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<p>This study evaluated dose–response relationships between haemoglobin concentration in pregnancy and maternal and neonatal outcomes based on comprehensive systematic reviews using the Burden of Proof meta-analytic framework. Risk estimates accounting for uncertainty and quantitative star ratings were generated to assess evidence strength. Our analysis revealed that even small deviations above or below haemoglobin levels with the lowest predicted risk—particularly on the low end (anaemia)—were associated with nonlinear increased risks of all-cause maternal and neonatal mortality, postpartum haemorrhage, maternal sepsis, preterm birth, low birth weight and large for gestational age. Across outcomes with at least moderate evidence strength (&gt;2 stars), maternal haemoglobin levels associated with the lowest risk ranged from 109 to 135 g l<sup>−1</sup>, challenging the appropriateness of fixed anaemia thresholds. Even modest population-level shifts in haemoglobin distributions could meaningfully affect the burden of adverse outcomes, supporting more refined, trimester- and outcome-specific thresholds to better identify at-risk individuals and guide clinical interventions.</p>

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Maternal and neonatal outcomes associated with haemoglobin concentration in pregnancy: a Burden of Proof study

  • 期刊论文

  • 发表日期：

    2026年6月24日

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  • Ni Gusti Ayu Nanditha,
  • Dong Keun Rhee,
  • Corey J. Teply,
  • Heidi A. Tandiono,
  • Ihunaya Okorie,
  • Heather J. Taylor,
  • Bridget L. Stollfus,
  • Huong T. Chu,
  • Taylor S. Noyes,
  • Kyle Humphrey,
  • Jackie Markt-Maloney,
  • Aishe Memetova,
  • Eunice Chung,
  • Ashley A. Harris,
  • Kia C. Fuller,
  • Maegan A. Dirac,
  • Zulfiqar A. Bhutta,
  • William M. Gardner,
  • Ksenia I. Ershova,
  • Domenico Girelli,
  • Khaled M. Musallam,
  • Parminder S. Suchdev,
  • Susan A. McLaughlin,
  • Reed J. D. Sorensen,
  • Aleksandr Y. Aravkin,
  • Peng Zheng,
  • Nora M. Gilbertson,
  • Christopher J. L. Murray,
  • Simon I. Hay,
  • Theresa A. McHugh,
  • Nandita Perumal,
  • Nicholas J. Kassebaum

摘要

This study evaluated dose–response relationships between haemoglobin concentration in pregnancy and maternal and neonatal outcomes based on comprehensive systematic reviews using the Burden of Proof meta-analytic framework. Risk estimates accounting for uncertainty and quantitative star ratings were generated to assess evidence strength. Our analysis revealed that even small deviations above or below haemoglobin levels with the lowest predicted risk—particularly on the low end (anaemia)—were associated with nonlinear increased risks of all-cause maternal and neonatal mortality, postpartum haemorrhage, maternal sepsis, preterm birth, low birth weight and large for gestational age. Across outcomes with at least moderate evidence strength (>2 stars), maternal haemoglobin levels associated with the lowest risk ranged from 109 to 135 g l−1, challenging the appropriateness of fixed anaemia thresholds. Even modest population-level shifts in haemoglobin distributions could meaningfully affect the burden of adverse outcomes, supporting more refined, trimester- and outcome-specific thresholds to better identify at-risk individuals and guide clinical interventions.