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

Rhona K. Baingana, John K. Enyaru, Harold Tjalsma, Dorine W. Swinkels, Lena Davidsson

Research output: Contribution to journalArticlepeer-review

12 Citations (Scopus)

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. Population-attributable 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.

Original languageEnglish
Pages (from-to)1423-1435
Number of pages13
JournalPublic Health Nutrition
Volume18
Issue number8
DOIs
Publication statusPublished - 1 Jan 2015

Keywords

  • Anaemia
  • Infection
  • Iron status
  • Pregnancy
  • Uganda

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