ArticleBMJ open2018
Pathways of association between maternal haemoglobin and stillbirth: path-analysis of maternity data from two hospitals in England.
Article in BMJ open, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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Who cites it
5 citing papers in PubMed, 10 citations in OpenAlex.
- Article
- Risk of stillbirth among pregnant women with anaemia in India: secondary analysis of multiple cohorts from the ICMR-SPIC consortium.The Lancet regional health. Southeast Asia · 2026Article
- A silent link between stillbirth and maternal anaemia: evidence from the fifth round of the National Family Health Survey.Reproductive health · 2026Article
- Iron Deficiency Anaemia in Pregnancy: A Narrative Review from a Clinical Perspective.Diagnostics (Basel, Switzerland) · 2024Review
- Prevalence and Correlates of Asymptomatic Malaria and Anemia on First Antenatal Care Visit among Pregnant Women in Southeast, Tanzania.International journal of environmental research and public health · 2020Article
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Authors and funding
6 authors at 5 institutions in 1 country.
Funding
Abstract
objectiveTo investigate the mechanisms that link maternal haemoglobin concentration with stillbirth.
designA retrospective cohort analysis using anonymised maternity data from two hospitals in England.
settingThe Royal Wolverhampton NHS Trust and Guy's and St Thomas' NHS Foundation Trust. STUDY POPULATION: 12 636 women with singleton pregnancies ≥24 weeks of gestation giving birth in the two hospitals during 2013-2015.
methodA conceptual framework of hypothesised pathways through birth weight-for-gestational age and maternal infection including potential confounders and other risk factors was developed and examined using path-analysis. Path-analysis was performed by fitting a set of regression equations using weighted least squares adjusted for mean and variance. Goodness-of-fit indices were estimated.
main outcome measuresCoefficient of association (β) for relationship between each parameter, and direct, indirect and total effects via the postulated pathways.
resultsThe path-model showed a significant adjusted indirect negative effect of maternal haemoglobin on stillbirth mediated via birth weight-for-gestational age (standardised estimate (SE)=-0.01; 95% CI=-0.01 to -0.001; P=0.028). The effect through maternal infection was not significant at P<0.05 (SE=0.001; 95% CI=-0.004 to 0.01; P=0.610). There was a residual direct negative effect of maternal haemoglobin on stillbirth (SE=-0.12; 95% CI -0.23 to -0.02; P=0.020) after accounting for the two pathways. Total indirect SE=-0.004; 95% CI -0.01 to 0.003; P=0.267; total direct and indirect SE=-0.13; 95% CI -0.23 to -0.02; P=0.016. The goodness-of-fit indices showed a good fit between the model and the data.
conclusionWhile some of the influence on risk of stillbirth acts through low birth weight-for-gestational age, the majority does not. Several new mechanisms have been suggested for how haemoglobin may be exerting its influence on the risk of stillbirth possibly involving genetic, epigenetic and/or alternative obstetric and nutritional pathologies, but much more research is needed.
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