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Broad J, Robertson RC, Evans C, Perussolo J, Lum G, Piper JD, Loucaides E, Ziruma A, Chasekwa B, Ntozini R, Bourke CD, Prendergast AJ. Maternal inflammatory and microbial drivers of low birthweight in low- and middle-income countries. Paediatr Int Child Health 2024; 44:79-93. [PMID: 39066726 DOI: 10.1080/20469047.2024.2380974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 07/10/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Low birthweight (LBW) is when an infant is born too soon or too small, and it affects one in seven infants in low- and middle-income countries. LBW has a significant impact on short-term morbidity and mortality, and it impairs long-term health and human capital. Antenatal microbial and inflammatory exposure may contribute to LBW. METHODS Ovid-Medline, Embase and Cochrane databases were searched for English-language articles evaluating inflammatory, microbial or infective causes of LBW, small-for-gestational age, intra-uterine growth restriction or prematurity. Inclusion criteria were human studies including published data; conference abstracts and grey literature were excluded. A narrative synthesis of the literature was conducted. RESULTS Local infections may drive the underlying causes of LBW: for example, vaginitis and placental infection are associated with a greater risk of prematurity. Distal infection and inflammatory pathways are also associated with LBW, with an association between periodontitis and preterm delivery and environmental enteric dysfunction and reduced intra-uterine growth. Systemic maternal infections such as malaria and HIV are associated with LBW, even when infants are exposed to HIV but not infected. This latter association may be driven by chronic inflammation, co-infections and socio-economic confounders. Antimicrobial prophylaxis against other bacteria in pregnancy has shown minimal impact in most trials, though positive effects on birthweight have been found in some settings with a high infectious disease burden. CONCLUSION Maternal inflammatory and infective processes underlie LBW, and provide treatable pathways for interventions. However, an improved understanding of the mechanisms and pathways underlying LBW is needed, given the impact of LBW on life-course.
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Affiliation(s)
- Jonathan Broad
- Maternal and Child Health Research Department, Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Blizard Institute, Queen Mary University of London, London, UK
- Paediatrics Department, Croydon University Hospital, London, UK
| | - Ruairi C Robertson
- Maternal and Child Health Research Department, Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Blizard Institute, Queen Mary University of London, London, UK
| | - Ceri Evans
- Maternal and Child Health Research Department, Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Blizard Institute, Queen Mary University of London, London, UK
- Institute of Infection, Veterinary and Ecological Sciences, Liverpool, UK
| | - Jeniffer Perussolo
- Maternal and Child Health Research Department, Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Blizard Institute, Queen Mary University of London, London, UK
| | - Gina Lum
- Centre for Genomics and Child Health, Barts and The London School of Medicine and Dentistry, London, UK
| | - Joe D Piper
- Maternal and Child Health Research Department, Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Blizard Institute, Queen Mary University of London, London, UK
| | - Eva Loucaides
- Paediatrics Department, Croydon University Hospital, London, UK
| | - Asaph Ziruma
- Blizard Institute, Queen Mary University of London, London, UK
| | - Bernard Chasekwa
- Maternal and Child Health Research Department, Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Blizard Institute, Queen Mary University of London, London, UK
| | - Robert Ntozini
- Maternal and Child Health Research Department, Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Blizard Institute, Queen Mary University of London, London, UK
| | - Claire D Bourke
- Maternal and Child Health Research Department, Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Blizard Institute, Queen Mary University of London, London, UK
| | - Andrew J Prendergast
- Maternal and Child Health Research Department, Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Blizard Institute, Queen Mary University of London, London, UK
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Liu X, Liu X, Yang Z, Li Z, Zhang L, Zhang Y, Liu J, Ye R, Li N. The Association of Infant Birth Sizes and Anemia under Five Years Old: A Population-Based Prospective Cohort Study in China. Nutrients 2024; 16:1796. [PMID: 38931151 PMCID: PMC11206821 DOI: 10.3390/nu16121796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 05/30/2024] [Accepted: 06/04/2024] [Indexed: 06/28/2024] Open
Abstract
Infant birth sizes are vital clinical parameters to predict poor growth and micronutrient deficiency in early life. However, their effects on childhood anemia remain unclear. We aimed to explore the associations between birth weight, crown-heel length, and head circumference with anemia in early childhood, as well as potential modification factors. This population-based prospective cohort study included 204,556 participants with singleton live births delivered at gestational ages of 28-42 weeks. A logistic regression model was used to estimate the associations of the measures of infant birth size and their Z-score with anemia under five years old. There were 26,802 (13.10%) children under five years old who were diagnosed has having anemia. Compared with children who did not have anemia, children who had anemia had a lower birth weight and smaller head circumference and a longer crown-heel length (all p-values < 0.05). After adjusting for confounders, not only birth weight (β coefficient, -0.008; 95% CI, -0.011--0.004; p < 0.001) and head circumference (β coefficient, -0.004; 95% CI, -0.007--0.001; p = 0.009), but also the related Z-scores were negatively associated with childhood anemia, while the trends for crown-heel length were the opposite. We further found significant interactions of folic acid use and maternal occupation with infant birth sizes. In conclusion, infants having abnormal sizes at birth are significantly associated with the risk for childhood anemia, which can be modified by folic acid use during pregnancy and maternal occupation.
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Affiliation(s)
- Xiaojing Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing 100191, China; (X.L.); (X.L.); (Z.Y.); (Z.L.); (L.Z.); (Y.Z.); (J.L.); (R.Y.)
- Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, Peking University Health Science Center, Beijing 100191, China
| | - Xiaowen Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing 100191, China; (X.L.); (X.L.); (Z.Y.); (Z.L.); (L.Z.); (Y.Z.); (J.L.); (R.Y.)
- Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, Peking University Health Science Center, Beijing 100191, China
| | - Zeping Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing 100191, China; (X.L.); (X.L.); (Z.Y.); (Z.L.); (L.Z.); (Y.Z.); (J.L.); (R.Y.)
- Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, Peking University Health Science Center, Beijing 100191, China
| | - Zhiwen Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing 100191, China; (X.L.); (X.L.); (Z.Y.); (Z.L.); (L.Z.); (Y.Z.); (J.L.); (R.Y.)
- Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, Peking University Health Science Center, Beijing 100191, China
| | - Le Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing 100191, China; (X.L.); (X.L.); (Z.Y.); (Z.L.); (L.Z.); (Y.Z.); (J.L.); (R.Y.)
- Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, Peking University Health Science Center, Beijing 100191, China
| | - Yali Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing 100191, China; (X.L.); (X.L.); (Z.Y.); (Z.L.); (L.Z.); (Y.Z.); (J.L.); (R.Y.)
- Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, Peking University Health Science Center, Beijing 100191, China
| | - Jianmeng Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing 100191, China; (X.L.); (X.L.); (Z.Y.); (Z.L.); (L.Z.); (Y.Z.); (J.L.); (R.Y.)
- Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, Peking University Health Science Center, Beijing 100191, China
| | - Rongwei Ye
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing 100191, China; (X.L.); (X.L.); (Z.Y.); (Z.L.); (L.Z.); (Y.Z.); (J.L.); (R.Y.)
- Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, Peking University Health Science Center, Beijing 100191, China
| | - Nan Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing 100191, China; (X.L.); (X.L.); (Z.Y.); (Z.L.); (L.Z.); (Y.Z.); (J.L.); (R.Y.)
- Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, Peking University Health Science Center, Beijing 100191, China
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Toma AJ, Gutvirtz G, Sheiner E, Wainstock T. Maternal Anemia and Long-Term Offspring Infectious Morbidity. Am J Perinatol 2024; 41:e968-e973. [PMID: 36347508 DOI: 10.1055/a-1973-7543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Anemia of pregnancy is a common condition associated with adverse obstetric outcomes. However, little is known about its long-term effect on the offspring. This study aimed to evaluate a possible association between anemia during pregnancy and the long-term incidence of infectious morbidity in the offspring. STUDY DESIGN A large population-based retrospective study was conducted at the Soroka University Medical Center, the sole tertiary medical center in the south of Israel. The study included deliveries between the years 1991 and 2014 and compared long-term infectious morbidity of offspring of women with and without anemia during pregnancy (defined as hemoglobin level below 11 g/dL). The long-term incremental incidence of hospitalizations of offspring up to 18 years of age due to infectious morbidity was evaluated using Kaplan-Meier survival curves, while Cox's regression model was used to control for confounders. RESULTS During the study period, 214,244 deliveries met the inclusion criteria, of which 110,775 (51.7%) newborns were born to mothers with anemia during pregnancy. The overall infectious-related hospitalization rate was significantly higher in children from the exposed group (odds ratio [OR] = 1.07, 95% confidence interval [CI]: 1.04-1.10, p < 0.01). Kaplan-Meier survival curves showed a significantly higher cumulative incidence of hospitalizations due to infectious diseases as compared with children in the unexposed group (log-rank test, p < 0.01). The Cox model demonstrated a significant and independent association between maternal anemia and the long-term risk for hospitalization due to infectious diseases of the offspring (adjusted hazard ratio [aHR]: 1.09, 95% CI: 1.06-1.12, p < 0.01). CONCLUSION Offspring of anemic mothers are at a greater risk for infectious-related hospitalizations in their first 18 years of life. KEY POINTS · Anemia is highly common in pregnancy.. · Maternal anemia has multiple short-term implications.. · Our study shows anemia of pregnancy is independently associated with long-term offspring infectious morbidity..
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Affiliation(s)
- Anika J Toma
- Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Gil Gutvirtz
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Tamar Wainstock
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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4
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Bakhsh E, Alkhaldi M, Shaban M. Exploring the Link between Maternal Hematological Disorders during Pregnancy and Neurological Development in Newborns: Mixed Cohort Study. Life (Basel) 2023; 13:2014. [PMID: 37895395 PMCID: PMC10608318 DOI: 10.3390/life13102014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 09/17/2023] [Accepted: 09/30/2023] [Indexed: 10/29/2023] Open
Abstract
Maternal hematological disorders during pregnancy may pose a risk to the neurological development of newborns. To investigate the association between maternal hematological disorders during pregnancy and neurological outcomes in newborns, this mixed cohort study was conducted on 200 pregnant women diagnosed with hematological disorders during pregnancy. Some cases have been identified in the past who have completed the pregnancy in full, as well as cases in pregnancy. Currently, the children of all mothers have been followed up to evaluate the neurological outcomes of the children at the age of three months. Logistic regression analysis was used to determine the association between maternal hematological disorders and neurological outcomes in newborns. Children born to mothers with hematological disorders had a higher risk of developmental delays (OR = 1.50, 95% CI = 0.90-2.50), cognitive impairments (OR = 1.80, 95% CI = 1.20-2.70), and motor impairments (OR = 1.60, 95% CI = 1.00-2.50) compared to children born to mothers without hematological disorders. Hemophilia was associated with the highest risk of neurological outcomes (developmental delay: OR = 2.80, 95% CI = 1.60-4.90; cognitive impairment: OR = 3.20, 95% CI = 2.00-5.10; motor impairment: OR = 2.60, 95% CI = 1.50-4.60). Conclusion: Our study suggests that maternal hematological disorders during pregnancy may increase the risk of negative neurological consequences in newborns. Further research is needed to identify potential mechanisms and explore preventive measures.
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Affiliation(s)
- Ebtisam Bakhsh
- Clinical Sciences Department, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh 11564, Saudi Arabia;
| | - Maan Alkhaldi
- College of Medicine, Al-Imam Mohammad Ibn Saud Islamic University, Riyadh 13317, Saudi Arabia
| | - Mostafa Shaban
- College of Nursing, Jouf University, Sakaka 72388, Saudi Arabia
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Um S, Cope MR, Muir JA. Child anemia in Cambodia: A descriptive analysis of temporal and geospatial trends and logistic regression-based examination of factors associated with anemia in children. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002082. [PMID: 37713392 PMCID: PMC10503718 DOI: 10.1371/journal.pgph.0002082] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 08/16/2023] [Indexed: 09/17/2023]
Abstract
Anemia in children remains a public health concern in many resource-limited countries. To better understand child anemia in Cambodia, we examined temporal and geospatial trends of childhood anemia and used logistic regression to analyze its association with individual and household characteristics using data from the Cambodia Demographic and Health Surveys for 2005, 2010, and 2014. The prevalence of childhood anemia decreased from 62.2% in 2005 to 56.6% in 2014. The prevalence of childhood anemia was highest in Pursat (84.3%) for 2005, Kampong Thom (67%) for 2010, and Preah Vihear and Steung Treng (68.6%) for 2014. After adjusting for other variables, factors positively associated with childhood anemia included having a mother who was anemic (adjusted odds ratio (AOR) = 1.77, 95% CI: 1.58-1.97); being male vs. female (AOR = 1.20, 95% CI: 1.07-1.33), underweight (AOR = 1.24, 95% CI: 1.14-1.57), or stunted (AOR = 1.24, 95% CI: 1.09-1.41); or having had a recent episode of fever (AOR = 1.16, 95% CI: 1.03-1.31). Children were less likely to have anemia if they were older than 12 months. They were also less likely to have anemia if they were from a wealthier household (AOR = 0.64; 95% CI: 0.50-0.84) or had taken medications for intestinal parasites (AOR = 0.86; 95% CI: 0.89-0.93). These associations were generally consistent across time and space. Public health interventions and policies to alleviate anemia should be prioritized to address these factors across geospatial divides. Anemia remains highly prevalent among children aged 6-59 months in Cambodia.
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Affiliation(s)
- Samnang Um
- The National Institute of Public Health, Tuol Kork District, Phnom Penh, Cambodia
| | - Michael R. Cope
- Department of Sociology, Brigham Young University, Provo, Utah, United States of America
| | - Jonathan A. Muir
- The Global Health Institute, Emory University, Atlanta, Georgia, United States of America
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Sun P, Zhou Y, Xu S, Wang X, Li X, Li H, Lin Z, Huang F, Zhu L, Zhu Y. Elevated first-trimester hepcidin level is associated with reduced risk of iron deficiency anemia in late pregnancy: a prospective cohort study. Front Nutr 2023; 10:1147114. [PMID: 37654476 PMCID: PMC10465702 DOI: 10.3389/fnut.2023.1147114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 08/02/2023] [Indexed: 09/02/2023] Open
Abstract
Background Iron deficiency (ID) and iron deficiency anemia (IDA) during pregnancy are highly prevalent worldwide. Hepcidin is considered an important biomarker of iron status. Currently, few longitudinal cohort studies have assessed the potential causal relationship between hepcidin and ID/IDA. Therefore, we aimed to investigate the association of first-trimester maternal serum hepcidin with third-trimester ID/IDA risk in a prospective cohort. Methods Total of 353 non-ID/IDA pregnant women at 11-13 weeks' gestation were enrolled in Southern China and followed up to 38 weeks of gestation. Data on demography and anthropometry were obtained from a structured questionnaire at enrollment. Iron biomarkers including hepcidin were measured at enrollment and follow-up. Regression models were used to evaluate the association of first-trimester hepcidin with third-trimester ID/IDA risk. Results Serum hepcidin levels substantially decreased from 19.39 ng/mL in the first trimester to 1.32 ng/mL in the third trimester. Incidences of third-trimester ID and IDA were 46.2 and 11.4%, respectively. Moreover, moderate and high levels of first-trimester hepcidin were positively related to third-trimester hepcidin (log-transformed β = 0.51; 95% CI = 0.01, 1.00 and log-transformed β = 0.66; 95% CI = 0.15, 1.17). Importantly, elevated first-trimester hepcidin was significantly associated with reduced risk of third-trimester IDA (OR = 0.38; 95% CI = 0.15, 0.99), but not with ID after adjustment with potential confounders. Conclusion First-trimester hepcidin was negatively associated with IDA risk in late pregnancy, indicating higher first-trimester hepcidin level may predict reduced risk for developing IDA. Nonetheless, given the limited sample size, larger studies are still needed.
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Affiliation(s)
- Peng Sun
- Shenzhen Nanshan Maternity and Child Healthcare Hospital, Shenzhen, China
| | - Yueqin Zhou
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Suhua Xu
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Xiaotong Wang
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Xiuxiu Li
- Shenzhen Nanshan Maternity and Child Healthcare Hospital, Shenzhen, China
| | - Hailin Li
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Zongyu Lin
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Fenglian Huang
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Lewei Zhu
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yanna Zhu
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
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7
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Abioye AI, Hughes MD, Sudfeld CR, Premji Z, Aboud S, Hamer DH, Roberts DJ, Duggan CP, Fawzi WW. The effect of iron supplementation on maternal iron deficiency anemia does not differ by baseline anemia type among Tanzanian pregnant women without severe iron deficiency anemia. Eur J Nutr 2023; 62:987-1001. [PMID: 36344770 PMCID: PMC9987582 DOI: 10.1007/s00394-022-03029-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 10/05/2022] [Indexed: 11/10/2022]
Abstract
PURPOSE Whether anemia type modifies the risk of pregnancy and newborn outcomes and the effectiveness of iron supplementation is unclear. We examined the association of iron deficiency anemia (IDA) and non-iron deficiency anemia (NIDA) on the risks of these outcomes and the extent to which anemia type modifies the impact of prenatal iron supplementation. METHODS This was a secondary analysis of a placebo-controlled trial of iron supplementation among 1450 HIV-negative women in Tanzania. Eligibility criteria included gestational age < 27 weeks, hemoglobin > 85 g/L, and ferritin > 12 µg/L. Individuals were categorized as non-anemia, IDA or NIDA using hemoglobin, ferritin and CRP. Analyses were conducted using regression models and likelihood ratio tests. RESULTS Compared to the non-anemia group, delivery hemoglobin was lower by 15 g/L (95% CI 10.9, 19.3) in the baseline IDA group, and 7.3 g/L (95% CI 3.1, 11.5) in the baseline NIDA group. The RRs of anemia severity, iron deficiency, placental malaria, stillbirths, perinatal mortality, birthweight, and preterm birth were not different among women in the baseline NIDA group (vs. non-anemia) compared to the baseline IDA group (vs. non-anemia). The difference in the mean delivery hemoglobin for iron supplementation and placebo arms was 8 g/L (95% CI 6, 11) in the non-anemia group, 7 g/L (95% CI 2, 13) in the NIDA group, and 16 g/L (95% CI 10, 22) in the IDA group. CONCLUSION Iron supplementation is effective even among pregnant women with NIDA. TRIAL REGISTRATION NCT01119612 (May 7, 2010).
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Affiliation(s)
- Ajibola Ibraheem Abioye
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard T.H. School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA.
| | - Michael D Hughes
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Christopher R Sudfeld
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard T.H. School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Said Aboud
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Davidson H Hamer
- Department of Global Health, School of Public Health, Boston University, Boston, MA, USA
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Drucilla J Roberts
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Christopher P Duggan
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard T.H. School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, USA
| | - Wafaie W Fawzi
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard T.H. School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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8
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Young MF, Nguyen P, Tran LM, Khuong LQ, Tandon S, Martorell R, Ramakrishnan U. Maternal hemoglobin concentrations across pregnancy and child health and development from birth through 6-7 years. Front Nutr 2023; 10:1114101. [PMID: 36875831 PMCID: PMC9978095 DOI: 10.3389/fnut.2023.1114101] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 01/31/2023] [Indexed: 02/18/2023] Open
Abstract
Background The role of changes in maternal hemoglobin (Hb) across pregnancy on child health and development (CHD) remains unclear. Objective We examined the association between maternal Hb trajectories and CHD outcomes: (a) birth outcomes (birth weight, length, gestational age, preterm, and small for gestational age); (b) child Hb at 3, 6, 12, and 24 months; and (c) motor and mental development at 12 and 24 months and cognitive functioning at age 6-7 years. Methods We used data from a randomized controlled trial (PRECONCEPT) conducted in Vietnam (N = 1,175 women enrolled during preconception with offspring follow-up through 6-7 years). Maternal Hb trajectories were developed using latent class analysis with Hb data at preconception, early (≤20 weeks), mid (21-29 weeks), and late (≥30 weeks) pregnancy. Multivariable linear and logistic regression models were used to assess the association between maternal Hb trajectories on CHD outcomes, adjusting for confounding variables at the maternal, child and household levels. Results Four distinct maternal Hb trajectories were identified. Track 1 (low initial Hb-decline) was associated with lower child Hb at 3 months (β [95% CI] -0.52 [-0.87, -0.16]), 6 months (-0.36 [-0.68, -0.05]), 12 months (-0.46 [-0.79, -0.13]), and 24 months (-0.44 [-0.72, -0.15]) and motor development at 12 months (-3.58 [-6.76, -0.40]) compared to track 4 (high initial Hb-decline). After adjustment for multiple testing, relationships remained robust with the exception of associations with child Hb at 6 months and motor development at 12 months. Track 2 (low initial Hb-improve) was the only Hb trajectory to increase across pregnancy; however, it was insufficiently powered. Track 3 (mid Hb-decline) was associated with lower child Hb at 12 months (-0.27 [-0.44, -0.10]) and 24 months (-0.20 [-0.34, -0.05]) compared to track 4 (high initial Hb-decline). Maternal Hb trajectories were not associated with birth outcomes or child development at 24 months or 6-7 years. Conclusion Maternal Hb trajectories during pregnancy are associated with child Hb concentrations across the first 1,000 days, but not with birth outcomes or later cognitive functioning. More work is needed to better understand and interpret changes in Hb levels during pregnancy especially in resource poor settings.
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Affiliation(s)
- Melissa F Young
- Hubert Department of Global Health, Emory University, Atlanta, GA, United States.,Doctoral Program in Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, GA, United States
| | - Phuong Nguyen
- Poverty, Health and Nutrition Division, International Food Policy Research Institute (IFPRI), Washington, DC, United States
| | - Lan Mai Tran
- Hubert Department of Global Health, Emory University, Atlanta, GA, United States.,Doctoral Program in Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, GA, United States
| | | | - Sonia Tandon
- Hubert Department of Global Health, Emory University, Atlanta, GA, United States.,Doctoral Program in Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, GA, United States
| | - Reynaldo Martorell
- Hubert Department of Global Health, Emory University, Atlanta, GA, United States.,Doctoral Program in Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, GA, United States
| | - Usha Ramakrishnan
- Hubert Department of Global Health, Emory University, Atlanta, GA, United States.,Doctoral Program in Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, GA, United States
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Hu Y, Lin J, Wang Y, Wu S, Wu J, Lv H, Ji X, Muyldermans S, Zhang Y, Wang S. Identification of Serum Ferritin-Specific Nanobodies and Development towards a Diagnostic Immunoassay. Biomolecules 2022; 12:biom12081080. [PMID: 36008974 PMCID: PMC9406126 DOI: 10.3390/biom12081080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 07/28/2022] [Accepted: 08/04/2022] [Indexed: 11/28/2022] Open
Abstract
Serum ferritin (SF) is an iron-rich protein tightly connected with iron homeostasis, and the variations are frequently observed in diseased states, including iron-deficiency anemia, inflammation, liver disease, and tumors, which renders SF level an indicator of potential malignancies in clinical practice. Nanobodies (Nbs) have been widely explored and developed into theranostic reagents. Surprisingly, no reports stated the identification of anti-SF Nbs, nor the potential of such Nbs as a diagnostic tool. In this study, we generated SF-specific Nbs and provided novel clinical diagnostic approaches to develop an immunoassay. An immune library was constructed after immunizing an alpaca with SF, and five Nbs specifically targeting human SF were retrieved. The obtained Nbs exhibited robust properties including high stability, affinity, and specificity. Then, an ELISA-based test using a heterologous Nb-pair was developed. The calibration curve demonstrated a linear range of SF between 9.0 to 1100 ng/mL, and a limit of detection (LOD) of 1.01 ng/mL. The detecting recovery and coefficient variation (CV) were determined by spiking different concentrations of SF into the serum sample, to verify the successful application of our selected Nbs for SF monitoring. In general, this study generated SF-specific Nbs and demonstrated their potential as diagnostic immunoassay tools.
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Affiliation(s)
- Yaozhong Hu
- Research Institute of Public Health, School of Medicine, Nankai University, Tianjin 300071, China
| | - Jing Lin
- Research Institute of Public Health, School of Medicine, Nankai University, Tianjin 300071, China
| | - Yi Wang
- Research Institute of Public Health, School of Medicine, Nankai University, Tianjin 300071, China
| | - Sihao Wu
- Research Institute of Public Health, School of Medicine, Nankai University, Tianjin 300071, China
| | - Jing Wu
- Research Institute of Public Health, School of Medicine, Nankai University, Tianjin 300071, China
| | - Huan Lv
- Research Institute of Public Health, School of Medicine, Nankai University, Tianjin 300071, China
| | - Xuemeng Ji
- Research Institute of Public Health, School of Medicine, Nankai University, Tianjin 300071, China
| | - Serge Muyldermans
- Laboratory of Cellular and Molecular Immunology, Vrije Universiteit Brussel, 1050 Brussels, Belgium
| | - Yan Zhang
- Research Institute of Public Health, School of Medicine, Nankai University, Tianjin 300071, China
- Correspondence: (Y.Z.); (S.W.); Tel.: +86-22-8535-8445 (S.W.)
| | - Shuo Wang
- Research Institute of Public Health, School of Medicine, Nankai University, Tianjin 300071, China
- Correspondence: (Y.Z.); (S.W.); Tel.: +86-22-8535-8445 (S.W.)
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10
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Balis B, Dessie Y, Debella A, Alemu A, Tamiru D, Negash B, Bekele H, Getachew T, Eyeberu A, Mesfin S, Eshetu B, Merga BT, Habte S, Yadeta TA. Magnitude of Anemia and Its Associated Factors Among Pregnant Women Attending Antenatal Care in Hiwot Fana Specialized University Hospital in Eastern Ethiopia. Front Public Health 2022; 10:867888. [PMID: 35719616 PMCID: PMC9198702 DOI: 10.3389/fpubh.2022.867888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 04/28/2022] [Indexed: 01/23/2023] Open
Abstract
Background Anemia is a significant public health issue, accounting for 20–40% of maternal deaths. Despite the government's commitment and the interventions of various stakeholders, the magnitude and major risk factors of anemia remain unabated. Though there are few documented studies on anemia among pregnant women in eastern Ethiopia in general, in the study area in particular, some of the variables such as helminthics and history of caesarian section in relation to anemia need to be studied. As a result, the purpose of this study was to determine the magnitude of anemia and associated factors among pregnant women attending antenatal care in University Hospital in eastern Ethiopia. Methods A facility-based cross-sectional study was conducted on a sample of 456 clients who were attending antenatal care in Hiwot Fana specialized university hospital from 01 to 30 June 2021. Systematic sampling was used to select the study participants. A pretested and structured interviewer-administered questionnaire and sample collection were used to collect the data. The data were coded, double-entered to Epi data version 3.1, cleaned, and exported to SPSS version 20 for analysis. Descriptive statistics were used to present frequency distributions. Variables with p-value < 0.25 during bivariate analysis were entered into the multivariate logistic regression models to control for all possible confounders to identify the factors associated with a magnitude of anemia. Odds ratio along with 95% CI were estimated to measure the strength of the association. The level of statistical significance was declared at a p-value of < 0.05. Result A total of 456 participants were interviewed, with a response rate of 96.9%. The magnitude of anemia among pregnant women was 112 [(25.3%) 95%CI: (21.5–29.2%)], of which, 27 (6.10%), 36 (8.13%), and 49 (11.08%) had mild, moderate, and severe anemia, respectively. Birth interval < 2 years [AOR: 3.24, (95% CI: (1.88, 4.32)], number of children ≥2 [AOR: 2.54, (95% CI: (1.12, 4.64)], monthly income < 1,000 birr [AOR: 2.89, (95% CI: (1.31, 5.58)], third trimester pregnancy [AOR: 2.89, (95% CI: 4.86, 12.62)], and abnormal menstrual history [AOR: 2.28, (95% CI: (1.69, 5.24)] were the factors significantly associated with anemia. Conclusion Anemia among pregnant women was relatively high compared to previous studies. Birth intervals, number of children, history of menstrual disorder, monthly income, and trimester of pregnancy were all significantly associated with anemia in pregnant women.
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Affiliation(s)
- Bikila Balis
- School of Nursing and Midwifery, College of Health and Medical sciences, Haramaya University, Dire Dawa, Ethiopia
| | - Yadeta Dessie
- School of Public Health, College of Health and Medical sciences, Haramaya University, Dire Dawa, Ethiopia
| | - Adera Debella
- School of Nursing and Midwifery, College of Health and Medical sciences, Haramaya University, Dire Dawa, Ethiopia
| | - Addisu Alemu
- School of Public Health, College of Health and Medical sciences, Haramaya University, Dire Dawa, Ethiopia
| | - Dawit Tamiru
- School of Nursing and Midwifery, College of Health and Medical sciences, Haramaya University, Dire Dawa, Ethiopia
| | - Belay Negash
- School of Public Health, College of Health and Medical sciences, Haramaya University, Dire Dawa, Ethiopia
| | - Habtamu Bekele
- School of Nursing and Midwifery, College of Health and Medical sciences, Haramaya University, Dire Dawa, Ethiopia
| | - Tamirat Getachew
- School of Nursing and Midwifery, College of Health and Medical sciences, Haramaya University, Dire Dawa, Ethiopia
| | - Addis Eyeberu
- School of Nursing and Midwifery, College of Health and Medical sciences, Haramaya University, Dire Dawa, Ethiopia
| | - Sinetibeb Mesfin
- School of Nursing and Midwifery, College of Health and Medical sciences, Haramaya University, Dire Dawa, Ethiopia
| | - Bajrond Eshetu
- School of Nursing and Midwifery, College of Health and Medical sciences, Haramaya University, Dire Dawa, Ethiopia
| | - Bedasa Taye Merga
- School of Public Health, College of Health and Medical sciences, Haramaya University, Dire Dawa, Ethiopia
| | - Sisay Habte
- School of Nursing and Midwifery, College of Health and Medical sciences, Haramaya University, Dire Dawa, Ethiopia
| | - Tesfaye Assebe Yadeta
- School of Nursing and Midwifery, College of Health and Medical sciences, Haramaya University, Dire Dawa, Ethiopia.,School of Public Health, College of Health and Medical sciences, Haramaya University, Dire Dawa, Ethiopia
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11
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Bustinduy AL, Randriansolo B, Sturt AS, Kayuni SA, Leustcher PDC, Webster BL, Van Lieshout L, Stothard JR, Feldmeier H, Gyapong M. An update on female and male genital schistosomiasis and a call to integrate efforts to escalate diagnosis, treatment and awareness in endemic and non-endemic settings: The time is now. ADVANCES IN PARASITOLOGY 2022; 115:1-44. [PMID: 35249661 DOI: 10.1016/bs.apar.2021.12.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The last decades have brought important insight and updates in the diagnosis, management and immunopathology of female genital schistosomiasis (FGS) and male genital schistosomiasis (MGS). Despite sharing a common parasitic aetiological agent, FGS and MGS have typically been studied separately. Infection with Schistosoma haematobium manifests with gender-specific clinical manifestations and consequences of infection, albeit having a similar pathogenesis within the human genital tract. Schistosoma haematobium is a known urinary bladder carcinogen, but its potential causative role in other types of neoplasia, such as cervical cancer, is not fully understood. Furthermore, the impact of praziquantel treatment on clinical outcomes remains largely underexplored, as is the interplay of FGS/MGS with relevant reproductive tract infections such as HIV and Human Papillomavirus. In non-endemic settings, travel and immigrant health clinics need better guidance to correctly identify and treat FGS and MGS. Our review outlines the latest advances and remaining knowledge gaps in FGS and MGS research. We aim to pave a way forward to formulate more effective control measures and discuss elimination targets. With a growing community awareness in health practitioners, scientists and epidemiologists, alongside the sufferers from these diseases, we aspire to witness a new generation of young women and men free from the downstream disabling manifestations of disease.
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Affiliation(s)
- Amaya L Bustinduy
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom.
| | | | - Amy S Sturt
- Section of Infectious Diseases, Veterans Affairs Palo Alto Health Care System, Palo Alto, United States
| | - Seke A Kayuni
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom; MASM Medi Clinics Limited, Blantyre, Malawi
| | - Peter D C Leustcher
- Centre for Clinical Research, North Denmark Regional Hospital, Hjoerring, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Lisette Van Lieshout
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
| | - J Russell Stothard
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Hermann Feldmeier
- Charité University Medicine Berlin, Institute of Microbiology, Infectious Diseases and Immunology, Berlin, Germany
| | - Margaret Gyapong
- Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
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12
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Shero N, Pandeya DR. Impact of Crohn's disease during pregnancy on children with attention deficit hyperactivity disorder: A review. Ann Med Surg (Lond) 2022; 75:103369. [PMID: 35198194 PMCID: PMC8851270 DOI: 10.1016/j.amsu.2022.103369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/07/2022] [Accepted: 02/10/2022] [Indexed: 11/09/2022] Open
Abstract
Background Iron deficiency anemia (IDA) is a common complication of inflammatory bowel disease (IBD) in pregnant women. Although studies have shown that certain maternal autoimmune diseases are associated with attention deficit hyperactivity disorder (ADHD) in children, no studies have found a relationship specifically between and IDA in pregnant women with IBD and ADHD in their children. This review aims identify a relationship between maternal Crohn's disease (CD) with IDA and ADHD in children. Materials and methods A review of existing literature was conducted using PubMed to search for articles on pregnant women with CD and IDA and children with ADHD. The studies included nested case-control studies, cohort studies, cross-sectional studies, case-control studies, and literature reviews published from 2012 to 2021. Results Among 876 articles generated, 11 studies were chosen for this review. Inclusion criteria consisted of no animal studies, meta-analysis or systematic reviews followed by ADHD related topics and maternal CD and IDA. The findings show that ADHD in progeny may be attributed to maternal CD. Although no studies have shown that IDA in mothers with CD is related to ADHD in offspring, several studies have shown a positive correlation between maternal IDA and ADHD in offspring. Some studies suggest inflammation in IBD during pregnancy can inflame the central nervous system, leading to ADHD in offspring. Conclusion IDA is a prevalent complication in CD, and inadequate iron levels are associated with neurodevelopmental problems, such as ADHD. Iron therapy for pregnant mothers diagnosed with CD is suggested to prevent ADHD in offspring. Iron deficiency anemia in Crohn's disease during pregnancy and its impact on children with ADHD. IDA in CD in pregnant women can potentially be considered as a risk factor in the pathophysiology of ADHD in offspring. Iron deficiency is the main cause of anemia in CD. Children with ADHD tend to have a higher risk of iron deficiency. Iron is involved in the dopaminergic pathway in the central nervous system.
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Abstract
OBJECTIVE To assess how pregnancy anaemia affects the offspring's early childhood development, child haemoglobin (Hb) levels child growth and diseases incidence 2 years after birth in a low-income setting. Furthermore, we investigate the mediating role of childhood Hb levels with disease incidences and skills. DESIGN Prospective cohort study. SETTING AND PARTICIPANTS The study participants are 941-999 mother-child dyads from rural Madhepura in Bihar, India. In 2015, the women were recruited during pregnancy from registers in mother-child centres of 140 villages for the first wave of data collection. At the time of the second wave in 2017, the children were 22-32 months old. PRIMARY AND SECONDARY OUTCOME MEASURES The recruited women were visited at home for a household survey and the measurement of the women's and child's Hb level, child weight and height. Data on the incidence of diarrhoea and respiratory diseases or fever were collected from interviews with the mothers. To test motor, cognitive, language and socioemotional skills of the children, we used an adapted version of the child development assessment FREDI. RESULTS The average Hb during pregnancy was 10.2 g/dL and 69% of the women had pregnancy anaemia. At the age of 22-32 months, a 1 g/dL increase in Hb during pregnancy was associated with a 0.17 g/dL (95% CI: 0.11 to 0.23) increase in Hb levels of the child. Children of moderately or severely anaemic women during pregnancy showed 0.57 g/dL (95% CI: -0.78 to -0.36) lower Hb than children of non-anaemic women. We find no association between the maternal Hb during pregnancy and early skills, stunting, wasting, underweight or disease incidence. While childhood anaemia does not correlate with childhood diseases, we find an association of a 1 g/dl increase in the child's Hb with 0.04 SDs higher test scores. CONCLUSIONS While pregnancy anaemia is a risk factor for anaemia during childhood, we do not find evidence for an increased risk of infectious diseases or early childhood development delays.
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Affiliation(s)
- Esther Heesemann
- Department of Economics, University of Mannheim, Mannheim, Germany
- Center for Evaluation and Development, Mannheim, Germany
| | - Claudia Mähler
- Institute for Psychology, University of Hildesheim, Hildesheim, Niedersachsen, Germany
| | | | - Sebastian Vollmer
- Department of Development Economics, Center for Modern Indian Studies, University of Göttingen, Goettingen, Niedersachsen, Germany
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14
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Ali M, Amin MR, Jarl J, Chisholm N, Saha S. Maternal health status and household food security on determining childhood anemia in Bangladesh -a nationwide cross-sectional study. BMC Public Health 2021; 21:1581. [PMID: 34418981 PMCID: PMC8380337 DOI: 10.1186/s12889-021-11581-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 08/02/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The aim of this study was to examine the effect of household food security on childhood anemia in Bangladesh while controlling for socioeconomic and demographic factors. METHODS We used nationally representative Bangladesh Demographic Health Survey (BDHS) 2011 data for this study, the only existing survey including anemia information and household food security. The sample included 2171 children aged 6-59 months and their mothers. Differences between socioeconomic and demographic variables were analyzed using Chi-square test. Univariate and multivariate logistic regression analyses were performed to estimate the effects of different socioeconomic and demographic factors on childhood anemia. We also performed mediation analysis to examine the direct and indirect effect of household food security on childhood anemia. RESULTS In Bangladesh, 53% male (95% CI: 50-56) and 51% female (95% CI: 47-54) children aged 6-59 months were anemic in 2011. The food insecure households have 1.20 times odds (95% CI: 0.97-1.48) of having anemic children comparing to food secure households in the unadjusted model. On the other hand, anemic mothers have 2 times odds (95% CI: 1.67-2.44) of having anemic children comparing to non-anemic mothers. However, household food security is no longer significantly associated with childhood anemia in the adjusted model while mothers' anemia remained a significant factor (OR 1.87: 95% CI: 1.53-2.29). Age of children is the highest associated factor, and the odds are 4.89 (95% CI: 3.21-7.45) for 6-12 months old children comparing to 49-59 months in the adjusted model. Stunting and household wealth are also a significant factor for childhood anemia. Although food security has no significant direct effect on childhood anemia, maternal anemia and childhood stunting mediated that relationship. CONCLUSIONS Future public health policies need to focus on improving mothers' health with focusing on household food security to eliminate childhood anemia.
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Affiliation(s)
- Masum Ali
- Department of Food Business and Development, O’Rahilly Building, University College Cork, Cork, Ireland
| | - Md. Ruhul Amin
- Institute of Nutrition and Food Science (INFS), University of Dhaka, Dhaka, 1000 Bangladesh
| | - Johan Jarl
- Department of Clinical Science (Malmö), Health Economics Unit, Lund University, Medicon Village, Scheelevagen 2, SE-223 63 Lund, Sweden
| | - Nick Chisholm
- Department of Food Business and Development, O’Rahilly Building, University College Cork, Cork, Ireland
- Center for Global Development and Department of Food Business and Development, O’Rahilly Building, University College Cork, Cork, Ireland
| | - Sanjib Saha
- Department of Clinical Science (Malmö), Health Economics Unit, Lund University, Medicon Village, Scheelevagen 2, SE-223 63 Lund, Sweden
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15
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Imai K. Parity-based assessment of anemia and iron deficiency in pregnant women. Taiwan J Obstet Gynecol 2021; 59:838-841. [PMID: 33218398 DOI: 10.1016/j.tjog.2020.09.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2020] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE This study aimed to separately evaluate the prevalence of anemia and iron deficiency in nulliparous and multiparous women. MATERIALS AND METHODS We retrospectively examined data of women who delivered in our clinic from January 2016 to December 2018. Inclusion criteria were delivery occurring at ≥36 weeks and singleton pregnancy. Pregnant women with severe medical disorders were excluded. We estimated complete blood count (CBC) and serum ferritin (SF) in the first trimester and only CBC in the late second trimester. Data of nulliparas and multiparas were analyzed separately. Statistically significance was set at p < 0.05. RESULTS Totally, 481 nulliparas and 603 and multiparas were enrolled. Mean hemoglobin values in the first trimester were 12.6 ± 1.0 and 12.4 ± 1.0 g/dl (p < 0.001), while median SF values were 42.7 (12.2, 108.2) and 27.7 (8.0, 72.6) ng/ml (p < 0.001) in nulliparas and multiparas, respectively. Hemoglobin in the late second trimester was 11.2 ± 0.9 and 10.7 ± 1.0 g/dl (p < 0.001) in nulliparas and multiparas, respectively. Low ferritin levels (SF < 12 ng/ml) were more frequently found in multiparas than in nulliparas (111/603 vs. 46/481, p < 0.001, Odds ratio [OR] = 2.13). Anemia in the first trimester (hemoglobin<11.0 g/dl) was found in 3.5% (17/481) and 8.8% (53/603) (p < 0.001; OR, 2.63), while that in late second trimester (hemoglobin<10.5) was observed in 21.0% (101/481) and 36.3% (219/603) (p < 0.001, OR = 2.15) nulliparas and multiparas, respectively. Non-anemic women (hemoglobin level ≥11.0) with low ferritin levels (SF < 12 ng/ml) in the first trimester showed higher rate of anemia development in the second trimester than those with both normal hemoglobin and ferritin levels, irrespective of parity (51.3% [19/37] vs. 16.2% [69/427], p < 0.001 in nulliparas and 76.9% [60/78] vs. 26.5% [125/472], p < 0.001 in multiparas]. CONCLUSION Anemia and low SF levels occurred more commonly in multiparous than in nulliparas. Further, low SF was a risk factor for anemia development in later pregnancy.
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Affiliation(s)
- Kimitoshi Imai
- Imai OB/GYN Clinic, Suehiro-cho 117-1, Aoi-ku, Shizuoka, 420-004, Japan.
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16
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Quezada-Pinedo HG, Cassel F, Duijts L, Muckenthaler MU, Gassmann M, Jaddoe VWV, Reiss IKM, Vermeulen MJ. Maternal Iron Status in Pregnancy and Child Health Outcomes after Birth: A Systematic Review and Meta-Analysis. Nutrients 2021; 13:nu13072221. [PMID: 34203528 PMCID: PMC8308244 DOI: 10.3390/nu13072221] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/18/2021] [Accepted: 06/24/2021] [Indexed: 12/29/2022] Open
Abstract
In pregnancy, iron deficiency and iron overload increase the risk for adverse pregnancy outcomes, but the effects of maternal iron status on long-term child health are poorly understood. The aim of the study was to systematically review and analyze the literature on maternal iron status in pregnancy and long-term outcomes in the offspring after birth. We report a systematic review on maternal iron status during pregnancy in relation to child health outcomes after birth, from database inception until 21 January 2021, with methodological quality rating (Newcastle-Ottawa tool) and random-effect meta-analysis. (PROSPERO, CRD42020162202). The search identified 8139 studies, of which 44 were included, describing 12,7849 mother–child pairs. Heterogeneity amongst the studies was strong. Methodological quality was predominantly moderate to high. Iron status was measured usually late in pregnancy. The majority of studies compared categories based on maternal ferritin, however, definitions of iron deficiency differed across studies. The follow-up period was predominantly limited to infancy. Fifteen studies reported outcomes on child iron status or hemoglobin, 20 on neurodevelopmental outcomes, and the remainder on a variety of other outcomes. In half of the studies, low maternal iron status or iron deficiency was associated with adverse outcomes in children. Meta-analyses showed an association of maternal ferritin with child soluble transferrin receptor concentrations, though child ferritin, transferrin saturation, or hemoglobin values showed no consistent association. Studies on maternal iron status above normal, or iron excess, suggest deleterious effects on infant growth, cognition, and childhood Type 1 diabetes. Maternal iron status in pregnancy was not consistently associated with child iron status after birth. The very heterogeneous set of studies suggests detrimental effects of iron deficiency, and possibly also of overload, on other outcomes including child neurodevelopment. Studies are needed to determine clinically meaningful definitions of iron deficiency and overload in pregnancy.
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Affiliation(s)
- Hugo G. Quezada-Pinedo
- The Generation R Study Group, Erasmus MC-Sophia, University Medical Center, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands; (H.G.Q.-P.); (V.W.V.J.); (I.K.M.R.)
- Department of Pediatrics, Erasmus MC-Sophia, University Medical Center, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands
| | - Florian Cassel
- Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia, University Medical Center, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands; (F.C.); (L.D.)
| | - Liesbeth Duijts
- Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia, University Medical Center, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands; (F.C.); (L.D.)
- Department of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC-Sophia, University Medical Center, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands
| | - Martina U. Muckenthaler
- Molecular Medicine Partnership Unit, University Hospital Heidelberg, D-69120 Heidelberg, Germany;
| | - Max Gassmann
- Institute of Veterinary Physiology, Vetsuisse Faculty, University of Zurich, CH-8057 Zurich, Switzerland;
- Zurich Center for Integrative, Human Physiology, University of Zurich, CH-8057 Zurich, Switzerland
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima 15102, Peru
| | - Vincent W. V. Jaddoe
- The Generation R Study Group, Erasmus MC-Sophia, University Medical Center, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands; (H.G.Q.-P.); (V.W.V.J.); (I.K.M.R.)
- Department of Pediatrics, Erasmus MC-Sophia, University Medical Center, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands
| | - Irwin K. M. Reiss
- The Generation R Study Group, Erasmus MC-Sophia, University Medical Center, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands; (H.G.Q.-P.); (V.W.V.J.); (I.K.M.R.)
- Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia, University Medical Center, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands; (F.C.); (L.D.)
| | - Marijn J. Vermeulen
- Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia, University Medical Center, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands; (F.C.); (L.D.)
- Correspondence:
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Vlasova RM, Wang Q, Willette A, Styner MA, Lubach GR, Kling PJ, Georgieff MK, Rao RB, Coe CL. Infantile Iron Deficiency Affects Brain Development in Monkeys Even After Treatment of Anemia. Front Hum Neurosci 2021; 15:624107. [PMID: 33716694 PMCID: PMC7947927 DOI: 10.3389/fnhum.2021.624107] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/25/2021] [Indexed: 12/26/2022] Open
Abstract
A high percent of oxidative energy metabolism is needed to support brain growth during infancy. Unhealthy diets and limited nutrition, as well as other environmental insults, can compromise these essential developmental processes. In particular, iron deficiency anemia (IDA) has been found to undermine both normal brain growth and neurobehavioral development. Even moderate ID may affect neural maturation because when iron is limited, it is prioritized first to red blood cells over the brain. A primate model was used to investigate the neural effects of a transient ID and if deficits would persist after iron treatment. The large size and postnatal growth of the monkey brain makes the findings relevant to the metabolic and iron needs of human infants, and initiating treatment upon diagnosis of anemia reflects clinical practice. Specifically, this analysis determined whether brain maturation would still be compromised at 1 year of age if an anemic infant was treated promptly once diagnosed. The hematology and iron status of 41 infant rhesus monkeys was screened at 2-month intervals. Fifteen became ID; 12 met clinical criteria for anemia and were administered iron dextran and B vitamins for 1-2 months. MRI scans were acquired at 1 year. The volumetric and diffusion tensor imaging (DTI) measures from the ID infants were compared with monkeys who remained continuously iron sufficient (IS). A prior history of ID was associated with smaller total brain volumes, driven primarily by significantly less total gray matter (GM) and smaller GM volumes in several cortical regions. At the macrostructual level, the effect on white matter volumes (WM) was not as overt. However, DTI analyses of WM microstructure indicated two later-maturating anterior tracts were negatively affected. The findings reaffirm the importance of iron for normal brain development. Given that brain differences were still evident even after iron treatment and following recovery of iron-dependent hematological indices, the results highlight the importance of early detection and preemptive supplementation to limit the neural consequences of ID.
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Affiliation(s)
- Roza M. Vlasova
- Department of Psychiatry, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Qian Wang
- Department of Food Science and Human Nutrition, Iowa State University, Ames, IA, United States
| | - Auriel Willette
- Department of Food Science and Human Nutrition, Iowa State University, Ames, IA, United States
| | - Martin A. Styner
- Department of Psychiatry, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Gabriele R. Lubach
- Harlow Center for Biological Psychology, University of Wisconsin-Madison, Madison, WI, United States
| | - Pamela J. Kling
- Department of Pediatrics, University of Wisconsin-Madison, Madison, WI, United States
| | - Michael K. Georgieff
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, United States
| | - Raghavendra B. Rao
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, United States
| | - Christopher L. Coe
- Harlow Center for Biological Psychology, University of Wisconsin-Madison, Madison, WI, United States
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Magnitude of Anemia and Its Associated Factors among Pregnant Women Attending Antenatal Care at Najo General Hospital, Northwest Ethiopia. Anemia 2020; 2020:8851997. [PMID: 33133691 PMCID: PMC7593740 DOI: 10.1155/2020/8851997] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/07/2020] [Accepted: 10/09/2020] [Indexed: 11/25/2022] Open
Abstract
Anemia is one of the major causes of morbidity for pregnant women in resource-limited regions. Yet robust research-based evidence on this vital public health problem in remote areas where the problem could be massive is quite limited in Ethiopia, one of the developing countries. Thus, this study is aimed to assess the magnitude of anemia and its associated risk factors among pregnant women attending one of the health facilities in Ethiopia. A facility-based cross-sectional study design was employed in 2019. A total of 384 pregnant women attending the antenatal care (ANC) unit of Najo General Hospital, Northwest Ethiopia, were included in the study. Their sociodemographic characteristics, and medical, obstetric, and gynecological history were collected using pretested interview questionnaires. Blood samples were collected from each participant for the determination of malaria parasite and hemoglobin (Hb) level. In addition, stool samples were collected for examination of intestinal parasites. Data were analyzed using Statistical Package for Social Science (SPSS) software version 25. The overall magnitude of anemia among pregnant women was 37.8% (95% CI, 32.8%–42.3%). The proportion of mild anemia, moderate anemia, and severe anemia was 24%, 11%, and 2.3%, respectively. Some variables such as absence of malaria infection (AOR: 0.195, 95% CI: 0.066–0.576), lack of history of abortion (AOR: 0.469, 95% CI: 0.265–0.830), and absence of history of anemia (AOR: 0.227, 95% CI: 0.134–0.385) were identified as protective variables of anemia during pregnancy, while urban residence (AOR: 1.753, 95% CI: 1.013–3.034) was unexpectedly found as a predisposing factor. Despite the higher number of anemic pregnant women observed in the current study, pregnancy-associated anemia is moderate public health importance in the study area.
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Means RT. Iron Deficiency and Iron Deficiency Anemia: Implications and Impact in Pregnancy, Fetal Development, and Early Childhood Parameters. Nutrients 2020; 12:E447. [PMID: 32053933 PMCID: PMC7071168 DOI: 10.3390/nu12020447] [Citation(s) in RCA: 116] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 02/03/2020] [Accepted: 02/06/2020] [Indexed: 12/16/2022] Open
Abstract
A normal pregnancy consumes 500-800 mg of iron from the mother. Premenopausal women have a high incidence of marginal iron stores or iron deficiency (ID), with or without anemia, particularly in the less developed world. Although pregnancy is associated with a "physiologic" anemia largely related to maternal volume expansion; it is paradoxically associated with an increase in erythrocyte production and erythrocyte mass/kg. ID is a limiting factor for this erythrocyte mass expansion and can contribute to adverse pregnancy outcomes. This review summarizes erythrocyte and iron balance observed in pregnancy; its implications and impact on mother and child; and provides an overview of approaches to the recognition of ID in pregnancy and its management, including clinically relevant questions for further investigation.
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Affiliation(s)
- Robert T. Means
- Departments of Internal Medicine, Medical Education, and Pathology, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN 37614, USA; ; Tel.: +1-423-439-6499; Fax: +1-423-439-6470
- Internal Medicine, Building 2/Room 109, Quillen College of Medicine, East Tennessee State University, Johnson City, TN 37614, USA
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