Anemia in pregnancy in rural Tanzania: associations with micronutrients status and infections

Hinderaker, Sven Gudmund; Olsen, Bjørg Evjen; Lie, RT; Bergsjø, Per; Gasheka, Petro; Bondevik, Gunnar Tschudi; Ulvik, Rune J.; Kvåle, Gunnar

doi:10.1038/sj.ejcn.1601300

Cited by 43 publications

(37 citation statements)

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“…Studies were categorized as those assessing the association between iron supplementation and malaria risk in pregnancy [33]–[39], iron deficiency and malaria risk in pregnancy [34], [40]–[50], iron biomarkers and malaria risk in pregnancy [40]–[43], [46], [47], [50]–[61], or iron treatment and malaria risk in pregnancy [62], [63]. These included two randomized controlled trials [36], [37] and one sub-group analysis [33] from the main trial [37], two prospective cohort studies [38], [62], one before-after study [39], one retrospective cohort study [63], six case-control studies [40], [47], [49], [52]–[54], and 18 cross-sectional studies (table 1–4) [34], [35], [41]–[46], [48], [50], [51], [55]–[61]. One cross-sectional study was described in two articles, the original analyzed serum ferritin relative to malaria infection [57] and the supplemental article considered iron deficiency status controlling for inflammation relative to malaria infection [45].…”

Section: Resultsmentioning

confidence: 99%

“…The effect of iron deficiency on malaria risk in pregnancy was assessed in 12 studies including three case-control studies [40], [47], [49], and nine cross-sectional studies (table 2) [34], [41]–[46], [48], [50]. Among these studies, five considered evidence of malaria at the time of delivery [40], [44], [48]–[50], six considered malaria at the time of enrollment [34], [41]–[43], [45], [47], and one did not specify when iron deficiency was assessed [46].…”

Section: Resultsmentioning

confidence: 99%

“…Among these studies, five considered evidence of malaria at the time of delivery [40], [44], [48]–[50], six considered malaria at the time of enrollment [34], [41]–[43], [45], [47], and one did not specify when iron deficiency was assessed [46]. Seven of these 12 studies used the same definitions of iron deficiency (serum ferritin <30 ng/mL with CRP< = 8.2 ng/mL or serum ferritin <70 ng/mL with CRP>8.2 ng/mL), and pooled analysis showed an overall decreased odds for peripheral parasitemia in pregnancy (OR pooled 0.35, 95% CI 0.24–0.51; I 2 59.2%, five studies, figure 3) associated with iron deficiency, but this was not significant for placental malaria (OR pooled 0.34, 95% CI 0.11–1.10; I 2 75·8%, two studies, figure 4).…”

Section: Resultsmentioning

confidence: 99%

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The Association between Malaria and Iron Status or Supplementation in Pregnancy: A Systematic Review and Meta-Analysis

et al. 2014

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IntroductionMalaria prevention and iron supplementation are associated with improved maternal and infant outcomes. However, evidence from studies in children suggests iron may adversely modify the risk of malaria. We reviewed the evidence in pregnancy of the association between malaria and markers of iron status, iron supplementation or parenteral treatment.Methods and FindingsWe searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, the Global Health Library, and the Malaria in Pregnancy library to identify studies that investigated the association between iron status, iron treatment or supplementation during pregnancy and malaria. Thirty one studies contributed to the analysis; 3 experimental and 28 observational studies. Iron supplementation was not associated with an increased risk of P. falciparum malaria during pregnancy or delivery in Africa (summary Relative Risk = 0.89, 95% Confidence Interval (CI) 0.66–1.20, I2 = 78.8%, 5 studies). One study in Asia reported an increased risk of P. vivax within 30 days of iron supplementation (e.g. adjusted Hazard Ratio = 1.75, 95% CI 1.14–2.70 for 1–15 days), but not after 60 days. Iron deficiency (based on ferritin and C-reactive protein) was associated with lower odds for malaria infection (summary Odds Ratio = 0.35, 0.24–0.51, I2 = 59.2%, 5 studies). With the exception of the acute phase protein ferritin, biomarkers of iron deficiency were generally not associated with malaria infection.ConclusionsIron supplementation was associated with a temporal increase in P vivax, but not with an increased risk of P. falciparum; however, data are insufficient to rule out the potential for an increased risk of P. falciparum. Iron deficiency was associated with a decreased malaria risk in pregnancy only when measured with ferritin. Until there is more evidence, it is prudent to provide iron in combination with malaria prevention during pregnancy.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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The Association between Malaria and Iron Status or Supplementation in Pregnancy: A Systematic Review and Meta-Analysis

et al. 2014

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“…Several studies have observed an association between anemia and vitamin A status in presumably HIV-uninfected pregnant women, notably in Tanzania (Hinderaker et al , 2002) and Nepal (Bondevik et al , 2000). In a randomized trial in Indonesia, 97% of pregnant women supplemented with both vitamin A and iron became non-anemic, compared to 68% of those who received iron alone (Suharno et al , 1993).…”

Section: Discussionmentioning

confidence: 99%

Lipid-soluble vitamins A, D, and E in HIV-infected pregnant women in Tanzania

et al. 2010

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Background/Objectives: There is limited published research examining lipid-soluble vitamins in human immunodeficiency virus (HIV)-infected pregnant women, particularly in resource-limited settings. Subjects/Methods: This is an observational analysis of 1078 HIV-infected pregnant women enrolled in a trial of vitamin supplementation in Tanzania. Baseline data on sociodemographic and anthropometric characteristics, clinical signs and symptoms, and laboratory parameters were used to identify correlates of low plasma vitamin A (o0.7 mmol/l), vitamin D (o80 nmol/l) and vitamin E (o9.7 mmol/l) status. Binomial regression was used to estimate risk ratios and 95% confidence intervals.Results: Approximately 35, 39 and 51% of the women had low levels of vitamins A, D and E, respectively. Severe anemia (hemoglobin o85 g/l; Po0.01), plasma vitamin E (P ¼ 0.02), selenium (P ¼ 0.01) and vitamin D (P ¼ 0.02) concentrations were significant correlates of low vitamin A status in multivariate models. Erythrocyte Sedimentation Rate (ESR) was independently related to low vitamin A status in a nonlinear manner (P ¼ 0.01). The correlates of low vitamin D status were CD8 cell count (P ¼ 0.01), high ESR (ESR 481 mm/h; Po0.01), gestational age at enrollment (nonlinear; P ¼ 0.03) and plasma vitamins A (P ¼ 0.02) and E (P ¼ 0.01). For low vitamin E status, the correlates were money spent on food per household per day (Po0.01), plasma vitamin A concentration (nonlinear; Po0.01) and a gestational age o16 weeks at enrollment (Po0.01). Conclusions: Low concentrations of lipid-soluble vitamins are widely prevalent among HIV-infected women in Tanzania and are correlated with other nutritional insufficiencies. Identifying HIV-infected persons at greater risk of poor nutritional status and infections may help inform design and implementation of appropriate interventions.

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“…In 20% anaemia was severe (Hb < 8.5 g/dl) enough to require a referral [13]. A study from rural Tanzania showed that about 60% of pregnant women had depleted iron stores and that anemia in pregnancy was associated with markers of infection and other nutritional deficiencies [14]. …”

Section: Introductionmentioning

confidence: 99%

Factors associated with prenatal folic acid and iron supplementation among 21,889 pregnant women in Northern Tanzania: A cross-sectional hospital-based study

et al. 2012

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BackgroundFolate and iron deficiency during pregnancy are risk factors for anaemia, preterm delivery, and low birth weight, and may contribute to poor neonatal health and increased maternal mortality. The World Health Organization recommends supplementation of folic acid (FA) and iron for all pregnant women at risk of malnutrition to prevent anaemia. We assessed the use of prenatal folic acid and iron supplementation among women in a geographical area with a high prevalence of anaemia, in relation to socio-demographic, morbidity and health services utilization factors.MethodsWe analysed a cohort of 21,889 women who delivered at Kilimanjaro Christian Medical Centre (KCMC), Moshi, Tanzania, between 1999 and 2008. Logistic regression models were used to describe patterns of reported intake of prenatal FA and iron supplements.ResultsPrenatal intake of FA and iron supplements was reported by 17.2% and 22.3% of pregnant women, respectively. Sixteen percent of women reported intake of both FA and iron. Factors positively associated with FA supplementation were advanced maternal age (OR = 1.17, 1.02-1.34), unknown HIV status (OR = 1.54, 1.42-1.67), a diagnosis of anaemia during pregnancy (OR = 12.03, 9.66-14.98) and indicators of lower socioeconomic status. Women were less likely to take these supplements if they reported having had a malaria episode before (OR = 0.57, 0.53-0.62) or during pregnancy (OR = 0.45, 0.41-0.51), reported having contracted other infectious diseases (OR = 0.45, 0.42-0.49), were multiparous (OR = 0.73, 0.66-0.80), had preeclampsia/eclampsia (OR = 0.48, 0.38-0.61), or other diseases (OR = 0.55, 0.44-0.69) during pregnancy. Similar patterns of association emerged when iron supplementation alone and supplementation with both iron and FA were evaluated.ConclusionsFA and iron supplementation are low among pregnant women in Northern Tanzania, in particular among women with co-morbidities before or during pregnancy. Attempts should be made to increase supplementation both in general and among women with pregnancy complications.

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Anemia in pregnancy in rural Tanzania: associations with micronutrients status and infections

Cited by 43 publications

References 41 publications

The Association between Malaria and Iron Status or Supplementation in Pregnancy: A Systematic Review and Meta-Analysis

The Association between Malaria and Iron Status or Supplementation in Pregnancy: A Systematic Review and Meta-Analysis

Lipid-soluble vitamins A, D, and E in HIV-infected pregnant women in Tanzania

Factors associated with prenatal folic acid and iron supplementation among 21,889 pregnant women in Northern Tanzania: A cross-sectional hospital-based study

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