Maternal and Neonatal Outcomes in Pregnant Women with Hemoglobin E: A Cross Sectional Study
Keywords:
N\AAbstract
Background: Hemoglobin E (HbE) is a prevalent hemoglobin variant in Southeast Asia. While HbE trait is often asymptomatic, HbE disease and HbE/β-thalassemia can cause clinically significant anemia, particularly during pregnancy. Despite its prevalence, the impact of HbE on maternal and fetal outcomes remains under-researched.
Methods: A hospital-based cross-sectional study was conducted at Saveetha Medical College among 355 pregnant women. Hemoglobin variants were identified via HPLC. Maternal characteristics, laboratory values, and pregnancy outcomes were recorded. Statistical analyses included chi-square tests and multivariate regression.
Results: HbE variants were present in 27.9% of participants: 22.0% had HbE trait, 3.4% had HbE disease, and 2.5% had HbE/β-thalassemia. Women with HbE variants, particularly HbE disease and HbE/β-thalassemia, had significantly higher rates of severe anemia (41.7–55.6%), blood transfusions (25–33.3%), and preterm births (25–33.3%). Early screening and management reduced complications significantly: severe anemia (8.9% vs. 38.9%), preterm birth (11.1% vs. 29.6%), and NICU admissions (6.7% vs. 22.2%).
Conclusions: HbE disorders significantly impact pregnancy outcomes, even in heterozygous states. Early screening and risk-based management can dramatically improve maternal and neonatal outcomes. These findings advocate for the integration of routine HbE screening into prenatal care in high-prevalence regions to inform targeted interventions and public health policies.
Downloads
References
Fucharoen, S., & Weatherall, D. J. (2012). The hemoglobin E thalassemias. Cold Spring Harbor Perspectives in Medicine, 2(8), a011734. https://doi.org/10.1101/cshperspect.a011734
Fucharoen, S., & Winichagoon, P. (2011). Haemoglobinopathies in Southeast Asia. Indian Journal of Medical Research, 134, 498–506.
Mettananda, S., Gibbons, R. J., & Higgs, D. R. (2016). Understanding α-globin gene regulation and implications for the treatment of β-thalassemia. Annals of the New York Academy of Sciences, 1368(1), 16–24. https://doi.org/10.1111/nyas.13005
Olivieri, N. F., Pakbaz, Z., & Vichinsky, E. (2011). Hb E/β-thalassaemia: A common & clinically diverse disorder. Indian Journal of Medical Research, 134, 522–531.
Tongsong, T., Wanapirak, C., Sirichotiyakul, S., et al. (2004). Pregnancy outcomes among women with Hb E trait. Journal of Obstetrics and Gynaecology Research, 30(4), 327–331. https://doi.org/10.1111/j.1447-0756.2004.00201.x
Luewan, S., & Tongsong, T. (2009). Outcomes of pregnancies complicated by beta-thalassemia/hemoglobin E disease. International Journal of Gynecology & Obstetrics, 104(3), 203–205. https://doi.org/10.1016/j.ijgo.2008.11.027
Leung, T. Y., & Lao, T. T. (2012). Thalassaemia in pregnancy. Best Practice & Research Clinical Obstetrics & Gynaecology, 26(1), 37–51. https://doi.org/10.1016/j.bpobgyn.2011.10.004
Srisupundit, K., Piyamongkol, W., & Tongsong, T. (2011). Hemoglobin E disorders and pregnancy outcomes. Journal of Maternal-Fetal & Neonatal Medicine, 24(9), 1114–1117. https://doi.org/10.3109/14767058.2010.531311
Leung, T. Y., & Lao, T. T. (2012). Thalassaemia in pregnancy. Best Practice & Research Clinical Obstetrics & Gynaecology, 26(1), 37–51. https://doi.org/10.1016/j.bpobgyn.2011.10.004 (Duplicate of #7)
Oteng-Ntim, E., Meeks, D., Seed, P. T., et al. (2015). Adverse maternal and perinatal outcomes in pregnant women with sickle cell disease: Systematic review and meta-analysis. Blood, 125(21), 3316–3325. https://doi.org/10.1182/blood-2014-11-607317
Ngim, C. F., Lai, N. M., Hong, J. Y., et al. (2019). Thalassaemia in pregnancy: An audit of antenatal care and transfusion management in a resource-limited setting. BMC Pregnancy and Childbirth, 19(1), 1–9. https://doi.org/10.1186/s12884-019-2230-1
Royal College of Obstetricians and Gynaecologists. (2014). Management of beta-thalassaemia in pregnancy (Green-top Guideline No. 66). https://www.rcog.org.uk/media/kylo15jj/gtg66.pdf
Srisupundit, K., Piyamongkol, W., & Tongsong, T. (2018). Hemoglobin E disorders and pregnancy outcomes. Journal of Maternal-Fetal & Neonatal Medicine, 31(9), 1159–1164. https://doi.org/10.1080/14767058.2017.1306515
Chaibunruang, A., Srisawat, U., Poodendaen, C., et al. (2013). Molecular and hematological studies in a large cohort of α(0)-thalassemia in northeast Thailand: Data from a single referral center. Blood Cells, Molecules, and Diseases, 51(2), 89–93. https://doi.org/10.1016/j.bcmd.2013.04.002
World Health Organization. (2008). Guidelines on the management of haemoglobin disorders in the European Region. https://www.euro.who.int/__data/assets/pdf_file/0010/98765/E81523.pdf
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
You are free to:
- Share — copy and redistribute the material in any medium or format
- Adapt — remix, transform, and build upon the material for any purpose, even commercially.
Terms:
- Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
