Effects of Deworming during Pregnancy on Maternal and Perinatal Outcomes in Entebbe, Uganda: A Randomized Controlled Trial

Ndibazza, Juliet; Muhangi, Lawrence; Akishule, Denise; Kiggundu, Molly; Ameke, Christine; Oweka, J.; Kammerer, Robert; Duong, Thi Hong; Kleinschmidt, Immo; Muwanga, Moses; Elliott, Alison M.

doi:10.1086/649924

Cited by 140 publications

(154 citation statements)

References 18 publications

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“…The prevalence of anaemia was 29·1 % which is comparable to 31 % reported in the Uganda Demographic and Health Survey 2011 (3) and is consistent with data from other studies in Uganda (36)(37)(38)(39) . However, IDA represented only a small proportion of all anaemia, about 5-10 % depending on the biomarker used and cut-off level applied.…”

Section: Discussionsupporting

confidence: 88%

The aetiology of anaemia during pregnancy: a study to evaluate the contribution of iron deficiency and common infections in pregnant Ugandan women

Baingana

Enyaru

Tjalsma

et al. 2014

Public Health Nutr.

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Objective: To describe the aetiology of anaemia in pregnant Ugandan women and explore Fe deficiency and common infections as contributors to anaemia in this population. Design: Cross-sectional study in which Hb, ferritin, transferrin receptor (sTfR), C-reactive protein, α-1 acid glycoprotein, hepcidin, malaria, hookworm infestation, syphilis and Helicobacter pylori infection were assessed. Setting: Antenatal care clinic at Kawempe Health Centre, Kampala, Uganda. Subjects: HIV-negative women (n 151) in their first or second pregnancy at 10-16 weeks' gestation. Results: The prevalence of anaemia was 29·1 %. Fe deficiency was 40·4 % and 14·6 % based on ferritin <30 μg/l and on adjusted ferritin <12 μg/l respectively, and 6·6 % based on sTfR >8·3 μg/ml. The prevalence of Fe-deficiency anaemia was 9·3 % based on ferritin <30 μg/l, 6·6 % based on adjusted ferritin <12 μg/l and 4·3 % based on sTfR >8·3 μg/ml. Hepcidin concentration was positively correlated with ferritin concentration (n 151, r = 0·578, P < 0·00001). H. pylori infection was highly prevalent (70 %) while malaria, hookworm infestation and syphilis were not common. Of all women, 60·3 % had α-1 acid glycoprotein >1 g/l and/or C-reactive protein >5 mg/l. Malaria parasitaemia (OR = 6·85; 95 % CI 1·25, 37·41, P = 0·026) and Fe deficiency defined using sTfR (OR = 5·58; 95 % CI 1·26, 24·80, P = 0·024) were independently and positively associated with anaemia. Populationattributable risk factors for anaemia for raised C-reactive protein, Fe deficiency defined by sTfR >8·3 μg/ml and presence of malaria parasites were 41·6 (95 % CI 11·1, 72·2) %, 13·5 (95 % CI 2·0, 25·0) % and 12·0 (95 % CI 1·4, 22·6) %, respectively. Conclusions: Infections and inflammation are of greater significance than Fe deficiency in the aetiology of anaemia in pregnant Ugandan women during the first trimester. Keywords Anaemia Iron status Pregnancy Infection UgandaNearly 25 % of the world's population suffers from anaemia, with pregnant women and children of pre-school age the most affected (1) . In Uganda, anaemia is the third leading cause of in-patient mortality (2) . In 2011, 49 % of under-fives, 23 % of women of child-bearing age and 31 % of pregnant women in Uganda had anaemia (3) . Anaemia in developing countries has a multifactorial aetiology which includes Fe deficiency (ID) due to dependence on predominantly plant-based diets from which adequate Fe cannot be absorbed (4,5) . Infections such as malaria and hookworm infestation also contribute significantly to the high prevalence of anaemia in many settings (6) . Additionally, infection and inflammation defined by raised biomarkers contribute to anaemia as was demonstrated in a study in Malawi in which C-reactive protein (CRP) was elevated in 73·5 % of anaemic pregnant women who were Fe-replete by bone marrow assessment (7) . Hinderaker et al. (8) also found an association between elevated CRP and anaemia in pregnant women in rural Tanzania. More recently, Helicobacter pylori, the most common infection globally, has been

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Section: Discussionsupporting

confidence: 88%

The aetiology of anaemia during pregnancy: a study to evaluate the contribution of iron deficiency and common infections in pregnant Ugandan women

Baingana

Enyaru

Tjalsma

et al. 2014

Public Health Nutr.

View full text Add to dashboard Cite

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“…15 However, a subsequent randomized controlled trial in Uganda did not find a difference in birth outcomes in pregnant women treated with albendazole or praziquantel. 6 Helminth infection intensities were low, however, and the data suggested a benefit on maternal anemia with albendazole in those women with heavy hookworm infections. 6 A study with mebendazole in Peru showed a reduction in very low birthweight in those receiving anti-helminthic drugs, but not an overall improvement in mean birthweights.…”

Section: Introductionmentioning

confidence: 98%

“…6 Helminth infection intensities were low, however, and the data suggested a benefit on maternal anemia with albendazole in those women with heavy hookworm infections. 6 A study with mebendazole in Peru showed a reduction in very low birthweight in those receiving anti-helminthic drugs, but not an overall improvement in mean birthweights. 16 Based on these data and others, a Cochrane review demonstrated no definitive benefit of anti-helminth treatment in pregnant women and did not recommend routine use.…”

Section: Introductionmentioning

confidence: 98%

“…In sub-Saharan Africa and other disease-endemic areas, pregnant women carry a high burden of single helminth infection and of co-infection, or polyparasitism, with multiple helminths or with helminths and malaria. [5][6][7] Historically, pregnant women have been left out of many mass drug administration programs in endemic areas because of concern about potential effects of anti-helminthic agents on the developing fetus. 8,9 Consequently, a woman in these diseaseendemic areas may not receive therapy for years while she is either pregnant or breastfeeding.…”

Section: Introductionmentioning

confidence: 99%

“…13,14 However, studies of helminth infections during pregnancy and of the benefits of treating pregnant women are still few in number and have shown mixed results. 6,15,16 The consensus is now shifting to giving pregnant women anti-helminth treatment because of apparent safety after years of inadvertent doses given to women unknowingly pregnant. Lack of adverse outcomes in animal studies, reports from mass campaigns, and a randomized trial in Uganda of ivermectin and albendazole also support treating pregnant women.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Birthweight in Offspring of Mothers with High Prevalence of Helminth and Malaria Infection in Coastal Kenya

Fairley¹,

Bisanzio²,

King

et al. 2013

The American Society of Tropical Medicine and Hygiene

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Abstract. Results of studies on the associations of maternal helminth infection and malaria-helminth co-infection on birth outcomes have been mixed. A group of 696 pregnant women from the Kwale district in Kenya were recruited and tested for malaria and helminth infection at delivery. Birthweight was documented for 664 infants. A total of 42.7% of the mothers were infected with Plasmodium falciparum, 30.6% with Schistosoma haematobium, 36.2% with filariasis, 31.5% with hookworm, and 5.9% with Trichuris trichiura; co-infection was present in 46.7%. Low birthweight (LBW) (weight 2,500 grams) was present in 15.4% of the offspring, and 8.3% had a weight z-score 2 SD below the World Health Organization mean. Only gravida, age, and locale had a significant association with LBW. The high prevalence of maternal infection coupled with a higher than expected percentage of LBW highlight a need for further investigation of the association of maternal co-infection with LBW.

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Effect of administration of antihelminthics for soil-transmitted helminths during pregnancy

Salam

Haider

Humayun³

et al. 2015

Cochrane Database of Systematic Reviews

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Effects of Deworming during Pregnancy on Maternal and Perinatal Outcomes in Entebbe, Uganda: A Randomized Controlled Trial

Cited by 140 publications

References 18 publications

The aetiology of anaemia during pregnancy: a study to evaluate the contribution of iron deficiency and common infections in pregnant Ugandan women

The aetiology of anaemia during pregnancy: a study to evaluate the contribution of iron deficiency and common infections in pregnant Ugandan women

Birthweight in Offspring of Mothers with High Prevalence of Helminth and Malaria Infection in Coastal Kenya

Effect of administration of antihelminthics for soil-transmitted helminths during pregnancy

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