Predictors of serum ferritin and haemoglobin during pregnancy, in a malaria-endemic area of western Kenya

Alusala, Dorcas; Estambale, Benson B.; Magnussen, Pascal; Friis, Henrik; Luoba, AI; Mwaniki, Dennis

doi:10.1179/136485908x278874

Cited by 5 publications

(5 citation statements)

References 30 publications

(29 reference statements)

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“…Nevertheless, in Kenyan pregnant women of less than 24 weeks’ gestational age, results close to the findings of this study were found by Alusala et al [25]. The authors showed that more than 40% of multigravidae were iron deficient, defined as serum ferritin concentrations below 12 μg/L vs less than 19% of primigravidae.…”

Section: Discussionsupporting

confidence: 90%

Malaria and gravidity interact to modify maternal haemoglobin concentrations during pregnancy

Ouédraogo

Bodeau-Livinec

Briand

et al. 2012

Malar J

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BackgroundPrimigravidity is one of the main risk factors for both malaria and anaemia. Since the implementation of intermittent preventive treatment (IPTp) in sub-Saharan Africa, the relationship between anaemia and gravidity and its evolution during pregnancy has been little explored. This study aimed to evaluate the impact of gravidity on the variation of haemoglobin during pregnancy according to the timing of gestation.MethodsData from three studies carried out in nearby areas in south Benin (Ouidah, Comé, Allada) between 2005 and 2012 were analysed. At inclusion (first antenatal visit, ANV1) women’s age, area of residence, schooling, gravidity, gestational age, weight and height were recorded. Thick blood smears were performed on ANV1, second visit (ANV2) and at delivery. In Allada, women’s serum ferritin and CRP concentrations were also assessed. The impact of gravidity on maternal haemoglobin (Hb) was analysed using a logistic or linear regression depending on the outcome. The statistical significance was set to P < 0.05.ResultsIn total, data from 3,591 pregnant women were analysed. Both univariate and multivariate analyses showed a constant association between Hb concentrations and gravidity in the three periods of Hb assessment (ANV1, ANV2 and delivery). Mean Hb concentration was significantly lower in primigravidae than in multigravidae at ANV1 (mean difference = -2.4 g/L, CI 95%: [-3.4, -1.4], P < 0.001). Afterwards, there was a significant increase in primigravidae only, with a tendency to reversal between primigravidae and multigravidae, which was confirmed at delivery (mean difference = 2.8 g/L, CI 95%: [1.3, 4.2], P < 0.001). The prevalence of malaria infection was halved between ANV1 and delivery in primigravidae while it decreased by only 38% among multigravidae, who were less prone to malaria infection (prevalence at ANV1, 20% and 10% respectively). Iron deficiency was more common in multigravidae, and it decreased slightly in this group between ANV1 and delivery.ConclusionIn a context of IPTp, Hb levels improved progressively throughout pregnancy in primigravidae, likely as a result of reduction in malaria infection. In multigravidae, the improvement was less perceptible and anaemia was mainly due to iron deficiency.

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Section: Discussionsupporting

confidence: 90%

Malaria and gravidity interact to modify maternal haemoglobin concentrations during pregnancy

Ouédraogo

Bodeau-Livinec

Briand

et al. 2012

Malar J

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“…14 Severe anemia was indicated by an Hb concentration of 7.0 g/dL and mild-moderate anemia by an Hb concentration of 7.0–10.5 g/dL The Hb concentration used as the threshold for anemia was thus reduced from the usual 11.0 g/dL to 10.5 g/dL, to allow for the hemodilution that occurs during pregnancy. 15 The cellulose acetate membrane (CAM) was used to determine the genotype of each patient. 16 …”

Section: Methodsmentioning

confidence: 99%

Prevalence of Dihydrofolate Reductase Gene Mutations in Plasmodium falciparum Isolate from Pregnant Women in Nigeria

Ojurongbe

Tijani

Fawole

et al. 2011

Infectious Disease Reports

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We assessed the prevalence of Plasmodium falciparum and the frequency of the dhfr triple mutation that is associated with antifolate drug resistance among P. falciparum isolates obtained from pregnant women in Ilorin, Nigeria. The study included 179 women in the second and third trimester of pregnancy who have been exposed to intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine. Thick and thin blood films and PCR were used for malaria parasite detection. Blood group and hemoglobin concentration were also determined. Mutations in P. falciparum dhfr were analyzed by sequencing DNA obtained from blood spots on filter paper. Prevalence of P. falciparum in the population (PCR corrected) was 44.1% (79/179) with 66.7% and 33.3% in the second and third trimester, respectively. Primigravide (51.3%) were more infected than multigravide (48.7%) but the difference was not statistically significant. Women in blood group A had the highest P. falciparum malaria infection (30.8%). The mean hemoglobin concentration was lower among those infected with malaria parasite. Also, more women with the malaria parasite (38.4%) had anemia compare to those without (21.4%). The prevalence of the P. falciparum dhfr mutant alleles was 64.1%, 61.5%, 38.5%, and 12.8% for I51, R59, N108 and T108, respectively. None of the samples had the L164 mutation. The combined triple dhfr mutation (51 + 59 + 108) in the population was 17.9% (7 of 39). Also, the prevalence of the triple mutant alleles was not significantly associated to the number of doses of SP taken by the women. These findings highlight the need for a regular assessment of IPTp/SP efficacy, and evaluation of possible alternative drugs.

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“…None of the five papers studied factors associated with iron deficiency in the sickle cell disease pregnant subpopulation. At least 80% of the participants in these studies were in low- and middle-income countries where iron deficiency could be explained by several sociocultural and health related factors [ 33 – 35 ]. A high prevalence of hookworm infestations, malaria parasitaemia, and low dietary iron intake are potential causes of iron deficiency [ 33 , 34 ].…”

Section: Discussionmentioning

confidence: 99%

Iron stores in pregnant women with sickle cell disease: a systematic review

Aroke

Kadia

Njim

2020

BMC Pregnancy Childbirth

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Background Gradual improvements in the management of sickle cell disease (SCD), have led to an increase in the number of women with SCD who reach the age of procreation. However, evidence on the iron status of pregnant women with sickle cell disease (PWSCD) remains inconclusive. We conducted the first systematic review on the prevalence, determinants and maternal/foetal outcomes of iron deficiency anaemia among PWSCD. Methods We searched MEDLINE, EMBASE, Global Health, Africa Index Medicus, the Cochrane library databases and reference lists of retrieved publications for studies describing the iron status of PWSCD. The literature search was done over a period of 1 month, with no language or date restrictions applied. Data were extracted on a Microsoft excel sheet. Two authors assessed all included studies for methodological quality and risk of bias. Results A total of 710 reports were identified for title and article screening. Five retained studies were conducted before or during the 90s and included 67 participants. After quality assessment, the observational studies were designated to have a “fair” quality assessment while the randomised control trial had an “unclear” quality assessment. The prevalence of iron deficiency anaemia among PWSCD varied by study design and diagnostic method. The overall prevalence ranged from 6.67–83.33%. None of the studies provided evidence on factors associated with iron deficiency anaemia and the randomized trial reported no difference in outcomes between PWSCD who had iron supplementation and those who did not. Conclusion Evidence on factors associated with iron deficiency anaemia among PWSCD and maternal/foetal outcomes in PWSCD who have iron deficiency anaemia is poor. The studies included in this review suggests that iron deficiency anaemia may be highly prevalent in PWSCD but due to the very small sample sizes and varied study designs, this evidence is inconclusive. The review shows that there is a need for more studies with robust designs and adequate sample sizes to assess the disease burden of iron deficiency anaemia in PWSCD.

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Predictors of serum ferritin and haemoglobin during pregnancy, in a malaria-endemic area of western Kenya

Cited by 5 publications

References 30 publications

Malaria and gravidity interact to modify maternal haemoglobin concentrations during pregnancy

Malaria and gravidity interact to modify maternal haemoglobin concentrations during pregnancy

Prevalence of Dihydrofolate Reductase Gene Mutations in Plasmodium falciparum Isolate from Pregnant Women in Nigeria

Iron stores in pregnant women with sickle cell disease: a systematic review

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