{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T19:54:15Z","timestamp":1784318055475,"version":"3.55.0"},"reference-count":40,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2023,12,8]],"date-time":"2023-12-08T00:00:00Z","timestamp":1701993600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100006014","name":"College of Medicine and Health Sciences, United Arab Emirates University","doi-asserted-by":"publisher","award":["31M426"],"award-info":[{"award-number":["31M426"]}],"id":[{"id":"10.13039\/501100006014","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Low hemoglobin (Hb) level is a leading cause of many adverse pregnancy outcomes. Patterns of changes in Hb levels during pregnancy are not well understood.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Aim<\/jats:title>\n<jats:p>This study estimated Hb levels, described its changing patterns across gestational trimesters, and identified factors associated with these changes among pregnant women.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Materials and methods<\/jats:title>\n<jats:p>Data from the ongoing maternal and child health cohort study\u2013The Mutaba\u2019ah Study, was used (N = 1,120). KML machine learning algorithm was applied to identify three distinct cluster trajectories of Hb levels between the first and the third trimesters. Descriptive statistics were used to profile the study participants. Multinomial multivariable logistic regression was employed to identify factors associated with change patterns in Hb levels.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Results<\/jats:title>\n<jats:p>The three identified clusters\u2013A, B and C\u2013had, respectively, median Hb levels (g\/L) of 123, 118, and 104 in the first trimester and 119, 100, and 108 in the third trimester. Cluster \u2019A\u2019 maintained average normal Hb levels in both trimesters. Cluster \u2019B\u2019, on average, experienced a decrease in Hb levels below the normal range during the third trimester. Cluster \u2019C\u2019 showed increased Hb levels in the third trimester but remained, on average, below the normal range in both trimesters. Pregnant women with higher gravida, diabetes mellitus (type 1 or 2), nulliparity or lower level of education were more likely to be in cluster \u2019B\u2019 than the normal cluster \u2019A\u2019. Pregnant women who reported using iron supplements before pregnancy or those with low levels of education. were more likely to be in cluster \u2019C\u2019 than the normal cluster \u2019A\u2019.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec005\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>The majority of pregnant women experienced low Hb levels during pregnancy. Changes in Hb levels during pregnancy were associated with parity, gravida, use of iron before pregnancy, and the presence of diabetes mellitus (type 1 or 2).<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0295549","type":"journal-article","created":{"date-parts":[[2023,12,8]],"date-time":"2023-12-08T18:28:15Z","timestamp":1702060095000},"page":"e0295549","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":6,"title":["Temporal trends of hemoglobin among pregnant women: The Mutaba\u2019ah study"],"prefix":"10.1371","volume":"18","author":[{"given":"Aminu S.","family":"Abdullahi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abubaker","family":"Suliman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4970-4618","authenticated-orcid":true,"given":"Moien AB","family":"Khan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Howaida","family":"Khair","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saad","family":"Ghazal-Aswad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iffat","family":"Elbarazi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatima","family":"Al-Maskari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom","family":"Loney","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6102-0353","authenticated-orcid":true,"given":"Rami H.","family":"Al-Rifai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5292-8212","authenticated-orcid":true,"given":"Luai A.","family":"Ahmed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,12,8]]},"reference":[{"issue":"9","key":"pone.0295549.ref001","doi-asserted-by":"crossref","first-page":"1281","DOI":"10.3324\/haematol.13692","article-title":"Variability and heritability of hemoglobin concentration: an opportunity to improve understanding of anemia in older adults","volume":"93","author":"KV Patel","year":"2008","journal-title":"haematologica"},{"key":"pone.0295549.ref002","volume-title":"Structure-function relations of human hemoglobins. Baylor University Medical Center Proceedings","author":"AJ Marengo-Rowe","year":"2006"},{"issue":"1","key":"pone.0295549.ref003","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1038\/s41598-022-05801-y","article-title":"Higher hemoglobin levels are an independent risk factor for gestational diabetes","volume":"12","author":"N Sissala","year":"2022","journal-title":"Scientific reports"},{"issue":"1","key":"pone.0295549.ref004","doi-asserted-by":"crossref","first-page":"257S","DOI":"10.1093\/ajcn\/72.1.257S","article-title":"Iron requirements in pregnancy and strategies to meet them","volume":"72","author":"TH Bothwell","year":"2000","journal-title":"The American journal of clinical nutrition"},{"key":"pone.0295549.ref005","volume-title":"Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity","author":"WH Organization","year":"2011"},{"key":"pone.0295549.ref006","unstructured":"Organization WH. WHO Global Anaemia Estimates, 2021 Edition. Anaemia in Women and Children Available online: https:\/\/www.who.int\/data\/gho\/data\/themes\/topics\/anaemia_in_women_and_children (accessed on 18 February 2022). 2021."},{"issue":"3","key":"pone.0295549.ref007","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1177\/026010600201600302","article-title":"Iron deficiency anaemia among children and pregnant women in the Arab Gulf countries: the need for action.","volume":"16","author":"AO Musaiger","year":"2002","journal-title":"Nutrition and Health"},{"issue":"1","key":"pone.0295549.ref008","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/S0306-9192(02)00070-2","article-title":"The economics of iron deficiency","volume":"28","author":"S Horton","year":"2003","journal-title":"Food policy"},{"issue":"6","key":"pone.0295549.ref009","doi-asserted-by":"crossref","first-page":"1234","DOI":"10.1097\/AOG.0000000000003557","article-title":"Maternal and perinatal morbidity and mortality associated with anemia in pregnancy.","volume":"134","author":"C Smith","year":"2019","journal-title":"Obstetrics and gynecology."},{"issue":"5","key":"pone.0295549.ref010","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1034\/j.1600-0412.2001.080005402.x","article-title":"Maternal hematological status and risk of low birth weight and preterm delivery in Nepal.","volume":"80","author":"GT Bondevik","year":"2001","journal-title":"Acta obstetricia et gynecologica Scandinavica."},{"issue":"2","key":"pone.0295549.ref011","doi-asserted-by":"crossref","first-page":"495","DOI":"10.3945\/ajcn.115.107896","article-title":"Maternal anemia and risk of adverse birth and health outcomes in low-and middle-income countries: systematic review and meta-analysis, 2","volume":"103","author":"MM Rahman","year":"2016","journal-title":"The American journal of clinical nutrition"},{"issue":"3","key":"pone.0295549.ref012","first-page":"125","article-title":"Maternal Anemia during pregnancy and infant low birth weight: A systematic review and Meta-analysis.","volume":"15","author":"S Rahmati","year":"2017","journal-title":"International journal of reproductive biomedicine"},{"issue":"2","key":"pone.0295549.ref013","first-page":"98","article-title":"Risks for preterm delivery and low birth weight are independently increased by severity of maternal anaemia","volume":"99","author":"HL Kidanto","year":"2009","journal-title":"South African Medical Journal"},{"key":"pone.0295549.ref014","first-page":"1035","article-title":"Assessment of Anemia, IDA and ID among pregnants in Qatar: Cross sectional survey.","volume":"2","author":"N Selim","year":"2016","journal-title":"SMJ Public Health Epidemiol"},{"issue":"7","key":"pone.0295549.ref015","doi-asserted-by":"crossref","first-page":"e0267005","DOI":"10.1371\/journal.pone.0267005","article-title":"Prevalence and predictors of anemia among pregnant women in Ethiopia: Systematic review and meta-analysis.","volume":"17","author":"TG Geta","year":"2022","journal-title":"PloS one."},{"issue":"6","key":"pone.0295549.ref016","doi-asserted-by":"crossref","first-page":"585","DOI":"10.3109\/09637486.2011.566848","article-title":"Risk factors associated with anemia and iron deficiency among Kuwaiti pregnant women","volume":"62","author":"F Ahmed","year":"2011","journal-title":"International journal of food sciences and nutrition"},{"issue":"3","key":"pone.0295549.ref017","first-page":"E653","article-title":"Prevalence of anemia and associated risk factors among pregnant women in an urban community at the North of Saudi Arabia","volume":"62","author":"MA Alreshidi","year":"2021","journal-title":"Journal of Preventive Medicine and Hygiene"},{"issue":"4","key":"pone.0295549.ref018","doi-asserted-by":"crossref","first-page":"322","DOI":"10.5001\/omj.2018.59","article-title":"Can gestational anemia be alleviated with increased awareness of its causes and management strategies? implications for health care services","volume":"33","author":"V Seshan","year":"2018","journal-title":"Oman medical journal"},{"issue":"8","key":"pone.0295549.ref019","doi-asserted-by":"crossref","first-page":"e030937","DOI":"10.1136\/bmjopen-2019-030937","article-title":"Mutaba\u2019ah\u2014Mother and Child Health Study: Protocol for a prospective cohort study investigating the maternal and early life determinants of infant, child, adolescent and maternal health in the United Arab Emirates","volume":"9","author":"A Al Haddad","year":"2019","journal-title":"BMJ open"},{"key":"pone.0295549.ref020","doi-asserted-by":"crossref","first-page":"1","DOI":"10.18637\/jss.v065.i04","article-title":"kml and kml3d: R packages to cluster longitudinal data","volume":"65","author":"C Genolini","year":"2015","journal-title":"Journal of Statistical Software"},{"issue":"10","key":"pone.0295549.ref021","doi-asserted-by":"crossref","first-page":"906","DOI":"10.1001\/archpediatrics.2011.153","article-title":"Developmental trajectories of body mass index in early childhood and their risk factors: an 8-year longitudinal study","volume":"165","author":"LE Pryor","year":"2011","journal-title":"Archives of pediatrics & adolescent medicine"},{"issue":"9","key":"pone.0295549.ref022","doi-asserted-by":"crossref","first-page":"3080","DOI":"10.3390\/nu13093080","article-title":"Longitudinal Plasma Metabolomics Profile in Pregnancy\u2014A Study in an Ethnically Diverse US Pregnancy Cohort.","volume":"13","author":"SD Mitro","year":"2021","journal-title":"Nutrients."},{"issue":"1","key":"pone.0295549.ref023","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/03610927408827101","article-title":"A dendrite method for cluster analysis.","volume":"3","author":"T Cali\u0144ski","year":"1974","journal-title":"Communications in Statistics-theory and Methods"},{"key":"pone.0295549.ref024","volume-title":"R: A language and environment for statistical computing.","author":"Team RC"},{"issue":"1","key":"pone.0295549.ref025","doi-asserted-by":"crossref","first-page":"56","DOI":"10.3109\/03630269.2013.848811","article-title":"Half of the Emirati population has abnormal red cell parameters: challenges for standards and screening guidelines","volume":"38","author":"B Al-Dabbagh","year":"2014","journal-title":"Hemoglobin"},{"key":"pone.0295549.ref026","doi-asserted-by":"crossref","first-page":"211","DOI":"10.3389\/fpubh.2020.00211","article-title":"Antenatal care initiation among pregnant women in the United Arab Emirates: the Mutaba\u2019ah study.","volume":"8","author":"N Ali","year":"2020","journal-title":"Frontiers in public health"},{"issue":"4","key":"pone.0295549.ref027","doi-asserted-by":"crossref","first-page":"773","DOI":"10.1093\/ajcn\/78.4.773","article-title":"Iron supplementation during pregnancy, anemia, and birth weight: a randomized controlled trial","volume":"78","author":"ME Cogswell","year":"2003","journal-title":"The American journal of clinical nutrition"},{"key":"pone.0295549.ref028","doi-asserted-by":"crossref","first-page":"949","DOI":"10.1007\/s00277-008-0518-4","article-title":"Prepartum anaemia: prevention and treatment","volume":"87","author":"N. Milman","year":"2008","journal-title":"Annals of hematology"},{"issue":"1","key":"pone.0295549.ref029","first-page":"78","article-title":"\u0130. The role of intravenous iron sucrose treatment in patients with iron deficiency anemia in pregnancy: a prospective controlled cohort study","volume":"3","author":"\u00c7\u00d6L \u015eahin ME","year":"2019","journal-title":"Journal of Surgery and Medicine"},{"key":"pone.0295549.ref030","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1590\/S1020-49892004000500005","article-title":"Efetividade de tr\u00eas esquemas com sulfato ferroso para tratamento de anemia em gestantes.","volume":"15","author":"AId Souza","year":"2004","journal-title":"Revista Panamericana de Salud P\u00fablica"},{"issue":"2","key":"pone.0295549.ref031","doi-asserted-by":"crossref","first-page":"100569","DOI":"10.1016\/j.ajogmf.2022.100569","article-title":"The impact of response to iron therapy on maternal and neonatal outcomes among pregnant women with anemia. American Journal of Obstetrics &","volume":"4","author":"SE Detlefs","year":"2022","journal-title":"Gynecology MFM"},{"issue":"2","key":"pone.0295549.ref032","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1016\/j.ajog.2004.08.028","article-title":"Role of Helicobacter pylori infection in iron deficiency during pregnancy","volume":"192","author":"M Weyermann","year":"2005","journal-title":"American journal of obstetrics and gynecology"},{"issue":"3","key":"pone.0295549.ref033","first-page":"326","article-title":"How I treat unexplained refractory iron deficiency anemia","volume":"123","author":"C Hershko","year":"2014","journal-title":"Blood, The Journal of the American Society of Hematology."},{"issue":"4","key":"pone.0295549.ref034","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1007\/s004040000107","article-title":"Obstetric outcome in grand multipara in the United Arab Emirates","volume":"264","author":"D Rizk","year":"2001","journal-title":"Archives of gynecology and obstetrics"},{"issue":"1","key":"pone.0295549.ref035","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/0020-7292(91)90171-Z","article-title":"Grand multiparity: a reappraisal of the risks","volume":"36","author":"P King","year":"1991","journal-title":"International Journal of Gynecology & Obstetrics."},{"issue":"5","key":"pone.0295549.ref036","doi-asserted-by":"crossref","first-page":"301","DOI":"10.3109\/01443619209015511","article-title":"Grand grand multiparity","volume":"12","author":"L. Silva","year":"1992","journal-title":"Journal of Obstetrics and Gynaecology"},{"issue":"4","key":"pone.0295549.ref037","doi-asserted-by":"crossref","first-page":"739","DOI":"10.4103\/jfmpc.jfmpc_33_17","article-title":"Prospective study on prevalence of anemia of pregnant women and its outcome: A community based study","volume":"6","author":"R Suryanarayana","year":"2017","journal-title":"Journal of family medicine and primary care"},{"key":"pone.0295549.ref038","doi-asserted-by":"crossref","first-page":"S685","DOI":"10.1016\/j.dsx.2017.04.026","article-title":"Diabetes and Anemia: International Diabetes Federation (IDF)\u2013Southeast Asian Region (SEAR) position statement.","volume":"11","author":"M Sahay","year":"2017","journal-title":"Diabetes & Metabolic Syndrome: Clinical Research & Reviews."},{"issue":"1 Suppl 1","key":"pone.0295549.ref039","doi-asserted-by":"crossref","first-page":"S86","DOI":"10.1016\/j.amepre.2010.10.006","article-title":"Strengthening the public research agenda for social determinants of health.","volume":"40","author":"CA Boyce","year":"2011","journal-title":"American journal of preventive medicine"},{"issue":"1","key":"pone.0295549.ref040","first-page":"64","article-title":"Anemia in pregnancy-consequences and challenges: a review of literature","volume":"4","author":"JA Noronha","year":"2012","journal-title":"Journal of South Asian Federation of Obstetrics and Gynecology"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0295549","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,12,8]],"date-time":"2023-12-08T18:28:50Z","timestamp":1702060130000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0295549"}},"subtitle":[],"editor":[{"given":"Hlengani Lawrence","family":"Chauke","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2023,12,8]]},"references-count":40,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2023,12,8]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0295549","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,12,8]]}}}