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Changes in hemoglobin F levels

in pregnant women unaffected


by clinical fetomaternal
hemorrhage

Introduction
Hemoglobin F (Hb F) is predominantly produced in fetal
life

F cells are measured as the proportion of total red cells


using the KleihauerBetke acid elution method or flow
cytometry
Hb F is measured as a proportion of the total Hb in red
cell lysates by high-performance liquid chromatography
(HPLC)

Introduction
Complete automation of the HPLC method has made this
procedure available to many clinical laboratories
As a high Hb F level interferes with Hb A1cmeasurements in
some commercially available assay systems [7], Hb F levels
may also be affected by Hb A1c
The physiological changes in %Hb F during pregnancy as
determined by HPLC have not been studied extensively

Material and methods


All 357 pregnant participants gave birth
between January 2011 and July 2012 at our
institution and were free from clinical
fetomaternal hemorrhage (FMH)
12 (3.4%) were known to be complicated with
diabetes mellitus and 48 (13.4%) were
diagnosed with gestational diabetes mellitus in
the current pregnancy
Total of 490 blood samples from the 357
women were used for simultaneous
determinations of both %Hb F and %Hb A1c

Material and methods


Before pregnant (n=21)
1st trimesters (n=150)

490 blood
samples from
357 women

2nd trimesters (n=116)


3rd trimesters (n=192)
postpartum (n=11)

Results
Longitudinal mean %Hb F level during the 1st
trimester did not differ significantly
study of 21
fromthat determined before pregnancy
women
Crosssectional
study

%Hb F level declined significantly during


pregnancy in the absence of a
significant change in Hb A1c level

Longitudinal
%Hb F level tended to increase after
study of 11
delivery (P=0.0667)
women

Fig. 1. Changes in the %Hb F levels before, during, and


after pregnancy

Results

An
analysis
of 49
women

the majority of women exhibited a decrease in


%Hb F level and none exhibited an increase in
%Hb F bymore than 0.1%
Women with a higher %Hb F level during the 1st
trimester were significantly more likely to
exhibit a larger decrease in %Hb F during
pregnancy
%Hb F levels : 0.1% to 2.9% with a median value
of 0.7% during the 1st trimester
%Hb F levels : 0.1% to 2.8% with a median of
0.5% during the 3rd trimester

Fig. 2. Longitudinal changes in %Hb F levels


during pregnancy in 49 women

Fig. 3. Correlation between %Hb F levels during the 1st


trimester and net decreases in %Hb F levels during
pregnancy

Fig. 4. Distribution of %Hb F levels determined during


the 1st and 3rd trimesters

Results
A weak but statistically significant negative
correlation between %Hb F and %Hb A1c
levels was observed

Mean %Hb F levels did not differ significantly


between 475 samples with %Hb A1c level
<6.5% and 15 samples with %Hb A1c level
6.5%

Fig. 5. Association between levels of %Hb F and %Hb


A1c in 490 blood samples from 357 women

Discussion
%Hb F level was highest during the 1st
trimester of pregnancy and declined gradually
toward the 3rd trimester
%Hb F level was significantly increased during
the 1st trimester compared with those during
the 2nd and 3rd trimesters
The increase in red cells containing Hb F during
the earlier stages of pregnancy has been
suggested to be due to an increased number of
adult F cells

Discussion
Fetal red cells during the 1st trimester exclusively contain
Hb F, while adult F cells contain both Hb F and Hb A Hb
F ranging up to 25% of the total Hb in adult F cells
Hb F accounts for an approximately 10% of the total Hb
in adult F cells

Physiological FMHmay have contributed partly to the


elevation of the 1st trimester Hb F levels

Discussion
Effect of parity on the Hb F level was not seen in
this study

A significant increase in %Hb F level during the 1st


trimester compared with that before pregnancy
was not confirmed in this study
Although the reason why %Hb F decreases in the
later stages of pregnancy remains to be
determined, it may be due to deceleration of
erythropoiesis during the latter half of pregnancy

Conclusion

The data presented in this work may be

used as reference intervals of %Hb F


determined with HPLC during

pregnancy

Thank You