{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T01:53:52Z","timestamp":1790042032272,"version":"4.0.1"},"reference-count":31,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2021,4,12]],"date-time":"2021-04-12T00:00:00Z","timestamp":1618185600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["U24 HD092094"],"award-info":[{"award-number":["U24 HD092094"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Limited data are available from low\u2010 and middle\u2010income countries (LMICs) on the relationship of haemoglobin levels to adverse outcomes at different times during pregnancy. We evaluated the association of haemoglobin levels in nulliparous women at two times in pregnancy with pregnancy outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>ASPIRIN Trial data were used to study the association between haemoglobin levels measured at 6<jats:sup>+0<\/jats:sup>\u201313<jats:sup>+6<\/jats:sup>\u00a0weeks and 26<jats:sup>+0<\/jats:sup>\u201330<jats:sup>+0<\/jats:sup>\u00a0weeks of gestation with fetal and neonatal outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Obstetric care facilities in Pakistan, India, Kenya, Zambia, The Democratic Republic of the Congo and Guatemala.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>A total of 11\u00a0976 pregnant women.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Generalised linear models were used to obtain adjusted relative risks and 95% CI for adverse outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>Preterm birth, stillbirth, neonatal death, small for gestational age (SGA) and birthweight &lt;2500\u00a0g.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The mean haemoglobin levels at 6<jats:sup>+0<\/jats:sup>\u201313<jats:sup>+6<\/jats:sup>\u00a0weeks and at 26\u201330\u00a0weeks of gestation were 116\u00a0g\/l (SD 17) and 107\u00a0g\/l (SD 15), respectively. In general, pregnancy outcomes were better with increasing haemoglobin. At 6<jats:sup>+0<\/jats:sup>\u201313<jats:sup>+6<\/jats:sup>\u00a0weeks of gestation, stillbirth, SGA and birthweight &lt;2500\u00a0g, were significantly associated with haemoglobin of 70\u201389\u00a0g\/l compared with haemoglobin of 110\u2013129\u00a0g\/l The relationships of adverse pregnancy outcomes with various haemoglobin levels were more marked at 26\u201330\u00a0weeks of gestation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Both lower and some higher haemoglobin concentrations are associated with adverse fetal and neonatal outcomes at 6<jats:sup>+0<\/jats:sup>\u201313<jats:sup>+6<\/jats:sup>\u00a0weeks and at 26\u201330\u00a0weeks of gestation, although the relationship with low haemoglobin levels appears more consistent and generally stronger.<\/jats:p><\/jats:sec><jats:sec><jats:title>Tweetable abstract<\/jats:title><jats:p>Both lower and some higher haemoglobin concentrations were associated with adverse fetal and neonatal outcomes at 6\u201313\u00a0weeks and 26\u201330\u00a0weeks of gestation.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.16676","type":"journal-article","created":{"date-parts":[[2021,2,25]],"date-time":"2021-02-25T07:56:04Z","timestamp":1614239764000},"page":"1487-1496","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["Association of haemoglobin levels in the first trimester and at 26\u201330\u00a0weeks with fetal and neonatal outcomes: a secondary analysis of the Global Network for Women's and Children's Health's ASPIRIN Trial"],"prefix":"10.1111","volume":"128","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3025-2025","authenticated-orcid":false,"given":"S","family":"Jessani","sequence":"first","affiliation":[{"name":"Department of Community Health Sciences Aga Khan University Karachi 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