Lower haemoglobin may be the result rather than the cause of larger fetuses

BMJ 1995;310:1601 (17 June)

Letters

Lower haemoglobin may be the result rather than the cause of larger fetuses

EDITOR,--Philip Steer and colleagues studied the relation betweenmaternal haemoglobin concentration in pregnancy and birth weightand suggested that their results show that low haemoglobin concentrationsare advantageous in improving fetal growth.¹ They even suggesteda theoretical risk that treatment to improve haemoglobin concentrationsmay be detrimental to the fetus. They do not discuss the alternativeexplanation that lower haemoglobin concentrations are the resultrather than the cause of larger fetuses. Expansion of plasmavolume, and therefore haemodilution, is greater in associationwith larger fetuses, and this may account for the relation Steerand colleagues observed.

Garn et al, who studied a large cohort of American women,² previouslydescribed a U shaped relation between the lowest maternal haemoglobinconcentration in pregnancy and poor outcome in the form of pretermdelivery, low birth weight, or perinatal death. The lowest incidenceof stillbirths occurred in association with haemoglobin concentrationsbetween 90 g/l . . . [Full text of this article]

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Relevant Article

Relation between maternal haemoglobin concentration and birth weight in different ethnic groups: Philip Steer, M Ash Alam, Jane Wadsworth, and Anne Welch
BMJ 1995 310: 489-491. [Abstract] [Full Text]