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Evaluating the Clinical Effect of Female Blood Donors of Child-Bearing Age on Maternal and Neonatal Outcomes: A Cohort Study.
Transfusion Medicine Reviews ( IF 4.5 ) Pub Date : 2019-12-02 , DOI: 10.1016/j.tmrv.2019.11.007
Michaël Chassé 1 , Alan Tinmouth 2 , Mindy Goldman 3 , Sheila F O'Brien 4 , Steven Hawken 2 , Malia S Q Murphy 2 , Mark Walker 2 , Ann E Sprague 5 , Kumanan Wilson 2 , Carl van Walraven 2 , Dean A Fergusson 2
Affiliation  

Iron deficiency is a global problem in women of child-bearing age and is associated with adverse maternal and newborn outcomes. Repeated blood donations deplete iron stores and decrease hemoglobin levels. However, the clinical impact of iatrogenic iron deficiency on mothers and neonates due to blood donation is uncertain. The objective of this study was to assess the association between repeated blood donations in female donors of child-bearing age and the associated risk of adverse maternal and neonatal outcomes. We undertook an observational cohort study of all women who delivered a live or stillborn infant in Ontario, Canada, between 1 January 2010 and 31 March 2012 using birth record data from the Better Outcomes Registry & Network, Canadian Blood Services, and the Institute of Clinical Evaluative Sciences. Only a woman's first pregnancy within the study time frame was included for analysis. We excluded women <18 years or >50 years of age at the time of delivery and multiple birth pregnancies. Data on all female donors who made whole blood donations between 1 January 2007 and 31 March 2012 were obtained from Canadian Blood Services. The primary newborn outcome was diagnosis of a small-for-gestational-age neonate (less than 10th centile). Secondary outcomes were preterm birth, stillbirth, APGAR <4 at 5 minutes, cord pH <7, neonatal death, maternal transfusion, infection, preeclampsia, gestational hypertension, gestational diabetes, placental abruption, and maternal death. Regression models evaluated the effect of repeated donation and the time interval between donations and conception on neonatal and maternal outcomes while adjusting for important clinical and demographic risk factors. A total of 260 037 women delivered live or stillborn singleton infants between 1 January 2010 and 31 March 2012. A total of 7919 (3.0%) women were blood donors, with a mean of 2.43 ± 2.10 lifetime donations. Mean maternal age at the time of delivery for nondonors and donors was 30.30 ± 5.38 and 29.74 ± 4.94 years, respectively. Small for gestational age occurred in 23 706 (9.4%) of neonates born to nondonors and 526 (6.6%) of neonates born to donors. There was a reduction in the risk of small for gestational age with increasing number of lifetime donations (adjusted odds ratio 0.89 [0.86-0.92] per additional donation). For the prespecified secondary outcomes, we observed a reduction in the risk of low birth weight (adjusted odds ratio 0.95 [0.91-0.98] per additional donation). There was no association with other secondary neonatal or maternal outcomes except for maternal hypertension. Proximity of donation to conception had no effect on risk of a small-for-gestational age neonate. Our data suggest that there is no increased risk of deleterious neonatal and maternal outcomes associated with repeated blood donations prior to pregnancy. Although possibly a result of a healthy donor effect, our findings are reassuring to female donors and their children as well as to clinicians and blood system stakeholders seeking to inform policy decisions.



中文翻译:

评价育龄女性献血者对母婴和新生儿结局的临床效果:一项队列研究。

铁缺乏是育龄妇女的一个全球性问题,并与不良的母亲和新生儿结局有关。重复献血会耗尽铁的储备并降低血红蛋白水平。但是,由于献血导致医源性铁缺乏对母亲和新生儿的临床影响尚不确定。这项研究的目的是评估育龄女性捐献者重复献血与母体和新生儿不良结局的相关风险之间的关系。我们进行了一项观察性队列研究,研究对象是2010年1月1日至2012年3月31日期间在加拿大安大略省分娩的活产或死产婴儿的所有妇女,均使用了改善结果登记与网络,加拿大血液服务和临床研究所的出生记录数据评价科学。只有一个女人 研究时间范围内的第一次妊娠也包括在内以进行分析。我们排除了分娩时<18岁或> 50岁的妇女和多胎妊娠的妇女。2007年1月1日至2012年3月31日期间进行全血献血的所有女性献血者的数据均来自加拿大血液服务。新生儿的主要结局是诊断为胎龄较小的新生儿(少于10个百分位数)。次要结局为早产,死产,5分钟时APGAR <4,脐带pH <7,新生儿死亡,产妇输血,感染,先兆子痫,妊娠高血压,妊娠糖尿病,胎盘早剥和产妇死亡。回归模型评估了重复捐赠的效果以及捐赠和受孕之间的时间间隔对新生儿和产妇的结局,同时针对重要的临床和人口统计学风险因素进行了调整。在2010年1月1日至2012年3月31日期间,共有260 037名妇女分娩了活产或死胎的单胎婴儿。共有7919名妇女(3.0%)是献血者,平均献血量为2.43±2.10。非捐赠者和捐赠者在分娩时的平均产妇年龄分别为30.30±5.38和29.74±4.94岁。在非供血者中有23 706(9.4%)的新生儿为小胎龄,在供血者中为526(6.6%)的新生儿。随着终生捐赠数量的增加,胎龄较小的风险降低(每增加一次捐赠,调整后的优势比为0.89 [0.86-0.92])。对于预定的次要结局,我们观察到低出生体重的风险有所降低(每增加一次捐赠,调整后的优势比0.95 [0.91-0.98])。除产妇高血压外,与其他继发新生儿或产妇结局无关联。接近受孕对小胎龄新生儿的风险没有影响。我们的数据表明,与怀孕前重复献血有关的有害新生儿和母亲结局的风险没有增加。尽管可能是健康捐赠者的结果,但我们的发现使女性捐赠者及其子女以及寻求为政策决策提供信息的临床医生和血液系统利益相关者感到放心。98]。除产妇高血压外,与其他继发新生儿或产妇结局无关联。接近受孕对小胎龄新生儿的风险没有影响。我们的数据表明,与怀孕前重复献血有关的有害新生儿和母亲结局的风险没有增加。尽管可能是健康捐赠者的结果,但我们的发现使女性捐赠者及其子女以及寻求为政策决策提供信息的临床医生和血液系统利益相关者感到放心。98]。除产妇高血压外,与其他继发新生儿或产妇结局无关联。接近受孕对小胎龄新生儿的风险没有影响。我们的数据表明,与怀孕前重复献血有关的有害新生儿和母亲结局的风险没有增加。尽管可能是健康捐赠者的结果,但我们的发现使女性捐赠者及其子女以及寻求为政策决策提供信息的临床医生和血液系统利益相关者感到放心。我们的数据表明,与怀孕前重复献血有关的有害新生儿和母亲结局的风险没有增加。尽管可能是健康捐赠者的结果,但我们的发现使女性捐赠者及其子女以及寻求为政策决策提供信息的临床医生和血液系统利益相关者感到放心。我们的数据表明,与怀孕前重复献血有关的有害新生儿和母亲结局的风险没有增加。尽管可能是健康捐赠者的结果,但我们的发现使女性捐赠者及其子女以及寻求为政策决策提供信息的临床医生和血液系统利益相关者感到放心。

更新日期:2019-12-02
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