Anaemia in pregnancy in a setting of high HIV prevalence rates

Tunkyi, Kay; Moodley, Jagidesa

doi:10.1080/23120053.2017.1342452

Cited by 8 publications

(13 citation statements)

References 10 publications

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“…Pregnancy associated major co morbidities were noted in 81% of seropositive women who delivered with anemia being the major co-morbidity in 55 of them amounting to 65%. Similar results were found in study performed by Kay Tunkyi et al 12 This could be attributable to high prevalence of anemia in pregnant women in India and due to ART which can exacerbate anemia.…”

Section: Discussionsupporting

confidence: 88%

A study on seroprevalence of HIV among women attending obstetric care in a tertiary care hospital of South India with maternal and perinatal outcomes

Shruthi¹,

Jois²

2018

Int J Reprod Contracept Obstet Gynecol

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Background: HIV is prevalent in epidemic proportions in India. Identifying the target population and effective intervention reduces chances of vertical transmission and new infection. Authors studied the seroprevalence of HIV among women attending obstetric care in a tertiary care hospital of South India and associated maternal and perinatal outcomes among seropositive women.Methods: Retrospective descriptive study of all women who were screened for HIV at Integrated Counselling and Testing Centre, Vani Vilas hospital, from January 2014 to December 2017 in their antenatal, intranatal and postnatal period. Demographic data of seropositive women, obstetric outcomes and status of children at 18months were obtained.Results: Of the 35,455 women who were screened, 0.28% were found positive for HIV. Percentage prevalence of HIV was highest in 2014 (0.32%). Majority of the seroprevalence belonged to age group of 25-29 years (44%), 32% illiterates, 82% homemakers and 79% belonged to urban areas. Unknown partner status in 22% and majority were diagnosed in antenatal period (66%). Of them 82% had favourable CD4 count. 74 % of them delivered live baby. Three maternal deaths were observed and anaemia (65%) was the major associated co-morbidity. Vaginal route was common mode of delivery (84%). Thirteen babies required NICU admission and 6 neonates deaths were encountered. Exclusive breastfeeding was practised in 91% of live births. 62% of children were found seronegative at 18 months follow up.Conclusions: Authors observed with adequate treatment to mother and prophylaxis to the baby, the burden of vertical transmission can be significantly reduced.

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Section: Discussionsupporting

confidence: 88%

A study on seroprevalence of HIV among women attending obstetric care in a tertiary care hospital of South India with maternal and perinatal outcomes

Shruthi¹,

Jois²

2018

Int J Reprod Contracept Obstet Gynecol

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“…Studies were excluded if they did not report on haemoglobin concentrations or any other accepted method of anaemia determination, were not available in full text, were case-control studies which did not report baseline prevalence or estimation studies which did not determine anaemia prevalence as a parameter within the study itself. We contacted the authors of three studies [ 18 – 20 ] that sampled the same population but reported on different outcome measures to determine the severity of anaemia in the overall sample. We included the population sample size from only one of these studies in our calculation of pooled prevalence.…”

Section: Methodsmentioning

confidence: 99%

The prevalence, risk factors and outcomes of anaemia in South African pregnant women: a systematic review and meta-analysis

2022

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BackgroundAnaemia is associated with maternal and perinatal morbidity and mortality. The pooled prevalence of anaemia in the South African (SA) pregnant population was ascertained by systematically reviewing available literature. Severity, risk factors (HIV, tuberculosis, race, province, year of study), maternal morbidity and mortality (hypertensive disorders of pregnancy), birth outcomes (including low birth weight) and supplementation during pregnancy were also described.MethodsEligible studies reported on haemoglobin concentration or prevalence of anaemia in a SA pregnant population and were available in full text. Case-control and estimation studies were excluded with no restriction on the date of publication. PubMed, CINAHL, EMBASE, EBSCO, Ovid maternity and infant care databases, Cochrane Database of Systematic Reviews, Web of Science and SCOPUS were searched, using the keywords ‘anaemia’, ’haemoglobin’, ‘pregnancy’, ‘South Africa’. Risk of bias was conducted using the Hoy tool and the Doi plot and LFK ratio. Overall study quality was assessed using the GRADE tool. Due to heterogeneity amongst studies subgroup analyses were performed (random effects and quality effects model) using MetaXL addon tool for Microsoft Excel.ResultsThe initial search yielded 7010 articles and 26 were selected for inclusion. Twenty studies were cross-sectional, three were longitudinal and one a randomised control trial. Studies ranged in publication year from 1969 to 2020. The pooled prevalence of anaemia in pregnant women in SA was determined to be 31% (95% CI, 23–40%). Hypertensive disorders of pregnancy and low birth weight were associated with anaemia. While iron deficiency was reported as the main cause, other risk factors included HIV and other infections.DiscussionLimitationsThere was limited data reporting on prevalence of anaemia and direct maternal and foetal outcomes. Heterogeneity amongst studies was not explained by subgroup analysis. Majority of cross-sectional study designs reduced the ability to infer causality.InterpretationWhile the prevalence of anaemia remains high and of concern, risk factors are varied. Iron deficiency is still common but the presence of comorbidities also contributes to anaemia and should not be ignored. More longitudinal research into associations between anaemia and birth outcomes is needed due to a lack of available evidence.Systematic review registrationPROSPERO 2020: CRD42020157191.

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“…Significantly elevated endogenous NO metabolite (nitrate and nitrite) levels were reported in serum taken from obese women (BMI > 30 kg/m 2 ) versus normal weight (BMI < 25 kg/m 2 ; Ghasemi, Zahediasl, & Azizi, 2013). Untreated HIV-infected patients tend to have lower blood iron levels versus those on ARV drugs (Tunkyi & Moodley, 2017), and were found to have the highest endogenous NO levels, while HIV-infected patients on HAART, and not the healthy non-HIV-infected patients, had the lowest NO levels (Soccal, Carvalho, Bochi, Moresco, & Silva, 2016). HIV-infected patients on HAART tend to develop symptoms of dyslipidaemia, obesity and hypertension (Crum-Cianflone et al, 2008), and in sub-Saharan African women, obesity was strongly correlated with HAART exposure in all Black ethnic race groups (McCormick et al, 2014).…”

Section: Discussionmentioning

confidence: 99%

Effect of maternal HIV infection, BMI and NOx air pollution exposure on birth outcomes in South African pregnant women genotyped for the p53 Pro72Arg (rs1042522)

Naidoo

Ramkaran

et al. 2020

Int J Immunogenetics

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Tumour suppressor protein, p53, plays a role in modulating innate immune responses, DNA repair, cell cycle arrest, senescence and apoptosis. Maternal nitrogen oxide (NOx) air pollution exposure, body mass index (BMI), human immunodeficiency virus (HIV) infection and p53 Pro72Arg (rs1042522) affect foetal growth. We investigated whether the aforementioned factors influence birth outcomes in a South African population. Pregnant women (n = 300; HIV −ve = 194 and HIV +ve = 106) were genotyped for the p53 rs1042522 using polymerase chain reaction–restriction fragment length polymorphism (PCR‐RFLP), and further stratified based on HIV status, infants' birthweight (BW; NBW: normal BW [>2,500 g] and LBW: low BW [<2,500 g]) and gestational age (GA; NGA: normal GA [>37 weeks] and PTB: preterm birth [≤37 weeks]). A land use regression model was developed to characterize maternal NOx exposure. Pearson's correlation and multivariate regression analysis statistical tests were used to determine the effect of rs1042522 genotyped pregnant women's BMI and NOx exposure on maternal blood pressure and haemoglobin and iron levels, and infants' anthropometric measurements and Appearance Pulse Grimace Activity and Respiration (APGAR) scores. The prevalence of LBW and PTB was 14.7% and 18.7%, respectively. The LBW group had a higher frequency of the variant Arg‐allele versus NBW group (47.7% vs. 31.4%, p = .0046, OR = 2.0, 95% CI = 1.26–3.17). No association was observed between NGA and PTB groups. A significant association between BMI and systolic blood pressure (r = .50, p = .00; B = 0.76, p = .002) and birth length (r = −.28, p = .01; B = −0.107, p = .011), and NOx and birth length (r = −.26, p = .08; B = −0.191, p = .046) and birthweight (B = −8.87, p = .048) was observed in HIV‐infected mothers with the variant Pro/Arg + Arg/Arg genotypes. Mothers from the LBW group with the variant genotypes displayed an association between NOx and diastolic blood pressure (r = .58, p = .04), blood iron levels (r = −.60, p = .04; B = −0.204, p = .004), APGAR scores at 1 min (r = −.86, p = .00; B = −0.101, p = .003) and 5 min (r = −.75, p = .01) and birth length (r = −.61, p = .04), and BMI and diastolic blood pressure (r = .72, p = .01). In the PTB group, maternal variant genotypes and NOx were associated with blood haemoglobin levels (B = −0.132, p = .045) and APGAR scores at 1 min (B = −0.161, p = .045) and 5 min (B = −0.147, p = .043). Maternal rs1042522 Arg‐allele, HIV infection, BMI and NOx exposure collectively play a role in lowering blood iron levels, gestational hypertension and LBW outcomes.

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Anaemia in pregnancy in a setting of high HIV prevalence rates

Cited by 8 publications

References 10 publications

A study on seroprevalence of HIV among women attending obstetric care in a tertiary care hospital of South India with maternal and perinatal outcomes

A study on seroprevalence of HIV among women attending obstetric care in a tertiary care hospital of South India with maternal and perinatal outcomes

The prevalence, risk factors and outcomes of anaemia in South African pregnant women: a systematic review and meta-analysis

Effect of maternal HIV infection, BMI and NOx air pollution exposure on birth outcomes in South African pregnant women genotyped for the p53 Pro72Arg (rs1042522)

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