Etiology of anemia in pregnancy in south Malawi.
van den Broek NR; Letsky EA
American Journal of Clinical Nutrition 2000 Jul;72(1 Suppl):247S-256S
BACKGROUND: Anemia in pregnancy is a major public health problem in
developing countries. In sub-Saharan Africa, such anemia is generally
accepted as resulting from nutritional deficiencies, particularly iron
deficiency. OBJECTIVE: We comprehensively assessed the full spectrum of
nutritional and nonnutritional factors associated with pregnancy anemia.
DESIGN: Iron, folate, vitamin B-12, and vitamin A were measured in serum
in a cross-sectional study of 150 pregnant women in Blantyre, Malawi.
Bone marrow aspirates were evaluated, peripheral blood films were examined
for malaria parasites, stool and urine samples were examined for helminthic
infection, and tests were done for genetic disorders and for HIV infection.
C-reactive protein (CRP) concentrations and erythrocyte sedimentation
rates were measured as markers of inflammation. RESULTS: Of the
150 anemic women, 23% were iron deficient with no evidence of folate,
vitamin B-12, or vitamin A deficiencies; 32% were deficient in iron and
one or more of the other micronutrients; 26% were not iron deficient but
had evidence of one of the other micronutrient deficiencies, most often
vitamin A; and 19% were not deficient in any of the micronutrients studied.
CRP concentrations were notably high in 54% of the anemic women with no
nutritional deficiencies and in 73.5% of the anemic women who were iron
replete by bone marrow assessment. CONCLUSION: The role of chronic inflammation
as a possible contributing factor to anemia in pregnancy has important
implications for the clinical evaluation and treatment of women.