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

Abstract

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

Iron deficiency among pregnant women attending an antenatal clinic in Northern Uganda: a cross-sectional study

“…In addition, the high burden of iron deficiency during pregnancy in this study could be due to the fact that, in Uganda as a whole, 32% of women of reproductive age are anemic before pregnancy [7] mainly as a result of iron deficiency. Similar findings were also reported by studies from Central Uganda [14] and parts of Portugal [18] among first trimester pregnant women in which the prevalence of iron deficiency was 40.4% and 38.3% respectively. Results of this study were also consistent with what was reported in a systematic review done among pregnant women in Ethiopia, Kenya, Nigeria and South Africa in which the prevalence of iron deficiency ranged from 19-61% [19].…”

“…The Kish-Leslie formula [13] was used to calculate the sample size of the study. A29.1% prevalence of anemia during pregnancy was used to calculate a sample size of 320 participants [14]. A consecutive sampling technique was used to enroll study participants.…”

Extragastric Diseases and Helicobacter pylori

“…Several studies from different countries recently reported a positive association between H. pylori infection and iron deficiency anemia (IDA) [43][44][45], and several factors, including hypochlorhydria, pro-hepcidin, and hepcidin may possibly affect this hematological condition [45,46]. Another recent study also demonstrated a significant improvement of some IDA status indices, including mean corpuscular volume and transferrin, following H. pylori eradication in children from Egypt [47].…”

Helicobacter pylori and Perinatal Pathologies: Pathogen Transmission During Childbirth?

“…Hyperemesis gravidarum [8][9][10][11][12] Preeclampsia [13][14][15]23] Iron-deficiency Anemia [16][17][18][19] Intrauterine growth Restriction [20][21][22]27] Spontaneous abortion [24][25][26] and inflammatory damage over the gastric epithelium resulting in gastrointestinal disturbance such as hyperemesis gravidarum. H. pylori sequesters essential micronutrients from the host organism such as Iron (Fe) and it causes iron deficiency anemia.…”

“…Baingana et al [19] in a study whose aim is to describe the etiology of anemia en pregnant women in Uganda, analyzes iron deficiency and common infections as contributors to anemia in this particular population. They found that infections and inflammation are more relevant than iron deficiency in the etiology of Uganda´s pregnant women during the first quarter of the year.…”