Total dose iron infusion, malaria and pregnancy in Papua New Guinea

Abstract

A study was made of 544 mothers and their 556 newborns in an area of endemic malaria, to analyse effects of total dose intravenous iron infusion (TDI) to mothers during pregnancy. 34% of these mothers received TDI before delivery. A range of haematological tests was carried out on newborns and mothers in addition to anthropometry. 84% of mothers had had ante-natal care and data were also collected retrospectively from ante-natal records. TDI was associated with more slide positive peri-natal malaria in primipara (odds ratio: 5.46) but not in multipara. When all relevant factors were considered TDI was not associated with an overall improvement in haemoglobin status from the first ante-natal level recorded to the post-natal check. Post-natal malaria was associated with lower ante-natal and post-natal haemoglobin levels. There was no evidence of any effect of TDI in pregnancy or of maternal malaria on foetal maturity or birth weight. Gestational age, maternal weight, parity and maternal post-natal haemoglobin were all significantly correlated with birth weight. TDI to the mother was associated with higher neo-natal serum ferritins and lower neo-natal haemoglobins. Maternal post-natal malaria was associated with significantly lower iron in serum in newborns. It is suggested that routine total dose iron infusion to anaemic pregnant mothers in malaria endemic areas may be contraindicated.

Community-Based Interventions for Improving Perinatal and Neonatal Health Outcomes in Developing Countries: A Review of the Evidence

“…It must be pointed out also that there is evidence that administration of parenteral iron to iron-deficient women during pregnancy in malaria-endemic areas may be associated with an increase in the incidence of malarial infections and clinical episodes of disease. 170,171 Thus, care must be exercised in administering iron supplements alone (without chemoprophylaxis) in malaria-endemic areas.…”

Combined iron/folic acid supplements and malaria prophylaxis reduce neonatal mortality in 19 sub-Saharan African countries

“…Regardless of the beneficial effect of iron/folic acid supplements, there have been reports of an adverse effect of iron supplements on malaria infections in children (16) and pregnant women living in malaria-endemic areas (17). In these studies, the rate of malaria infections was reported to increase in women and children who received iron (16)(17)(18)(19).…”

“…In these studies, the rate of malaria infections was reported to increase in women and children who received iron (16)(17)(18)(19). However, a recent metaanalysis showed no evidence of adverse effects of iron treatment in children from endemic-malaria areas (20).…”

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

“…However, in endemic areas, malaria may be an equally important cause of anaemia, especially in primigravidae (BRABIN, 1983). Two studies have shown that parenteral iron administration during pregnancy increased susceptibility to malaria (BYLES & D'SA, 1970;OPPENHEIMER et al, 1986). We therefore carried out a controlled trial of iron supplementation in pregnant women resident in a rural area of The Gambia where malaria is common.…”