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Relation between maternal haemoglobin concentration and birth weight in different ethnic groups

BMJ 1995; 310 doi: https://doi.org/10.1136/bmj.310.6978.489 (Published 25 February 1995) Cite this as: BMJ 1995;310:489
  1. Philip Steer, professora,
  2. M Ash Alam, medical studentb,
  3. Jane Wadsworth, senior lecturerc,
  4. Anne Welch, research assistantd
  1. a Academic Department of Obstetrics and Gynaecology, Charing Cross and Westminster Medical School, Chelsea and Westminster Hospital, London SW10 9NH
  2. b St Bartholomew's Hospital Medical College, London EC1A 7BE
  3. c Academic Department of Public Health, St Mary's Hospital Medical School, London W2 1PG
  4. d Academic Department of Obstetrics and Gynaecology, St Mary's Hospital Medical School, London W2 1PG
  1. Correspondence to: Professor Steer.
  • Accepted 12 December 1994

Abstract

Objective: To assess the relation of the lowest haemoglobin concentration in pregnancy with birth weight and the rates of low birth weight and preterm delivery in different ethnic groups.

Design: Retrospective analysis of 153602 pregnancies with ethnic group and birth weight recorded on a regional pregnancy database during 1988-91. The haemoglobin measurement used was the lowest recorded during pregnancy.

Setting: North West Thames region.

Subjects: 115262 white women, 22206 Indo-Pakistanis, 4570 Afro-Caribbeans, 2642 mediterraneans, 3905 black Africans, 2351 orientals, and 2666 others.

Main outcome measures: Birth weight and rates of low birth weight (<2500 g) and preterm delivery (<37 completed weeks).

Results: Maximum mean birth weight in white women was achieved with a lowest haemoglobin concentration in pregnancy of 85-95 g/l; the lowest incidence of low birth weight and preterm labour occurred with a lowest haemoglobin of 95-105 g/l. A similar pattern occurred in all ethnic groups.

Conclusions: The magnitude of the fall in haemoglobin concentration in pregnancy is related to birth weight; failure of the haemoglobin concentration to fall below 105 g/l indicates an increased risk of low birth weight and preterm delivery. This phenomenon is seen in all ethnic groups. Some ethnic groups have higher rates of low birth weight and preterm delivery than white women, and they also have higher rates of low haemoglobin concentrations. This increased rate of “anaemia,” however, does not account for their higher rates of low birth weight, which occurs at all haemoglobin concentrations.

Key messages

  • Key messages

  • Failure of the haemoglobin concentration to fall during pregnancy was associated with a five to sevenfold increase in the incidence of low birth weight and preterm birth

  • Routine haematinic administration in pregnancy is unnecessary on fetal grounds for most pregnancies

  • The mean corpuscular volume may be a better indicator of maternal iron deficiency, but this needs prospective study

Footnotes

    • Accepted 12 December 1994
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