title: Association of hemoglobin values at booking with adverse maternal outcomes among Peruvian populations living at different altitudes.
abstract: OBJECTIVE
  To determine hemoglobin values associated with adverse maternal outcomes among Peruvian populations at different altitudes.
  
  
  METHODS
  A retrospective cohort study was conducted using data from the Perinatal Information System. Adverse maternal outcomes were assessed.
  
  
  RESULTS
  Risk of pre-eclampsia increased at maternal hemoglobin levels above 14.5 g/dL (OR 1.27; 95% CI, 1.18-1.36) or below 7.0 g/dL (OR 1.52; CI 95%, 1.08-2.14). Altitude above 2000 m reduced risk (OR 0.65; 95% CI 0.62-0.68). Risk of postpartum hemorrhage (PPH) increased with moderate/severe anemia (OR 6.15; 95% CI, 3.86-9.78) and at moderate altitudes (OR 1.26; 95% CI, 1.12-1.43). Mild anemia at any altitude was associated with reduced risk of pre-eclampsia (OR 0.85, 95% CI, 0.81-0.89) and PPH (OR 1.01; 95% CI, 0.88-1.15). Risk of premature rupture of membranes was reduced at high hemoglobin values. Maternal mortality increased at hemoglobin levels below 9.0 g/dL (OR 5.68; 95% CI, 2.97-10.80) and above 14.5 g/dL (OR 2.18; 95% CI, 1.22-3.91). Maternal mortality increased at moderate altitudes (OR 29.2; 95% CI, 2.62-324.60) and high altitudes (OR 66.4; 95% CI, 6.65-780.30) when hemoglobin levels were below 9.0 g/dL.
  
  
  CONCLUSIONS
  Elevated altitude and hemoglobin levels influence maternal outcomes.
authors.affiliation: Department of Biological and Physiological Sciences, Universidad Peruana Cayetano Heredia, Lima, Peru. gustavo.gonzales@upch.pe
authors.forename: Gustavo F
authors.initials: GF
authors.lastname: Gonzales
authors.forename: Vilma
authors.initials: V
authors.lastname: Tapia
authors.forename: Manuel
authors.initials: M
authors.lastname: Gasco
authors.forename: Carlos E
authors.initials: CE
authors.lastname: Carrillo
authors.forename: Alfredo L
authors.initials: AL
authors.lastname: Fort
mesh_terms: D000328:Adult; D000531:Altitude; D000740:Anemia / Q000453:epidemiology / Q000209:etiology; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000453:epidemiology / Q000209:etiology; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D008428:Maternal Mortality; D010568:Peru / Q000453:epidemiology; D006473:Postpartum Hemorrhage / Q000453:epidemiology / Q000209:etiology; D011225:Pre-Eclampsia / Q000453:epidemiology / Q000209:etiology; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
chemical_list: D006454:Hemoglobins