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Greater hemoglobin improvement at 20–24 weeks is associated with a lower risk of stillbirth, while hemoglobin below 10.5 g/dL is associated with progressively higher risks of stillbirth and early preterm birth.
A rise in hemoglobin (Hb) during pregnancy may be more than a marker of treatment success—it could also signal how well a pregnancy is progressing. Novel findings from a large multicentre analysis suggest that pregnant women whose Hb fails to improve adequately after iron therapy may face a greater likelihood of stillbirth and early preterm birth.
The investigation examined data from 4,252 pregnant singletons diagnosed with moderate iron deficiency anemia (IDA; baseline Hb: 7.0–9.9 g/dL) between 14 and 17 weeks of gestation. Volunteers were assigned across three treatment arms:
Predictors of interest—including maternal Hb, serum ferritin, and transferrin saturation (TSAT)—were evaluated at 20 to 24 weeks of gestation, alongside longitudinal tracking throughout pregnancy.
A Stronger Hb Rise, Lower Stillbirth Risk
The most striking finding was the connection between Hb response and stillbirth. Each unit rise in Hb response at 20–24 weeks was linked with a lower risk of stillbirth (relative risk, 0.74)—equivalent to an approximately 26% lower relative risk.
The researchers also identified a threshold-like pattern. Stillbirth risk progressively increased as Hb fell below 10.5 g/dL. A similar progressive increase was observed for early preterm birth before 34 weeks.
No Clear Association With Small-for-Gestational-Age (SGA) Birth
Although Hb illustrated a prominent quadratic relationship with SGA birth, the relative risk associated with lower Hb was not statistically significant.
To sum up, suboptimal hematologic recovery at 20–24 weeks gestation highlights a crucial window where persistent anemia poses severe fetal threats. The findings emphasize the urgent requisition for timely mid-pregnancy screening to monitor iron treatment efficacy. Future clinical research must assess whether preconception or early first-trimester iron interventions yield superior protective benefits against adverse perinatal events.
The American Journal of Obstetrics & Gynecology
Association between hematologic response to iron therapy and risk of stillbirth in pregnant singletons with moderate iron deficiency anemia
Rupsa C Boelig et al.
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