Risk factors for fetal anaemia in a malarious area of Malawi

Brabin, Bernard; Kalanda, Boniface; Verhoeff, Francine H.; Chimsuku, L.; Broadhead, Robin L.

doi:10.1179/027249304225019136

Cited by 64 publications

(62 citation statements)

References 27 publications

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“…In poor-resource countries, fetal anaemia is more common and is associated with severe maternal iron deficiency anaemia. In malarious areas the degree of fetal anaemia is out of proportion to the level of maternal anaemia and is likely to relate to the density of placental malaria as well as the risk of developing infant anaemia (Brabin, 1992;Brabin et al, 2004b). Glucose-6-phosphate dehydrogenase deficiency (G6PDD) might contribute to fetal anaemia.…”

Section: Discussionmentioning

confidence: 99%

A cohort study of haemoglobin and zinc protoporphyrin levels in term Zambian infants: effects of iron stores at birth, complementary food and placental malaria

et al. 2007

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Objective: To examine zinc-protoporphyrin (ZPP) and haemoglobin levels, and to determine predictors of iron deficiency anaemia (IDA) in Zambian infants. Subjects and methods: Ninety-one women and their normal birth weight (NBW) infants were followed bi-monthly during the first 6 months of life, and iron status, food intake, malaria parasitaemia and growth were monitored. At 4 months, the infants were divided into two groups, and the data were analysed according to whether or not they were exclusively breastfed. Results: Almost two-third of infants were born with low iron stores as defined by ZPP levels, and this proportion increased with age. Over 50% had developed IDA by 6 months. Exclusive breastfeeding at 4 months could be a protective factor for IDA (odds ratio (OR): 0.2; 95% confidence interval (CI): 0.0-1.1). Exclusively breastfed infants had higher haemoglobin values at 4 and 6 months (mean difference 0.6; 95% CI: 0.1-1.2 g/dl and mean difference 0.9; 95% CI: 0.2-1.7 g/dl, respectively), compared with infants with early complementary feeding. In univariate analysis, past or chronic placental malaria appeared to be a predictor of IDA at 4 and 6 months, but the significance was lost in multivariate analysis. Conclusions: Zambian NBW infants are born with low iron stores and have a high risk to develop IDA in the first 6 months of life. Continuation of exclusive breastfeeding after 4 months is associated with a reduction of anaemia. The effect of placental malaria infection on increased risk of infant IDA could not be proven.

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Section: Discussionmentioning

confidence: 99%

A cohort study of haemoglobin and zinc protoporphyrin levels in term Zambian infants: effects of iron stores at birth, complementary food and placental malaria

et al. 2007

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“…The exact mechanism leading to IUGR with placental malaria is unclear although placental insufficiency and reduction of oxygen and/or glucose transport to the fetus are likely to play a role. This may relate to a number of mechanisms, for example, mechanical blockage from the thickening of the trophoblast basement membrane, increased nutrient requirements by replicating parasites, or poor oxygen and glucose transfer [33,34]. Placental abnormalities resulting from nutritional deficiency or maternal vascular changes affecting the placenta may be involved [35].…”

Section: Discussionmentioning

confidence: 99%

Adverse birth outcomes in a malarious area

et al. 2005

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SUMMARYTo determine factors associated with fetal growth, preterm delivery and stillbirth in an area of high malaria transmission in Southern Malawi, a cross-sectional study of pregnant women attending and delivering at two study hospitals was undertaken. A total of 243 (17 . 3 %) babies were preterm and 54 (3 . 7%) stillborn. Intra-uterine growth retardation (IUGR) occurred in 285 (20 . 3 %), of whom 109 (38 . 2%) were low birthweight and 26 (9 . 1%) preterm. Factors associated with IUGR were maternal short stature [adjusted odds ratio (AOR) 1 . 6, 95 % confidence interval (CI) 1 . 0-2 . 5] ; primigravidae (AOR 1 . 9, 95 % CI 1 . 4-2 . 7) ; placental or peripheral malaria at delivery (AOR 1 . 4, 95 % CI 1 . 0-1 . 9) and maternal anaemia at recruitment (Hb <8 g/dl) (AOR 1 . 9, 95% CI 1 . 3-2 . 7). Increasing parasite density in the placenta was associated with both IUGR (P=0 . 008) and prematurity (P=0 . 02). Factors associated with disproportionate fetal growth were maternal malnutrition [mid-upper arm circumference (MUAC) <23 cm, AOR 1 . 9, 95% CI 1 . 0-3 . 7] and primigravidae (AOR 1 . 8, 95% CI 1 . 0-3 . 1). Preterm delivery and stillbirth were associated with <5 antenatal care visits (AOR 2 . 2, 95% CI 1 . 3-3 . 7 and AOR 3 . 1, 95 % CI 1 . 4-7 . 0 respectively) and stillbirth with a positive Venereal Disease Research Laboratory (VDRL) test (AOR 4 . 7, 95 % CI 1 . 5-14 . 8). Interventions to reduce poor pregnancy outcomes must reduce the burden of malaria in pregnancy, improve antenatal care and maternal malnutrition.

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“…This indicates that the lower Z-scores from about 8 weeks of age in infants receiving early complementary foods were not specifically occurring in low birthweight babies. Infant anaemia was a common problem especially in low birthweight babies and was associated with a high prevalence of fetal anaemia (Le Cessie et al, 2002;Brabin et al, 2004).…”

Section: Mean W/a Z-scorementioning

confidence: 99%

Breast and complementary feeding practices in relation to morbidity and growth in Malawian infants

2005

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Objectives: The objective of this study was to compare growth, morbidity incidence and risk factors for undernutrition between infants receiving complementary feeding early, before 3 months of age, with those receiving complementary foods after 3 months in a poor rural Malawian community. Methods: A cohort of babies was enrolled at birth for follow-up to 12 months of age. Weight, length, morbidity and feeding patterns were recorded at 4 weekly intervals from birth to 52 weeks. Results: Mean age at introduction of water was 2.5 months (range 0-11.8), complementary foods 3.4 months (range, 1.0-10.7) and solids 4.5 months (range 1.2-13.8). Over 40% of infants had received complementary foods by 2 months and 65% by 3 months. The proportion of exclusively breast-fed infants, which included those receiving supplemental water, was 13% at 4 months, 6.3% at 5 months and 1.5% at 6 months. Infants with early complementary feeding had lower weight for age at 3 and 6 months (Po0.05), and at 9 months (P ¼ 0.07) and at 2 months they were approximately 200 g lighter. Early complementary feeding was significantly associated with increased risk for respiratory infection (Po0.05), and marginally increased risk for eye infection and episodes of malaria. Maternal illiteracy was associated with early complementary feeding (OR ¼ 2.1, 95% CI 1.3, 3.2), while later complementary feeding was associated with reduced infant morbidity and improved growth. Conclusion: Breast-feeding promotion programmes should target illiterate women. Greater emphasis is required to improve complementary feeding practices.

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Risk factors for fetal anaemia in a malarious area of Malawi

Cited by 64 publications

References 27 publications

A cohort study of haemoglobin and zinc protoporphyrin levels in term Zambian infants: effects of iron stores at birth, complementary food and placental malaria

A cohort study of haemoglobin and zinc protoporphyrin levels in term Zambian infants: effects of iron stores at birth, complementary food and placental malaria

Adverse birth outcomes in a malarious area

Breast and complementary feeding practices in relation to morbidity and growth in Malawian infants

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