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01.12.2012 | Research | Ausgabe 1/2012 Open Access

Malaria Journal 1/2012

Malaria and gravidity interact to modify maternal haemoglobin concentrations during pregnancy

Zeitschrift:
Malaria Journal > Ausgabe 1/2012
Autoren:
Smaïla Ouédraogo, Florence Bodeau-Livinec, Valérie Briand, Bich-Tram Huynh, Ghislain K Koura, Manfred MK Accrombessi, Nadine Fievet, Achille Massougbodji, Philippe Deloron, Michel Cot
Wichtige Hinweise

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

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.

Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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.
Literatur
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