Agrawal R.1,Srivastava
P.2
1Dr.
Rohit Agrawal, Assistant Professor, Department of Pediatrics, T.S. Misra
Medical College and Hospital, Lucknow, 2Dr.Prachi Srivastava, Assistant
Professor, Department of Obstetrics and Gynecology, T.S.Misra Medical College
and Hospital, Lucknow.
Corresponding
Author: Dr.Prachi Srivastava, Assistant
Professor, Department of Obstetrics and Gynecology, T.S. Misra Medical College
and Hospital, Lucknow. Email id: dr.prachi26@gmail.com
Abstract
Introduction:
Maternal anemia is a significant problem.Mothers with anemia are likely to
deliver anemic babies. Cord blood hemoglobin can be used to diagnose neonatal
anemia.Materials and methods: This
was a cross sectional study conducted from January 2017 to January 2018 in Department
of Pediatrics and Department of Obstetrics and Gynecology at T.S. MisraMedical College
andHospital. 100 mothers delivering in labor room and their newborns were
included in the study. Maternal hemoglobin was estimated prior to delivery.
After the delivery of baby cord blood hemoglobin was collected. Cord blood
hemoglobin of anemic and non-anemic mothers were compared. Anemic mothers were categorized
as mild, moderate and severe. We compared cord blood hemoglobin of babies in
all three groups and also with cord blood hemoglobin of non-anemic mothers.Results:Difference betweenmean cord
blood hemoglobin of anemic and non-anemic mothers was found to be statistically
significant. Difference between cord blood hemoglobin of all three groups (mild,
moderate and severe anemia) found to be statistically significant.Conclusion:This study shows direct
correlation between maternal and fetal hemoglobin levels. We stress the
importance of preventing maternal anemia and maintaining adequate iron storage
in mothers during pregnancy to ensure better maternal and fetal outcome. We
also emphasize the importance of cord blood hemoglobin for early diagnosis of
neonatal anemia.
Key
words:Anemia, Maternal hemoglobin, Cord blood
hemoglobin
Author Corrected: 26th July 2018 Accepted for Publication: 31st July 2018
Introduction
Anemia isa very common medical
disorder during pregnancy affecting nearly 50% of pregnant women globally. This
includes nearly 75% of women in developing countries[1,2].
WHO defines maternal anemia as
hemoglobin level less than 11 gm/dl during pregnancy. It is further classified
as mild (Hblevels: 10-10.9gm/dl), moderate (Hb: 7-9.9gm/dl) and severe (Hb<7
gm/dl)[1].Mothers with anemia are more likely to deliver anemic babies.
Umbilical cord hemoglobin is an
important hematological parameter which though promising is very much underutilized
[3]. It can be utilized for early diagnosis of anemia in new born babies.
This study was conducted to find
correlation between maternal anemia and cord blood hemoglobin levels to
reinforce that umbilical cord hemoglobin levels can be implemented routinely to
improve neonatal outcomes.
Materials and Methods
This was a cross sectional study
conducted in T.S. Mishra Medical College and hospital, Lucknow.
Type
of study- cross sectional study
Duration
of study-conducted for a period of one year from January
2017 to January 2018
Place
of study- Department of Pediatrics and Department
of Obstetrics and Gynecology combinedlyat T.S.Mishra Medical College and
hospital, Lucknow.
Sampling
method-100 women whodelivered in T.S.Mishra
medical college and hospital and their newborn babies were included in the
study.
Inclusion
criteria- singleton full term neonates (>37
weeks) delivered vaginally or by cesarean section with no other maternal and
fetal complications apart from maternal anemia.
Exclusion
criteria- Subjects with any kind of maternal or
fetal complications in antenatal period apart from maternal anemia were
excluded from the study.
Methodology-Maternal
hemoglobin was estimated prior to delivery. After the delivery of baby cord
blood hemoglobin was collected. Umbilical cord was clamped after delivery of
infant and before expulsion of placenta. Cord blood was collected from
umbilical vein from placental end of clamped and separated cord. Hemoglobin
estimation was done from cord sample.
Based on maternal hemoglobin
levels, mothers were classified into anemic (Hb<10gm/dl) and non anemic
(Hb>10gm/dl)Cord blood hemoglobin of anemic and non anemic mothers were
compared. As anemic mothers were categorized into mild, moderate and severe, we
compared cord blood hemoglobin of babies in all three groups. Comparison was
also made with cord blood hemoglobin of non anemic mothers.
Statistical analysis was done using
SPSS21. Student t test was used to determine level of significance.
Results
Analysis of demographic profile
showed the mean age of anemic mothers to be 26.72±1.34 yrs and mean age of non
anemic mothers to be 25.82±2.32 years. Out of total 100 patients included in
the study, 65 patients were from rural area while 35 patients were from urban
area. The mean maternal hemoglobin in anemic mothers was found to be 8.67±0.5
gm/dl and in non anemic mothers was found to be 11.23±0.34 gm/dl.
Out of 100 mothers enrolled for
study based on inclusion and exclusion criteria, 47 patients (47%) were anemic
while 53 patients (53%) were non anemic. Amongst anemic mothers, 23(48.9%) were
mildly anemic with hemoglobin level between 10-10.5 gm/dl, 19(40.4%) were
moderately anemic with hemoglobin level between 7-9.9gm/dland 5(10.7%) were
severely anemic with hemoglobin level less than 7 gm/dl. Amongst 100 babies delivered,
90 babies were full term babies and 10 babies were preterm babies.
Mean cord blood hemoglobin between
anemic and non anemic mothers was compared and the difference was found to be
statistically significant (Table-1).
Cord blood hemoglobin of all three
groups (patients with mild, moderate and severe anemia) was compared and
difference was found to be statistically significant (Table 2).
Table-1:Comparison
of cord blood levels between anemic and non anemic mothers
Group |
Mean
age (in years) |
Mean
maternal hemoglobin (in gm/dl) |
Meancord
blood hemoglobin (in gm/dl) |
Anemic mothers |
26.72±1.34 |
8.67±0.5 |
14.06±1.2 |
Non anemic mothers |
25.82±2.32 |
11.23±0.34 |
16.22±0.45 |
P value <0.05
Table-2: Comparison
of mean maternal hemoglobin levels with cord blood hemoglobin
Severity
of maternal anemia |
Mean
hemoglobin (gm/dl) |
No.
of patients |
Mean
cord blood hemoglobin (gm/dl) |
P
value |
Mild (Hb: 10-10.9 gm/dl) |
10.3±0.13 |
23 |
15±0.72 |
P<0.05 |
Moderate (Hb: 9.9-7 gm/dl) |
9.1±0.62 |
19 |
14.6±0.88 |
P<0.05 |
Severe (<7 gm/dl) |
6.5±0.42 |
6 |
13.1±0.79 |
P<0.05 |
Discussion
Survival ofneonates can be
increased by improved maternal care in antenatal period and earlydiagnosis and
treatment of neonatal problems. Neonatal anemia is one of the problems
affecting neonates of anemic mothers.
Early diagnosis and treatment of
neonatal anemia can go a long way in improving neonatal outcome. Cord blood
hemoglobin can be used for early diagnosis of neonatal anemia.
This study was conducted to find
correlation between cord blood hemoglobin and maternal hemoglobin and thus
establishing the utility of cord blood hemoglobin in diagnosis of neonatal
anemia.
This study was conducted on 100 patients
and their newborn babies. It was found in study that there was direct
correlation between maternal hemoglobin and cord blood hemoglobin levels. Thus,
babies with mothers who had lower blood hemoglobin levels also showed lower
values of cord blood and this reduction of fetal hemoglobin was significant
when compared to non-anemic mothers. This observation was contrary to popular
belief that fetus continues to extract iron even from anemic mother to fulfill its
requirement.
Sweet et al [4] in her study showed
that mothers with iron deficiency anemia during pregnancy gave birth to
newborns with lower hemoglobin levels.Similar findings were seen in study by Sareen
A etal [5]. In his study Debbarma et al [6] found a linear relationship between
maternal hemoglobin, cord blood hemoglobin and birth weight of newborns.
Sisson TRC et al [7] andNhonoli etal
[8] found that if mother was iron deficient and anemic, then the newborn too
had lower hemoglobin levels and low iron in cord blood. Singla et al [9] also
showed significant association between maternal hemoglobin levels and cord
blood iron levels. Fenton et al [10] found direct correlation between maternal
ferritin and cord blood ferritin levels.
However in his study done by
Marmoury GH et al [11], no association was seen between maternal and cord blood
hemoglobin levels.Najeeba CM et al [12] showed decrease in cord blood levels of
hemoglobin with decreasing maternal hemoglobin levels. However, this reduction
was not statistically significant.Cantwell et al [13] also showed that mothers
who were not given adequate iron in pregnancy still had similar levels of cord
blood hemoglobin. Turkay et al [14] found no correlation between maternal and
cord blood hemoglobin. Bhargava et al [15] reported that iron depletion in
mother did not have any significant effect on the fetus.Rusia et al [16] found
that maternal hemoglobin levels did not correlate with cord blood hemoglobin levels,
however, found it to be correlated directly with cord blood ferritin levels.
Teref B et al [17] in his study
showed reduced iron stores in neonates born of mothers with anemia compared to
non anemic mothers. He also showed reduced hemoglobin levels in newborns of
anemic mothers compared to non anemicones. This finding correlates with our
study too.
In previous studies it has been suggested that
fetus continues to extract iron from mother regardless of her iron status.However,
many recent studies including our study shows thatiron supply to fetus is
nonetheless affected in maternal anemia and fetus extract iron from mother in
direct proportion to mother’s level.
Iron transportation occurs actively
from mother to fetus. There occurs upgradation of iron transport proteins in
placenta in iron deficient states.Howeverplacental mechanisms of iron transport
from mother to fetus may be affected in high degrees of maternal anemia, thus,
causing lower levels of cord blood hemoglobin as also shown in our study.
Our study also had certain
limitations. Sample size was small. Iron status of mother and baby was not
determined. However, it is likely that such mothers and their babies had
decreased iron stores.
Conclusion
This study thus, shows direct
correlation between maternal and fetal hemoglobin levels. we, therefore stress
the importance of preventing maternal anemia and maintaining adequate iron storage
in mothers during pregnancy to ensure better maternal and fetal outcome. We
also emphasize the importance of cord blood hemoglobin for early diagnosis of
neonatal anemia and early intervention if required.
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