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Effect of high parity on occurrence of anemia in pregnancy a cohort study.doc

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Effect of high parity on occurrence of anemia in pregnancy a cohort study

Al-Farsietal.BMCPregnancyandChildbirth2011,11:7 /1471-2393/11/7 RESEARCH ARTICLE OpenAccess Effectofhighparityonoccurrenceofanemiain pregnancy:acohortstudy YahyaMAl-Farsi1,2*?,DanielRBrooks2?,MarthaMWerler2?,HowardJCabral2?,MohammedAAl-Shafei1?, HenkCWallenburg3? Abstract Background:Studiesthatexplorethecontroversialassociationbetweenparityandanaemia-in-pregnancy(AIP) wereoftenhamperedbynotdistinguishingincidentcasescausedbypregnancyfromprevalentcasescomplicated bypregnancy.Theauthors’aiminconductingthisstudywastoovercomethismethodologicalconcern. Methods:AretrospectivecohortstudywasconductedinOmanon1939pregnanciesamong479parousfemale participantswithavailablepregnancyrecordsinacommunitytrial.Wecollectedinformationfromparticipants,the communitytrial,andhealthrecordsofeachpregnancy.Throughoutthefollow-upperiod,weenumerated684AIP casesofwhich289(42.2%)wereincidentcases.Highparity(HP,≥5pregnancies)accountedfor48.7%oftotal pregnancies.Twosetsofregressionanalyseswereconducted:thefirstrestrictedtoincidentcasesonly,andthe secondinclusiveofallcases.Therelationwithparityasadichotomyandasmultiplecategorieswasexaminedfor eachset;multi-levellogisticregression(MLLR)wasemployedtoproduceadjustedmodels. Results:InthefullyadjustedMLLRmodelsthatwererestrictedtoincidentcases,womenwithHPpregnancieshad ahigherriskofAIPcomparedtothosewhohadhadfewerpregnancies(RiskRatio,RR=2.92;95%CI2.02,4.59); theAIPriskincreasedinadose-responsefashionovermultiplecategoriesofparity.InthefullyadjustedMLLR modelsthatincludedallcases,theassociationdisappeared(RR=1.11;95%CI0.91,1.18)andthedose-response patternflattened. Conclusions:ThisstudyshowstheimportanceofspecifyingwhichcasesofAIPareincidentandprovides supportiveevidenceforacausalrelationbetweenparityandoccurrenceofincidentalAIP. Background antenatal carevisit“asameasureofoccurrence ofAIP Despite being a major public health issue, anaemia in [2],whileothersconsideredanyantenatallowhemoglo- pregnancy (AIP) is, surprisingly, still not well under- bi