Antepartum hemoglobin concentrations and postpartum patient-reported outcomes: a retrospective study

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Abstract
This study aimed to evaluate the association between antepartum hemoglobin concentration and postpartum recovery among women receiving obstetric anesthesia care. We included pregnant women aged ≥ 18 years who underwent cesarean delivery (CD) or vaginal delivery (VD) with epidural analgesia (EA). The primary outcome was the Obstetric Quality of Recovery (ObsQoR)-11 score. Associations between antepartum hemoglobin concentration and ObsQoR-11 scores were evaluated using multivariable regression analyses in the overall cohort and separately in women undergoing CD and those undergoing VD with EA. Because no validated cutoff value exists for the ObsQoR-11 score, exploratory analyses were performed to examine the association between antepartum hemoglobin concentration and poor recovery, defined as an ObsQoR-11 score one standard deviation below the mean. Among the 466 women included in the final analysis, the mean (standard deviation) ObsQoR-11 score on postpartum day 1 was 67.4 (20.8). After adjustment, antepartum hemoglobin concentration was associated with a higher ObsQoR-11 score (regression coefficient, 1.9; 95% confidence interval [CI] 0.27-3.54) and lower odds of poor recovery (odds ratio [OR], 0.74; 95% CI 0.57-0.96). These associations were observed among women undergoing CD (regression coefficient, 2.0; 95% CI 0.03-4.04; OR, 0.72; 95% CI 0.55-0.95) but not clearly demonstrated among women undergoing VD with EA (regression coefficient, 1.7; 95% CI - 1.2-4.7; OR, 0.96; 95% CI 0.41-2.25). Higher antepartum hemoglobin concentrations were associated with higher ObsQoR-11 scores and better early postpartum recovery, mainly after CD; the association was not clearly demonstrated after VD with EA.

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