{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T06:37:38Z","timestamp":1763015858027,"version":"3.45.0"},"reference-count":59,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T00:00:00Z","timestamp":1762992000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Anemia in premature infants, a high-risk category of patients, has been shown to impose significant economic and psychological burdens on families and society at large. Anemia is the most prevalent disease among pregnant women. The impact of anemia on the clinical high-risk status of premature infants remains elucidated; therefore, this study aims to investigate the risk factor of clinical high-risk infants in Chinese women based on anemia status.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>A retrospective analysis of the data from premature infants in four medical centres was conducted from January 2023\u2013May 2025. The data, including demographic information, medical histories, gestational diseases, fetal development, and fetal position, were collected. The analysis to identify the factors contributing to the clinical high risk of premature infants was conducted between the anemia groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 191 subjects were involved, with an average age of 29.20\u2009\u00b1\u20095.00 years, but only 34 (17.8%) cases were classified as clinical high-risk. The mean weight of the infants was recorded as 2483\u2009\u00b1\u2009458\u2005g, and the mean gestational age was determined to be 34.96\u2009\u00b1\u20091.20 weeks, including 72(37.7%) females. A statistically significant variation was observed among the anemia groups concerning maternal age, hypertension, uterine abnormalities, scarred uterus, and placental abnormalities (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.05). However, no statistically significant difference was found between high-risk and low-risk premature infants (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.838). In the nonanemia group, a statistically significant difference was observed among the variables of gender, gestational hypertension, placental abnormalities, placental abruption, umbilical cord abnormalities, and fetal dysplasia (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.05), with male was the protective factor [\n                      <jats:italic>OR<\/jats:italic>\n                      \u2009=\u20090.240, 95% CI\u2009=\u2009(0.076, 0.764)], while placental abruption [\n                      <jats:italic>OR<\/jats:italic>\n                      \u2009=\u200931.499, 95% CI\u2009=\u2009(2.707, 366.599)], and fetal dysplasia [\n                      <jats:italic>OR<\/jats:italic>\n                      \u2009=\u200916.927, 95% CI\u2009=\u2009(3.161, 90.630)] were risk factor. In the anemia group, mild anemia, severe anemia, and placenta previa were found to be statistically significant (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.05), but only severe anemia was a high-risk factor [\n                      <jats:italic>OR<\/jats:italic>\n                      \u2009=\u200918.600, 95% CI\u2009=\u2009(1.757, 196.927)].\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The findings of this study demonstrate that anemia exerts a significantly different influence on the clinical high-risk symptoms of premature infants. These differences can provide important reference points for managing pregnant women.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fped.2025.1690771","type":"journal-article","created":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T06:30:55Z","timestamp":1763015455000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Analysis of clinical risk factors of premature infants in Chinese women based on anemia status"],"prefix":"10.3389","volume":"13","author":[{"given":"Weiwei","family":"Ou","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhu","family":"Xu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dan","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,11,13]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1261","DOI":"10.1016\/S0140-6736(23)00878-4","article-title":"National, regional, and global estimates of preterm birth in 2020, with trends from 2010: a systematic analysis","volume":"402","author":"Ohuma","year":"2023","journal-title":"Lancet"},{"key":"B2","doi-asserted-by":"publisher","first-page":"e1226","DOI":"10.1016\/S2214-109X(21)00298-9","article-title":"Preterm births in China between 2012 and 2018: an observational study of more than 9 million women","volume":"9","author":"Deng","year":"2021","journal-title":"Lancet Glob Health"},{"key":"B3","doi-asserted-by":"publisher","first-page":"383","DOI":"10.1186\/s12884-022-04713-z","article-title":"Preterm delivery rate in China: a systematic review and meta-analysis","volume":"22","author":"Song","year":"2022","journal-title":"BMC Pregnancy Childbirth"},{"key":"B4","doi-asserted-by":"publisher","first-page":"e48815","DOI":"10.2196\/48815","article-title":"Spatiotemporal characteristics and risk factors for all and severity-specific preterm births in Southern China, 2014\u20132021: large population-based study","volume":"10","author":"Miao","year":"2024","journal-title":"JMIR Public Health Surveill"},{"key":"B5","doi-asserted-by":"publisher","first-page":"e211058","DOI":"10.1001\/jamapediatrics.2021.1058","article-title":"Association of very preterm birth or very low birth weight with intelligence in adulthood: an individual participant data meta-analysis","volume":"175","author":"Eves","year":"2021","journal-title":"JAMA Pediatr"},{"key":"B6","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1016\/j.jpeds.2022.09.032","article-title":"Risk-taking behavior of adolescents and young adults born preterm","volume":"253","author":"Alenius","year":"2023","journal-title":"J Pediatr"},{"key":"B7","doi-asserted-by":"publisher","first-page":"231","DOI":"10.1038\/s41598-023-30739-0","article-title":"Author correction: school grades and educational attainments of adolescents and young adults born preterm","volume":"13","author":"Alenius","year":"2023","journal-title":"Sci Rep"},{"key":"B8","doi-asserted-by":"publisher","first-page":"e196961","DOI":"10.1001\/jamanetworkopen.2019.6961","article-title":"Association of preterm birth and low birth weight with romantic partnership, sexual intercourse, and parenthood in adulthood: a systematic review and meta-analysis","volume":"2","author":"Mendon\u00e7a","year":"2019","journal-title":"JAMA Netw Open"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1565897","DOI":"10.3389\/fped.2025.1565897","article-title":"Long-term health outcomes of preterm birth: a narrative review","volume":"13","author":"Gette","year":"2025","journal-title":"Front Pediatr"},{"key":"B10","doi-asserted-by":"publisher","first-page":"14357","DOI":"10.1038\/s41598-025-98868-2","article-title":"Rising public costs of preterm infant hospitalization in South Korea from a nationwide observational study","volume":"15","author":"Lee","year":"2025","journal-title":"Sci Rep"},{"key":"B11","doi-asserted-by":"publisher","first-page":"106","DOI":"10.1016\/S2352-4642(21)00311-4","article-title":"Global, regional, and national causes of under-5 mortality in 2000\u201319: an updated systematic analysis with implications for the sustainable development goals","volume":"6","author":"Perin","year":"2022","journal-title":"Lancet Child Adolesc Health"},{"key":"B12","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1186\/s12978-025-02033-x","article-title":"Born too soon: global epidemiology of preterm birth and drivers for change","volume":"22","author":"Bradley","year":"2025","journal-title":"Reprod Health"},{"key":"B13","doi-asserted-by":"publisher","first-page":"2637","DOI":"10.1007\/s00277-023-05481-2","article-title":"Pathophysiology and management of iron deficiency anaemia in pregnancy: a review","volume":"103","author":"Kirthan","year":"2024","journal-title":"Ann Hematol"},{"key":"B14","doi-asserted-by":"publisher","first-page":"2306","DOI":"10.3390\/diagnostics14202306","article-title":"Iron deficiency anaemia in pregnancy: a narrative review from a clinical perspective","volume":"14","author":"Obianeli","year":"2024","journal-title":"Diagnostics"},{"key":"B15","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1186\/s12884-018-1739-8","article-title":"Prevalence, risk factors and associated adverse pregnancy outcomes of anaemia in Chinese pregnant women: a multicentre retrospective study","volume":"18","author":"Lin","year":"2018","journal-title":"BMC Pregnancy Childbirth"},{"key":"B16","doi-asserted-by":"publisher","first-page":"722","DOI":"10.1093\/fampra\/cmac148","article-title":"Maternal anaemia and birth weight: a cross-sectional study from Jiangxi province, China","volume":"40","author":"Xiong","year":"2023","journal-title":"Fam Pract"},{"key":"B17","doi-asserted-by":"publisher","first-page":"271","DOI":"10.3390\/nu14020271","article-title":"Preconception hemoglobin concentration and risk of low birth weight and small-for-gestational-age: a large prospective cohort study in China","volume":"14","author":"Liu","year":"2022","journal-title":"Nutrients"},{"key":"B18","doi-asserted-by":"publisher","first-page":"1102","DOI":"10.1007\/s43032-021-00534-1","article-title":"Iron deficiency anaemia and atonic postpartum haemorrhage following labour","volume":"29","author":"Lao","year":"2022","journal-title":"Reprod Sci"},{"key":"B19","doi-asserted-by":"publisher","first-page":"858","DOI":"10.3390\/nu14040858","article-title":"Maternal hemoglobin concentrations and birth weight, low birth weight (Lbw), and small for gestational age (Sga): findings from a prospective study in Northwest China","volume":"14","author":"Liu","year":"2022","journal-title":"Nutrients"},{"key":"B20","doi-asserted-by":"publisher","first-page":"100312","DOI":"10.1016\/j.jmh.2025.100312","article-title":"Prevalence and determinants of anaemia in south Asian diaspora women residing in Hong Kong: an exploratory cross-sectional study","volume":"11","author":"Chung","year":"2025","journal-title":"J Migr Health"},{"key":"B21","doi-asserted-by":"publisher","first-page":"236","DOI":"10.1186\/s12889-023-17620-5","article-title":"The impact of China\u2019s universal two-child policy on total, preterm, and multiple births: a nationwide interrupted time-series analysis","volume":"24","author":"Geng","year":"2024","journal-title":"BMC Public Health"},{"key":"B22","doi-asserted-by":"publisher","first-page":"1495","DOI":"10.1016\/j.ijsu.2014.07.013","article-title":"The strengthening the reporting of observational studies in epidemiology (strobe) statement: guidelines for reporting observational studies","volume":"12","author":"von Elm","year":"2014","journal-title":"Int J Surg"},{"key":"B23","year":""},{"key":"B24","doi-asserted-by":"publisher","first-page":"1084","DOI":"10.3390\/cells14141084","article-title":"The sex difference in the pathophysiology of preterm birth","volume":"14","author":"Lee","year":"2025","journal-title":"Cells"},{"key":"B25","doi-asserted-by":"publisher","first-page":"1724","DOI":"10.1089\/thy.2019.0818","article-title":"The association between isolated maternal hypothyroxinemia in early pregnancy and preterm birth","volume":"30","author":"Yang","year":"2020","journal-title":"Thyroid"},{"key":"B26","doi-asserted-by":"publisher","first-page":"201","DOI":"10.1016\/j.jtherbio.2018.04.001","article-title":"An epidemiological assessment of the effect of ambient temperature on the incidence of preterm births: identifying windows of susceptibility during pregnancy","volume":"74","author":"Zheng","year":"2018","journal-title":"J Therm Biol"},{"key":"B27","doi-asserted-by":"publisher","first-page":"104651","DOI":"10.1016\/j.ebiom.2023.104651","article-title":"Increased late preterm birth risk and altered uterine blood flow upon exposure to heat stress","volume":"93","author":"Yuzen","year":"2023","journal-title":"EBioMedicine"},{"key":"B28","doi-asserted-by":"publisher","first-page":"87009","DOI":"10.1289\/EHP10831","article-title":"Extreme temperature exposure and risks of preterm birth subtypes based on a nationwide survey in China","volume":"131","author":"Yu","year":"2023","journal-title":"Environ Health Perspect"},{"key":"B29","doi-asserted-by":"publisher","first-page":"S1313","DOI":"10.1016\/j.ajog.2022.06.059","article-title":"Placental abruption at near-term and term gestations: pathophysiology, epidemiology, diagnosis, and management","volume":"228","author":"Brandt","year":"2023","journal-title":"Am J Obstet Gynecol"},{"key":"B30","doi-asserted-by":"publisher","first-page":"620","DOI":"10.1186\/s12884-025-07718-6","article-title":"Preterm placental abruption and its association with adverse maternal and neonatal outcomes: a retrospective study","volume":"25","author":"Zhang","year":"2025","journal-title":"BMC Pregnancy Childbirth"},{"key":"B31","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1016\/j.ejogrb.2006.01.016","article-title":"Evidence of placental abruption as a chronic process: associations with vaginal bleeding early in pregnancy and placental lesions","volume":"128","author":"Ananth","year":"2006","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"B32","doi-asserted-by":"publisher","first-page":"245","DOI":"10.1160\/TH06-07-0387","article-title":"Thrombin activation of endometrial endothelial cells: a possible role in intrauterine growth restriction","volume":"97","author":"Krikun","year":"2007","journal-title":"Thromb Haemost"},{"key":"B33","doi-asserted-by":"publisher","first-page":"760","DOI":"10.1002\/ijgo.70079","article-title":"Obstetric and neonatal outcomes in clinically diagnosed placental abruption with and without placental histopathologic confirmation-a retrospective study","volume":"170","author":"Gonen","year":"2025","journal-title":"Int J Gynaecol Obstet"},{"key":"B34","doi-asserted-by":"publisher","first-page":"489","DOI":"10.1186\/s40001-025-02778-y","article-title":"Analysis of maternal fetal outcomes and complete blood count parameters according to the stages of placental abruption: a retrospective study","volume":"30","author":"Sener","year":"2025","journal-title":"Eur J Med Res"},{"key":"B35","doi-asserted-by":"publisher","first-page":"2767","DOI":"10.1007\/s00268-012-1750-6","article-title":"Trauma during pregnancy: a population-based analysis of maternal outcome","volume":"36","author":"Cheng","year":"2012","journal-title":"World J Surg"},{"key":"B36","doi-asserted-by":"publisher","first-page":"351","DOI":"10.1186\/s12884-025-07482-7","article-title":"Independent risk factors for placental abruption: a systematic review and meta-analysis","volume":"25","author":"Chen","year":"2025","journal-title":"BMC Pregnancy Childbirth"},{"key":"B37","doi-asserted-by":"publisher","first-page":"2745","DOI":"10.12998\/wjcc.v12.i16.2745","article-title":"Relationship between ultrasound parameters of the umbilical and middle cerebral arteries and intrauterine fetal distress","volume":"12","author":"Chen","year":"2024","journal-title":"World J Clin Cases"},{"key":"B38","doi-asserted-by":"publisher","first-page":"e64624","DOI":"10.7759\/cureus.64624","article-title":"Umbilical artery thrombosis causing fetal distress: a case report","volume":"16","author":"Li","year":"2024","journal-title":"Cureus"},{"key":"B39","doi-asserted-by":"publisher","first-page":"1417","DOI":"10.3390\/nu17091417","article-title":"Fetal distress as a determinant for refeeding syndrome in preterm neonates","volume":"17","author":"Di Chiara","year":"2025","journal-title":"Nutrients"},{"key":"B40","doi-asserted-by":"publisher","first-page":"160438","DOI":"10.1016\/j.scitotenv.2022.160438","article-title":"Association between maternal short-term exposure to ambient air pollution and the risk of fetal distress: a matched case-control study","volume":"860","author":"Xiao","year":"2023","journal-title":"Sci Total Environ"},{"key":"B41","doi-asserted-by":"publisher","first-page":"10045","DOI":"10.2147\/IJGM.S346544","article-title":"Placental and umbilical cord indices and their association with fetal distress in Hadiya zone public hospitals, Southern Ethiopia: a cross-sectional study","volume":"14","author":"Meskele","year":"2021","journal-title":"Int J Gen Med"},{"key":"B42","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1016\/j.ogc.2019.10.008","article-title":"The placental basis of fetal growth restriction","volume":"47","author":"Zur","year":"2020","journal-title":"Obstet Gynecol Clin North Am"},{"key":"B43","doi-asserted-by":"publisher","first-page":"9752","DOI":"10.1038\/s41467-024-53597-4","article-title":"Metabolomic signatures associated with fetal growth restriction and small for gestational age: a systematic review","volume":"15","author":"Conde-Agudelo","year":"2024","journal-title":"Nat Commun"},{"key":"B44","doi-asserted-by":"publisher","first-page":"860","DOI":"10.3390\/metabo12090860","article-title":"The exploration of fetal growth restriction based on metabolomics: a systematic review","volume":"12","author":"Yao","year":"2022","journal-title":"Metabolites"},{"key":"B45","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1016\/j.jpeds.2022.09.057","article-title":"Association of gestation and fetal growth restriction on cardiovascular health in preterm-born children","volume":"255","author":"Course","year":"2023","journal-title":"J Pediatr"},{"key":"B46","doi-asserted-by":"publisher","first-page":"560","DOI":"10.1038\/s41372-023-01621-8","article-title":"Intracranial ultrasound abnormalities and mortality in preterm infants with and without fetal growth restriction stratified by fetal doppler study results","volume":"43","author":"Kim","year":"2023","journal-title":"J Perinatol"},{"key":"B47","doi-asserted-by":"publisher","first-page":"110","DOI":"10.1016\/j.ajog.2016.09.076","article-title":"The role of aspirin dose on the prevention of preeclampsia and fetal growth restriction: systematic review and meta-analysis","volume":"216","author":"Roberge","year":"2017","journal-title":"Am J Obstet Gynecol"},{"key":"B48","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1002\/jcu.22753","article-title":"Fetal tricuspid regurgitation in second trimester of pregnancies at risk for fetal chromosomal defects","volume":"48","author":"Benchamanon","year":"2020","journal-title":"J Clin Ultrasound"},{"key":"B49","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1159\/000455947","article-title":"Fetal tricuspid regurgitation in the first trimester as a screening marker for congenital heart defects: systematic review and meta-analysis","volume":"42","author":"Scala","year":"2017","journal-title":"Fetal Diagn Ther"},{"key":"B50","doi-asserted-by":"publisher","first-page":"879","DOI":"10.3390\/children12070879","article-title":"Isolated mild fetal tricuspid regurgitation in low-risk pregnancies: an incidental doppler finding or a marker of postnatal cardiac risk?","volume":"12","author":"Kavgaci","year":"2025","journal-title":"Children (Basel)"},{"key":"B51","doi-asserted-by":"publisher","first-page":"610","DOI":"10.1186\/s12884-020-03310-2","article-title":"Ultrasonic detection of fetal persistent right umbilical vein and incidence and significance of concomitant anomalies","volume":"20","author":"Li","year":"2020","journal-title":"BMC Pregnancy Childbirth"},{"key":"B52","doi-asserted-by":"publisher","first-page":"1473","DOI":"10.1007\/s10995-022-03450-1","article-title":"Global prevalence of anemia in pregnant women: a comprehensive systematic review and meta-analysis","volume":"26","author":"Karami","year":"2022","journal-title":"Matern Child Health J"},{"key":"B53","doi-asserted-by":"publisher","first-page":"1502585","DOI":"10.3389\/fgwh.2025.1502585","article-title":"Anemia during pregnancy and adverse pregnancy outcomes: a systematic review and meta-analysis of cohort studies","volume":"6","author":"Wang","year":"2025","journal-title":"Front Glob Womens Health"},{"key":"B54","doi-asserted-by":"publisher","first-page":"1854","DOI":"10.3390\/nu16121854","article-title":"The prevalence of anemia among pregnant women in China: a systematic review and meta-analysis","volume":"16","author":"Zhou","year":"2024","journal-title":"Nutrients"},{"key":"B55","doi-asserted-by":"publisher","first-page":"626","DOI":"10.3945\/ajcn.111.025684","article-title":"Association of Tmprss6 polymorphisms with ferritin, hemoglobin, and type 2 diabetes risk in a Chinese han population","volume":"95","author":"Gan","year":"2012","journal-title":"Am J Clin Nutr"},{"key":"B56","doi-asserted-by":"publisher","first-page":"e2147046","DOI":"10.1001\/jamanetworkopen.2021.47046","article-title":"Severity of anemia during pregnancy and adverse maternal and fetal outcomes","volume":"5","author":"Shi","year":"2022","journal-title":"JAMA Netw Open"},{"key":"B57","doi-asserted-by":"publisher","first-page":"CD004905","DOI":"10.1002\/14651858.CD004905.pub6","article-title":"Multiple-micronutrient supplementation for women during pregnancy","volume":"3","author":"Keats","year":"2019","journal-title":"Cochrane Database Syst Rev"},{"key":"B58","doi-asserted-by":"publisher","first-page":"e1150","DOI":"10.1002\/cl2.1150","article-title":"Effects of nutritional interventions during pregnancy on birth, child health and development outcomes: a systematic review of evidence from low- and middle-income countries","volume":"17","author":"Lassi","year":"2021","journal-title":"Campbell Syst Rev"},{"key":"B59","doi-asserted-by":"publisher","first-page":"e078635","DOI":"10.1136\/bmj-2023-078635","article-title":"How can China tackle its declining fertility rate?","volume":"386","author":"Wang","year":"2024","journal-title":"Br Med J"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2025.1690771\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T06:30:56Z","timestamp":1763015456000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2025.1690771\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,13]]},"references-count":59,"alternative-id":["10.3389\/fped.2025.1690771"],"URL":"https:\/\/doi.org\/10.3389\/fped.2025.1690771","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,13]]},"article-number":"1690771"}}