The authors declare that they have no competing interests.
SO participated to conceive APEC study, participated in its design and coordination, performed statistical analyses and drafted and finalized the manuscript. FBL participated in statistical analyses and the finalization of the manuscript. VB participated to conceive Ouidah study, participated in its design and coordination, participated to the statistical analyses of the manuscript. BTH participated to implement and coordinate STOPPAM study and the finalization of the manuscript. GKK participated to implement APEC study, in the statistical analyses and the finalization of the manuscript. MMKA participated to the implementation and coordination of APEC study. NF participated to conceive, implement and coordinate STOPPAM study and the finalization of the manuscript. AM participated to conceive, implement and coordinate STOPPAM study and the finalization of the manuscript. PD participated to conceive and coordinate STOPPAM study and the finalization of the manuscript. MC participated to conceive and coordinate the three studies (Ouidah, STOPPAM, APEC), in the statistical analyses and the finalization of the manuscript. All authors read and approved the final manuscript.
Primigravidity 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.
Data 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.
In 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.
In 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.
Ouédraogo S, Koura GK, Bodeau-Livinec F, Accrombessi MMK, Massougbodji A, Cot M: Maternal anaemia in pregnancy: assessing the effect of preventive measures in a malaria endemic area. Am J Trop Med Hyg. in press
Brabin BJ, Ginny M, Sapau J, Galme K, Paino J: Consequences of maternal anaemia on outcome of pregnancy in a malaria endemic area in Papua New Guinea. Ann Trop Med Parasitol. 1990, 84: 11-24. PubMed
Briand V, Bottero J, Noel H, Masse V, Cordel H, Guerra J, Kossou H, Fayomi B, Ayemonna P, Fievet N, Massougbodji A, Cot M: Intermittent treatment for the prevention of malaria during pregnancy in Benin: a randomized, open-label equivalence trial comparing sulfadoxine-pyrimethamine with mefloquine. J Infect Dis. 2009, 200: 991-1001. 10.1086/605474. CrossRefPubMed
Huynh BT, Fievet N, Gbaguidi G, Dechavanne S, Borgella S, Guezo-Mevo B, Massougbodji A, Ndam NT, Deloron P, Cot M: Influence of the timing of malaria infection during pregnancy on birth weight and on maternal anemia in Benin. Am J Trop Med Hyg. 2011, 85: 214-220. 10.4269/ajtmh.2011.11-0103. PubMedCentralCrossRefPubMed
Planche T, Krishna S, Kombila M, Engel K, Faucher JF, Ngou-Milama E, Kremsner PG: Comparison of methods for the rapid laboratory assessment of children with malaria. Am J Trop Med Hyg. 2001, 65: 599-602. PubMed
WHO: The prevalence of anaemia in women. A tabulation of available information. 1992, Geneva: WHO, 2
Kayentao K, Kodio M, Newman RD, Maiga H, Doumtabe D, Ongoiba A, Coulibaly D, Keita AS, Maiga B, Mungai M, Parise ME, Doumbo O: Comparison of intermittent preventive treatment with chemoprophylaxis for the prevention of malaria during pregnancy in Mali. J Infect Dis. 2005, 191: 109-116. 10.1086/426400. CrossRefPubMed
Schultz LJ, Steketee RW, Macheso A, Kazembe P, Chitsulo L, Wirima JJ: The efficacy of antimalarial regimens containing sulfadoxine-pyrimethamine and/or chloroquine in preventing peripheral and placental Plasmodium falciparum infection among pregnant women in Malawi. Am J Trop Med Hyg. 1994, 51: 515-522. PubMed
Parise ME, Ayisi JG, Nahlen BL, Schultz LJ, Roberts JM, Misore A, Muga R, Oloo AJ, Steketee RW: Efficacy of sulfadoxine-pyrimethamine for prevention of placental malaria in an area of Kenya with a high prevalence of malaria and human immunodeficiency virus infection. Am J Trop Med Hyg. 1998, 59: 813-822. PubMed
Hommerich L, von Oertzen C, Bedu-Addo G, Holmberg V, Acquah PA, Eggelte TA, Bienzle U, Mockenhaupt FP: Decline of placental malaria in southern Ghana after the implementation of intermittent preventive treatment in pregnancy. Malar J. 2007, 6: 144-10.1186/1475-2875-6-144. PubMedCentralCrossRefPubMed
Garner P, Gulmezoglu AM: Drugs for preventing malaria-related illness in pregnant women and death in the newborn. Cochrane Database Syst Rev. 2003, 4: CD000169-
- Malaria and gravidity interact to modify maternal haemoglobin concentrations during pregnancy
Ghislain K Koura
Manfred MK Accrombessi
- BioMed Central
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