Trichuris and hookworm infections associated with anaemia during pregnancy

Abstract

Summaryobjective To assess the following associations between the second and third trimesters of pregnancy: (i) the intensity of soil-transmitted helminth (STH) infection and haemoglobin ⁄ anaemia, (ii) the effect of mebendazole treatment on the occurrence of STH infection, and (iii) the effect of mebendazole treatment on haemoglobin ⁄ anaemia.methods Data originated from a trial of 1042 pregnant women recruited in their second trimester and followed to delivery. Baseline assessments included socio-demographic ⁄ health information from questionnaires, haemoglobin ⁄ anaemia from HemoCue ascertainment of fingerprick blood, and the presence and intensity of STH (Ascaris lumbricoides, hookworms and Trichuris trichiura) infections from KatoKatz examination. All women were given iron supplements; half were randomly allocated to receive single dose 500 mg mebendazole, and half, placebo. Haemoglobin ⁄ anaemia and STH infection status were determined again in the third trimester of pregnancy.results Complete information was available from 935 (89.7%) women. Mebendazole significantly reduced the prevalence and intensity of all three STH infections. Higher intensities of hookworm and Trichuris infections in the second trimester were associated with a higher risk of anaemia in the third trimester. Overall, women with moderate ⁄ heavy Trichuris infection were found to be at a higher risk of anaemia; the highest risk was observed among those with moderate ⁄ heavy hookworm co-infection (adjusted OR = 2.77; 95% CI: 1.26, 6.11). Mebendazole treatment did not reduce the risk of anaemia.conclusion Higher intensities of both Trichuris and hookworm infections are associated with anaemia in pregnancy. The importance of Trichuris infections during pregnancy requires renewed attention.

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

“…[23][24][25] A recent study has also shown an adverse effect of T. trichiura infection as well as co-infection with hookworm and T. trichiura on maternal anemia. 26 Maternal hemoglobin may therefore be an appropriate surrogate marker of adverse birth outcomes. In studies one can control for iron supplementation, which may make it easier to detect an impact of the parasitic infections.…”

Blood Drain: Soil-Transmitted Helminths and Anemia in Pregnant Women

“…However, none of these studies had differentiated between Trichuris infection intensity categories. Of the single study which had examined Trichuris infection intensity categories, results showed that pregnant women with moderate or heavy Trichuris infection in their second trimester of pregnancy had statistically significantly lower Hb levels compared to those with no or light Trichuris infection, despite all of the women receiving iron supplementation [16]. It, therefore, showed an association between both Trichuris infection and increasing Trichuris intensity, as well as an increased risk of anemia—and this despite iron supplementation.…”

“…Moreover, there is limited evidence demonstrating that, in cases where there is co-infection of Trichuris with hookworm, the risk of anemia increases with increasing intensity of either Trichuris infection or hookworm infection [16]. However, more research is needed on this topic.…”

Prevalence of Anemia Among Pregnant Women in Ethiopia and Its Management: A Review

“…An analysis of the baseline (second trimester) data for an randomized controlled trials investigating the effectiveness of de-worming and iron supplementation in a population of more than 1000 pregnant women living in and around Iquitos in the Peruvian Amazon showed that women with moderate-to-heavy intensities of both hookworm and Trichuris infection were more than twice as likely to concurrently have anemia as those with no or light infection. An analysis of the trial proper documented the effect of mebendazole and iron supplementation on anemia and on the presence and intensity of STH infections 75 . A clinical study conducted in Venezuela shows that intestinal parasitic infections, especially due to helminthes, increase anemia in pregnant women and the results of this are low pregnancy weight gain and intra uterine growth retardation, followed by low birth weight, with its associated greater risks of infection and higher perinatal mortality rates.…”