The response to iron supplementation of pregnant women with the haemoglobin genotype AA or AS

Abstract

The influence of haemoglobin genotype on the response to iron supplementation was studied in a randomized, double blind, placebo-controlled trial involving 497 multigravid pregnant women from a rural area of The Gambia. Women were randomly allocated to receive either oral iron (60mg elemental iron per day) or placebo. At 36 weeks of pregnancy, women who had received oral iron during pregnancy had higher mean haemoglobin, packed cell volume, plasma iron and ferritin levels than did women who received placebo. Iron sup lementation creases in the pat IR of pre ed cell volume (P E nant women with the AA haemoglobin genotype also resulted in in-V) and haemoglobin level measured after delivery, and in the birth weight of the infant. However, in AS women PCV and haemoglobin level at delivery were lower in the supplemented group and supplementation was also associated with reduced birth weights. In malaria endemic areas, pregnant women with the haemoglobin genotype AS may not benefit from iron supplementation during pregnancy.

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

“…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].…”

“…The effect of iron supplementation on malaria risk in pregnancy was assessed in seven studies which included the two trials [36], [37], the one randomized trial sub-group analysis [33], one prospective cohort study [38], one before-after study [39], and two cross-sectional studies [34], [35]. The dose and duration of iron supplementation varied in the studies, as did the level of malaria endemicity and use of malaria prevention interventions (table 1).…”

“…This analysis excluded the sub-group analysis from the RCT because these women were represented in the parent study [33], and the study using hazard ratios because these data were only presented by duration of iron supplementation and therefore not comparable to the other studies [38]. The overall pooled result of iron supplementation during pregnancy or delivery was not associated with an increased risk of malaria (RR pooled 0.89, 95% CI 0.66–1.20; I 2 78.8%, figure 2).…”

Malaria in pregnancy: the difficulties in measuring birthweight

“…The case reports did not contain sufficient details on the methodology used to measure birthweight and were excluded 10–12 . Forty‐three studies described in 59 publications were reviewed (Table S1, see Supporting information) 13–72 . Most (56%, 24/43) were studies on the prevention of malaria by intermittent preventive treatment (IPTp) or chemoprophylaxis in the African subcontinent (Table S1).…”

Prevalencia de anemia en gestantes, Hospital Regional de Pucallpa, Perú

“…Desde el punto de vista clínico, la mayor atención recae en la anemia del embarazo y por ello es frecuente observar en los servicios de ginecología y obstetricia la administración de suplementos de hierro a las embarazadas (7,8). Esta medida está destinada a prevenir la anemia y sus consecuencias en el feto y recién nacido (9,10).…”