Malaria and gravidity interact to modify maternal haemoglobin concentrations during pregnancy

Malaria Journal

Research

Manfred MK Accrombessi¹  Achille Massougbodji¹  Florence Bodeau-Livinec²  Smaïla Ouédraogo³  Bich-Tram Huynh⁴  Nadine Fievet⁴  Valérie Briand⁴  Michel Cot⁴  Philippe Deloron⁴  Ghislain K Koura⁴ 

[1] Laboratoire de Parasitologie, Faculté des Sciences de la Santé, Cotonou, Benin;Mère et enfant face aux infections tropicales, IRD Unité mixte de recherche 216, Paris, France;Ecole des Hautes Etudes en Santé Publique, Rennes, France;PRES Sorbonne Paris Cité, Faculté de pharmacie, Paris, France;Mère et enfant face aux infections tropicales, IRD Unité mixte de recherche 216, Paris, France;Laboratoire de Parasitologie, Faculté des Sciences de la Santé, Cotonou, Benin;PRES Sorbonne Paris Cité, Faculté de pharmacie, Paris, France;Mère et enfant face aux infections tropicales, IRD Unité mixte de recherche 216, Paris, France;PRES Sorbonne Paris Cité, Faculté de pharmacie, Paris, France;

关键词: Anaemia;    Gravidity;    Malaria;    Iron deficiency;    Prevention;   

DOI  :  10.1186/1475-2875-11-348

 received in 2012-06-26, accepted in 2012-10-18,  发布年份 2012

来源: Springer

【 摘 要 】

BackgroundPrimigravidity is one of the main risk factors for both malaria and anaemia. Since the implementation of intermittent preventive treatment (IPTp) in sub-Saharan Africa, the relationship between anaemia and gravidity and its evolution during pregnancy has been little explored. This study aimed to evaluate the impact of gravidity on the variation of haemoglobin during pregnancy according to the timing of gestation.MethodsData from three studies carried out in nearby areas in south Benin (Ouidah, Comé, Allada) between 2005 and 2012 were analysed. At inclusion (first antenatal visit, ANV1) women’s age, area of residence, schooling, gravidity, gestational age, weight and height were recorded. Thick blood smears were performed on ANV1, second visit (ANV2) and at delivery. In Allada, women’s serum ferritin and CRP concentrations were also assessed. The impact of gravidity on maternal haemoglobin (Hb) was analysed using a logistic or linear regression depending on the outcome. The statistical significance was set to P < 0.05.ResultsIn total, data from 3,591 pregnant women were analysed. Both univariate and multivariate analyses showed a constant association between Hb concentrations and gravidity in the three periods of Hb assessment (ANV1, ANV2 and delivery). Mean Hb concentration was significantly lower in primigravidae than in multigravidae at ANV1 (mean difference = -2.4 g/L, CI 95%: [-3.4, -1.4], P < 0.001). Afterwards, there was a significant increase in primigravidae only, with a tendency to reversal between primigravidae and multigravidae, which was confirmed at delivery (mean difference = 2.8 g/L, CI 95%: [1.3, 4.2], P < 0.001). The prevalence of malaria infection was halved between ANV1 and delivery in primigravidae while it decreased by only 38% among multigravidae, who were less prone to malaria infection (prevalence at ANV1, 20% and 10% respectively). Iron deficiency was more common in multigravidae, and it decreased slightly in this group between ANV1 and delivery.ConclusionIn a context of IPTp, Hb levels improved progressively throughout pregnancy in primigravidae, likely as a result of reduction in malaria infection. In multigravidae, the improvement was less perceptible and anaemia was mainly due to iron deficiency.

【 授权许可】

CC BY   
© Ouédraogo et al.; licensee BioMed Central Ltd. 2012