) で,不発症のない出産前死産においてより強く示された.
- 貧血 (<110 g/L) は死産リスクと有意に関連していなかった. 週間のヘモグロビン値の変化は有意な関連性を示さなかったが,減少は保護的になる傾向があった.
結論:
- 出産前の最初の診察で母親のヘモグロビン濃度の上昇は,死産のリスクが高いことと関連しています.
- このリスクは,特に早産および妊娠年齢に比べて小さい (SGA) 産前死産で顕著です.
- この関連性の背後にあるメカニズムを理解するために,さらなる研究が必要になるかもしれません.
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