Iron deficiency anaemia in Nigerian pregnant women

Tropical obstetrics and gynaecology. 1. Anaemia in pregnancy in tropical Africa

Major causes of anaemia in pregnancy in tropical Africa are malaria, iron deficiency, folate deficiency and haemoglobinopathies: now there is added also the acquired immune deficiency syndrome (AIDS). Anaemia is often multifactorial, with the different causes interacting in a vicious cycle of depressed immunity, infection and malnutrition. Anaemia progresses through 3 stages: compensation, with breathlessness on exertion only; decompensation, with breathlessness at rest and haemoglobin (Hb) below about 70 g/litre; cardiac failure, with Hb below about 40 g/litre. Without treatment, over half of the women with haematocrit less than 0.13 and heart failure die. Maternal anaemia, malaria and deficiencies of iron and folate cause intrauterine growth retardation, premature delivery and, when severe, perinatal mortality. Surviving infants have low birthweights, immune deficiency and poor reserves of iron and folate. They have entered already the vicious cycle of infection, malnutrition and impaired immunity. Treatment with blood transfusions is even more hazardous since the advent of AIDS, and should be limited to saving the life of the mother. Treatment of malaria is complex as chloroquine-resistant strains are now common. Prevention remains relatively easy with proguanil and supplements of iron and folic acid and is highly cost-effective in the improvement of maternal and infant health; it is more important than ever as it avoids the unnecessary exposure of women and infants to HIV transmitted through blood transfusion.

Anaemia and iron status of pregnant and non-pregnant women in the guinea savanna of Nigeria

Haemoglobin concentration, serum iron, iron binding capacity, transferrin saturation, free erythrocyte protoporphyrin and serum ferritin (SF) were measured in 66 elite non-pregnant and 95 pregnant (27 elite and 68 non-elite) Nigerian women at Zaria, in the guinea savanna. Anaemia (as defined) was observed in 46% non-pregnant, 37% pregnant elite and 52% pregnant non-elite women. Iron deficiency (as defined) was diagnosed in 54, 30 and 25%, respectively. The mean SF in pregnant elite (28.9 micrograms l-1 was lower, but not significantly, than in pregnant non-elite women (33.6 micrograms l-1, either because of less inflammatory disease or because of more iron deficiency. The prevalence of anaemia tended to fall with increasing parity, being 52% in primigravidae and 40% in grande-multigravidae; this was probably due to greater risk of malaria-induced anaemia in primigravidae. In contrast, prevalence of iron deficiency increased with parity, being 18 and 35%, respectively, in primigravidae and grande-multigravidae. Anaemia and iron deficiency were seen most frequently in the third trimester. Pregnant women in the north of Nigeria require iron supplements irrespective of socioeconomic status or maternal parity.

The relationship between the percentage saturation of maternal and cord plasma transferrin and the maternal and cord blood free erythrocyte protoporphyrin:haem ratio

The relationship between the percentage saturation of maternal and cord plasma transferrin and the maternal and cord blood free erythrocyte protoporphyrin:haem ratio were investigated in 49 healthy mothers following an uncomplicated pregnancy, and in their full term newborn infants. The variables studied were plasma iron, plasma total iron-binding capacity, percentage saturation of plasma transferrin, free erythrocyte protoporphyrin:haem ratio and haematocrit value. The same variables were also investigated in a group of 60 healthy university students. Though the measurement of free erythrocyte protoporphyrin:haem ratio has broad application in public health studies, little information is available regarding the possible application and clinical use of this variable in the Nigerian population. The results obtained suggest that the free erythrocyte protoporphyrin:haem ratio of blood has a significant negative correlation with that of the percentage saturation of plasma transferrin of the sample. The maternal percentage saturation of plasma transferrin has a significant positive correlation with that of the corresponding fetal (cord) sample. There was no significant correlation between maternal and cord free erythrocyte protoporphyrin [FEP]:haem ratio.

Dietary iron intake of pregnant Nigerian women with anemia

The daily dietary iron intake of nine pregnant Nigerian women with confirmed iron deficiency anemia was determined. The daily dietary iron intake from hospital meals served to ten other pregnant women was also assessed to serve as a control. The mean daily iron intake of the group of anemic patients on home diet was 14.6 mg (range of individual means = 8.37-25.28 mg), whereas the group of patients served hospital meals had a mean daily dietary iron intake of 36.92 mg (range of individual means = 25.09-46.47 mg). It is, therefore, clear that the etiology of iron deficiency in the patients studied was mainly dietary. Thus, our pregnant patients, many of whom are on diets similar to those of the group studied, should receive iron supplements during pregnancy.