The relationship between markers of antenatal iron stores and birth outcomes differs by malaria prevention regimen—a prospective cohort study

Autor:	Amalia Karahalios, Valentina Laurita Longo, Elizabeth H. Aitken, Stephen J. Rogerson, Holger W. Unger, Stephan Karl, Julie A. Simpson, Andie V. Bleicher, Maria Ome-Kaius
Jazyk:	angličtina
Rok vydání:	2021
Předmět:	medicine.medical_specialty 030309 nutrition & dietetics Anemia Iron Plasmodium falciparum wa_395 wa_310 qv_183 Cohort Studies 03 medical and health sciences 0302 clinical medicine Pregnancy medicine Humans 030212 general & internal medicine Prospective Studies Prospective cohort study Iron supplementation 2. Zero hunger 0303 health sciences Obstetrics business.industry Intermittent preventive treatment Iron deficiency Infant Newborn Pregnancy Outcome Gestational age Infant General Medicine Odds ratio Iron stores medicine.disease Adverse birth outcomes 3. Good health wc_750 Malaria ws_420 Premature birth Pregnancy Complications Parasitic Cohort Premature Birth Medicine Female business Infection Cohort study Research Article
Zdroj:	BMC Medicine, Vol 19, Iss 1, Pp 1-13 (2021) BMC Medicine
ISSN:	1741-7015
Popis:	Background Iron deficiency (ID) has been associated with adverse pregnancy outcomes, maternal anaemia, and altered susceptibility to infection. In Papua New Guinea (PNG), monthly treatment with sulphadoxine-pyrimethamine plus azithromycin (SPAZ) prevented low birthweight (LBW; Methods Plasma ferritin levels measured at antenatal enrolment in a cohort of 1892 women were adjusted for concomitant inflammation using C-reactive protein and α-1-acid glycoprotein. Associations of ID (defined as ferritin Results At first antenatal visit (median gestational age, 22 weeks), 1256 women (66.4%) had ID. Overall, ID or ferritin levels at first antenatal visit were not associated with birth outcomes. There was effect modification by treatment arm. Amongst SPCQ recipients, ID was associated with a 81-g higher mean birthweight (95% confidence interval [CI] 10, 152; P = 0.025), and a twofold increase in ferritin levels was associated with increased odds of SGA (adjusted odds ratio [aOR] 1.25; 95% CI 1.06, 1.46; P = 0.007). By contrast, amongst SPAZ recipients, a twofold increase in ferritin was associated with reduced odds of LBW (aOR 0.80; 95% CI 0.67, 0.94; P = 0.009). Mediation analyses suggested that malaria infection or haemoglobin levels during pregnancy do not substantially mediate the association of ID with birth outcomes amongst SPCQ recipients. Conclusions Improved antenatal iron stores do not confer a benefit for the prevention of adverse birth outcomes in the context of malaria chemoprevention strategies that lack the non-malarial properties of monthly SPAZ. Research to determine the mechanisms by which ID protects from suboptimal foetal growth is needed to guide the design of new malaria prevention strategies and to inform iron supplementation policy in malaria-endemic settings. Trial registration ClinicalTrials.gov NCT01136850.
Databáze:	OpenAIRE
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