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Gragasin FS, Ospina MB, Serrano-Lomelin J, Kim SH, Kokotilo M, Woodman AG, Renaud SJ, Bourque SL. Maternal and Cord Blood Hemoglobin as Determinants of Placental Weight: A Cross-Sectional Study. J Clin Med 2021; 10:jcm10050997. [PMID: 33801215 PMCID: PMC7957881 DOI: 10.3390/jcm10050997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/16/2021] [Accepted: 02/20/2021] [Indexed: 12/12/2022] Open
Abstract
Background: Both high and low placental weights are associated with adverse pregnancy outcomes. Maternal hemoglobin levels can influence placental weight, but the evidence is conflicting. Since maternal hemoglobin does not invariably correlate with fetal/neonatal blood hemoglobin levels, we sought to determine whether cord blood hemoglobin or maternal hemoglobin status more closely associates with placental weight in women undergoing elective cesarean section at term. Methods: This was a cross-sectional study conducted at the Royal Alexandra Hospital, Edmonton, Canada, involving 202 women with term singleton pregnancies undergoing elective cesarean section. Maternal blood and mixed cord blood hemoglobin levels were analyzed using a HemoCue Hb201+ system. Birth weight, placental weight, one- and five-minute APGAR scores, American Society of Anesthesiologists physical state classification, maternal age, and maternal height were also recorded. Relationships between maternal and cord blood hemoglobin levels with placental weight, birth weight, and birth weight to placental weight ratio were the main outcome measures. Results: A total of 182 subjects were included in the analysis. Regression analysis showed that cord blood hemoglobin, but not maternal hemoglobin, was inversely related with placental weight (β = −2.4, p = 0.001) and positively related with the birth weight to placental weight ratio (β = 0.015, p = 0.001 and p = 0.63, respectively). Conclusions: Our findings suggest that measuring cord blood hemoglobin levels, rather than maternal hemoglobin levels, may provide important diagnostic information about in utero fetal adaptation to suboptimal placental function and neonatal health.
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Affiliation(s)
- Ferrante S. Gragasin
- Department of Anesthesiology & Pain Medicine, University of Alberta, Edmonton, AB T6G 2G3, Canada; (F.S.G.); (M.K.)
- Women and Children’s Health Research Institute, University of Alberta, Edmonton, AB T6G 1C9, Canada; (M.B.O.); (J.S.-L.); (A.G.W.)
| | - Maria B. Ospina
- Women and Children’s Health Research Institute, University of Alberta, Edmonton, AB T6G 1C9, Canada; (M.B.O.); (J.S.-L.); (A.G.W.)
- Department of Obstetrics & Gynecology, University of Alberta, Edmonton, AB T6G 2R7, Canada
| | - Jesus Serrano-Lomelin
- Women and Children’s Health Research Institute, University of Alberta, Edmonton, AB T6G 1C9, Canada; (M.B.O.); (J.S.-L.); (A.G.W.)
- Department of Obstetrics & Gynecology, University of Alberta, Edmonton, AB T6G 2R7, Canada
| | - Su Hwan Kim
- Department of Mathematical & Statistical Sciences, University of Alberta, Edmonton, AB T6G 2G1, Canada;
| | - Matthew Kokotilo
- Department of Anesthesiology & Pain Medicine, University of Alberta, Edmonton, AB T6G 2G3, Canada; (F.S.G.); (M.K.)
| | - Andrew G. Woodman
- Women and Children’s Health Research Institute, University of Alberta, Edmonton, AB T6G 1C9, Canada; (M.B.O.); (J.S.-L.); (A.G.W.)
- Department of Pharmacology, University of Alberta, Edmonton, AB T6G 2H7, Canada
| | - Stephen J. Renaud
- Department of Anatomy and Cell Biology, University of Western Ontario, London, ON N6A 5C1, Canada;
| | - Stephane L. Bourque
- Department of Anesthesiology & Pain Medicine, University of Alberta, Edmonton, AB T6G 2G3, Canada; (F.S.G.); (M.K.)
- Women and Children’s Health Research Institute, University of Alberta, Edmonton, AB T6G 1C9, Canada; (M.B.O.); (J.S.-L.); (A.G.W.)
- Department of Pharmacology, University of Alberta, Edmonton, AB T6G 2H7, Canada
- Correspondence: ; Tel.: +1-780-492-6000
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Tsikouras P, Niesigk B, von Tempelhoff GF, Rath W, Schelkunov O, Daragó P, Csorba R. Blood rheology during normal pregnancy. Clin Hemorheol Microcirc 2018; 69:101-114. [PMID: 29758932 DOI: 10.3233/ch-189104] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Recent studies have shown increased RBC aggregation and no difference in plasma viscosity in the presence of markedly lower hematocrit in women at term compared to non-pregnant women. Little is known about the outcome of blood rheological parameters and red blood cell (RBC) deformability particularly in the course of normal pregnancy. METHODS During a 36 months interval 1.913 blood samples were randomly collected from a total of 945 pregnant women in the course of their pregnancy (n = 1.259) and during puerperium (upto 1 week; n = 654). Next to the blood count, hemorheological parameters including red blood cell (RBC) -aggregation (stasis E0; low shear E1), -deformability (low, moderate and high shear conditions) and plasma viscosity (pv) were assessed. Plasma viscosity (pv) was examined using KSPV 1 Fresenius, RBC aggregation (stasis: E0 and low shear: E1) using MA1-Aggregometer; Myrenne and RBC deformability (def) was determined by Rheodyn SSD Diffractometer, Myrenne, Roetgen, Germany were tested. In some of these women laboratory results prior to pregnancy (n = 145) were available which were compared with those during pregnancy. RESULTS Mean maternal pv remained unchanged within each trimester and compared to the values before pregnancy and during early puerperium (Range of means: 1.18-1.20 mPa S). In contrast, RBC agg (E0 and E1) was markedly higher in the 2nd (21.8 ± 7.0 and 28.9 ± 9.4; p < 0.001) and 3rd trimester (18.74 ± 8.4 and 28.2 ± 9.4; p < 0.01) compared to the values before pregnancy (16.4 ± 6.4 and 20 ± 7.5) and during 1st trimester (17.49 ± 6.5 and 22.4 ± 7.4). There was a stat. significant temporary reduction in RBC def. under all shear rate conditions during 2nd trimester compared to the values before pregnancy which remained significantly lower during 3rd trimester only under high shear rates.An increase RBC agg was stat. significantly inversely correlated with reduced RBC def being most pronounced under low shear rate conditions. While RBC rigidity was stat. significantly correlated with higher hematocrit values there was only a weak correlation between RBC agg and haematocrit (E0: r = -0.084; p = 0.03; E1: r = -0.06; p = 0.1). Pv was not correlated with haematocrit or RBC def but stat. significantly correlated with RBC agg. CONCLUSIONS Blood rheological changes manifest during 1st trimester, and fairly remain unchanged during 2nd trimester until term. Physiologic hemodilution and increasing hypercoagulability is accompanied by high RBC -aggregation and - rigidity during 2nd trimester while plasma viscosity remains nearly unaffected throughout normal pregnancy.
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Affiliation(s)
- Panagiotis Tsikouras
- Department of Obstetrics and Gynecology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Barbara Niesigk
- Department of Obstetrics and Gynecology, City Hospital of Aschaffenburg, Aschaffenburg, Germany
| | | | - Werner Rath
- Department of Obstetrics and Gynecology, University of Schleswig-Holstein Kiel, Germany
| | - Olga Schelkunov
- Department of Obstetrics and Gynecology, Vinzenz Hospital of Hanau, Germany
| | - Peter Daragó
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Hungary
| | - Roland Csorba
- Department of Obstetrics and Gynecology, City Hospital of Aschaffenburg, Aschaffenburg, Germany.,Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Hungary
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