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Adequate maternal selenium level is essential for immune response and healthy pregnancy. This study aimed to shed light on the selenium status of pregnant women with COVID‐19 and the effects of potential deficiency in serum selenium levels. Totally 141 pregnant women, 71 of them were COVID‐19 patients, in different trimesters were included in the study. Maternal serum selenium levels, demographic and clinical parameters were determined. Serum selenium levels of pregnant women in the second (p: .0003) and third (p: .001) trimesters with COVID‐19 were significantly lower than in the healthy group. Maternal selenium level was found to be negatively correlated with gestational week (p

It is estimated that a quarter of the world’s population suffers from anemia,1 and it has been established that pregnant women are one of the most affected groups, particularly in low-income countries.2 According to a study published in 2008, which summarized global data on anemia for the period 1993–2005, 55.8% of pregnant women in Africa were anemic.1 Another more recent publication, which compared anemia trends worldwide between 1995 and 2011, reported a reduction in the prevalence of anemia at the global level and showed again the heterogeneity of the problem of anemia according to the different regions of the globe.3 Between 1995 and 2011, the overall prevalence of anemia decreased from 43% to 38%. In Eastern Africa, this prevalence decreased from 46% to 36%, and in Central and Western Africa, it decreased from 61% to 56%.3 The 2007 Democratic Republic of Congo (DRC) demographic and health survey (DHS) estimated a 53% national prevalence of anemia with a 39% regional prevalence in South Kivu province among women of child-bearing age.4 Furthermore, the 2007 DRC DHS estimated the national prevalence of anemia at 60% among pregnant women, but the report lacked this data for individual provinces. According to the World Health Organization (WHO), this level of prevalence, at national level, is considered to be a severe public health problem.5 Anemia during pregnancy is known to be associated with a high risk of poor birth outcomes.6 It causes fatigue, reduces work capacity,7 and is associated with a high risk of maternal mortality6,8; which remains a real public health problem with a 2015 global estimate of 300,000 maternal deaths.9 In anemic (and undernourished) women, even minimal blood losses can have serious consequences; complications of postpartum hemorrhage are higher in the presence of preexisting anemia.10 Hemorrhage tops among the leading five clinical conditions responsible for at least 80% of maternal death.11 Geller et al.12 estimates that postpartum hemorrhage accounts for 25–33% of all maternal deaths. The etiology of anemia is multifactorial; the common causes being of nutritional origin (such as iron deficiency [ID]), infections, and genetic disorders.2,13 These causes may vary between different settings and may be synergistic at varying degrees in different settings. WHO estimates that half of all cases of anemia are related to ID.6 Despite the high burden of anemia in DRC, there are limited data on its etiology among pregnant women and especially the relative contribution of ID. In 1994, Kuvibidila et al.14 found a higher prevalence of ID in the western province of Kongo Central (formerly Bas-Congo) among pregnant women than nonpregnant women and a control group of nonpregnant Caucasian women living in the United States of America. The study used ferritin or adjusted ferritin in case of inflammation to evaluate iron store, and it was generally found that Congolese women had a lower mean plasma iron as compared with the control group regardless of their physiological status.14 In his 1996 article from the same region, Kuvibidila and colleagues15 reported a 56% ID prevalence among pregnant women without inflammation as determined by a serum ferritin (SF) < 12 μg/L and/or transferrin saturation < 16%. It should be noted that these results could not be generalized to the entire country owing to the different sociodemographic, geographic, genetic, and behavioral differences (including eating habits) between different ethnic groups and regions. The 2007 DHS used hemoglobin (Hb) alone as a proxy for ID on the assumption that ID contributes to half of all cases of anemia. This was an oversight in determining the prevalence of ID considering that causes of anemia are diverse and even synergistic in some individuals, more specifically pregnant women. There has been no documented study carried out using validated biochemical parameters for iron store evaluation among pregnant women in Kivu. This study aimed at bridging this information gap with the following objectives: 1) to determine the prevalence of anemia and that of ID and 2) to identify other factors associated with anemia among pregnant women from the rural Miti-Murhesa health zone in South Kivu province in eastern DRC.

Maternal anaemia in early pregnancy is associated with poor pregnancy outcomes. Furthermore, preconceptional health can influence the health during pregnancy. The aim of this study was to investigate which preconceptional factors were associated with haemoglobin (Hb) concentration in early pregnancy.In Tanzania, 226 women were followed at preconception and during early pregnancy. Red blood cell (RBC) morphology, serum micronutrient concentration, demographic characteristics and health status were assessed in preconception and in early pregnancy. The association between preconceptional factors and Hb concentration in early pregnancy was investigated using simple and multiple linear regression analyses stratified by preconceptional anaemia status.Mean Hb was 123 and 119 g/l before conception and during early pregnancy (median gestational age 53 days) respectively. Preconceptional mid-upper arm circumference (MUAC) (adjusted coefficient (AC) 0.35 95% CI 0.9-0.61) and preconceptional Hb concentration (AC 0.45 95% CI 0.36-0.54) were positively associated with early pregnancy Hb concentration, whereas preconceptional microcytic hypochromic RBC morphology (AC -6.00 95% CI -9.56 to -2.44) was negatively associated with early pregnancy Hb concentration. In addition, treatment of preconceptional malaria was positively associated with early pregnancy Hb concentration (AC 6.45 95% CI 0.74-12.2) among women with preconceptional anaemia. In contrast, among preconceptional non-anaemic women, only preconceptional Hb concentration and medium socio-economic status was positively associated with early pregnancy Hb concentration.Mid-upper arm circumference (MUAC) and Hb measurements in preconception can help to detect women at increased risk of low Hb concentration in early pregnancy.L'anémie maternelle en début de grossesse est associée à de mauvais résultats de grossesse. En outre, la santé préconceptionnelle peut influer sur la santé pendant la grossesse. Le but de cette étude était d'investiguer les facteurs préconceptionnels associés à la concentration d'hémoglobine (Hb) en début de grossesse. MÉTHODES: En Tanzanie, 226 femmes ont été suivies avant la conception et durant le début de la grossesse. La morphologie des globules rouges (GR), la concentration sérique en micronutriments, les caractéristiques démographiques et l’état de santé ont été évalués avant la conception et durant le début de la grossesse. L'association entre les facteurs préconceptionnels et la concentration d'Hb au début de la grossesse a été investiguée en utilisant des analyses de régression linéaire simples et multiples stratifiées selon le statut d'anémie préconceptionnelle. RÉSULTATS: Les concentrations moyennes d'Hb étaient respectivement de 123 g/L et de 119 g/L avant la conception et en début de grossesse (âge gestationnel médian: 53 jours). Le périmètre brachial (PB) préconceptionnel (coefficient ajusté (AC): 0.35; IC 95%: 0.9 à 0.61) et la concentration préconceptionnelle d'Hb (AC: 0.45; IC 95%: 0.36 à 0.54) étaient positivement associés à la concentration d'Hb au début de la grossesse, alors que la morphologie hypochrome microcytaire des GR préconceptionnelle (AC: −6.00; IC 95%: −9.56 à −2.44) était négativement associée à la concentration d'Hb en début de grossesse. De plus, le traitement du paludisme préconceptionnel était positivement associé à la concentration d'Hb au début de la grossesse (AC: 6.45; IC 95%: 0.74 à 12.2) chez les femmes souffrant d'anémie préconceptionnelle. En revanche, chez les femmes non anémiques en préconception, seule la concentration d'Hb préconceptionnelle et le statut socioéconomique moyen présentaient une association positive avec la concentration d'Hb en début de grossesse.Les mesures du PB et de la concentration d'Hb avant la conception peuvent aider à détecter les femmes à risque accru de faible concentration d’HB en début de grossesse.

Adverse pregnancy outcomes place the lives of mother and new born babies in jeopardy, especially in Sub Saharan Africa. Although a well-balanced network of the pregnancy-associated hormones and lipid fractions is necessary for healthy pregnancy, the profiles of some of these biomarkers alongside those of some cytokines in relation to placental malaria (PM) and poor pregnancy outcomes are unknown. Therefore between 2013 and 2014, paired peripheral and placental blood samples were collected from 135 Cameroonian women at delivery. Parasitaemia was determined microscopically and haemoglobin levels using Coulter counter. Plasma levels of cytokines (IFN-γ, IL-1β and IL-7) and pregnancy-associated hormones (17β oestradiol and progesterone) were measured by ELISA and the levels of lipid fractions: total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and triglycerides (TG) determined by Colorimetric enzymatic methods. Parasitaemia was inversely related to parity, haemoglobin levels and birth weight (P≤0.019). While the levels of IFN-γ and cholesterol (total, HDL and LDL) were higher in peripheral plasma, those of IL-1β, 17β oestradiol, progesterone and triglyceride were higher in placental blood (P

Introduction We hypothesized that nutritional deficiency would be common in a cohort of postpartum, human immunodeficiency virus (HIV)-infected women and their infants. Methods Weight and height, as well as blood concentrations of retinol, α-tocopherol, ferritin, hemoglobin, and zinc, were measured in mothers after delivery and in their infants at birth and at 6-12 weeks and six months of age. Retinol and α-tocopherol levels were quantified by high performance liquid chromatography, and zinc levels were measured by atomic absorption spectrophotometry. The maternal body mass index during pregnancy was adjusted for gestational age (adjBMI). Results Among the 97 women 19.6% were underweight. Laboratory abnormalities were most frequently observed for the hemoglobin (46.4%), zinc (41.1%), retinol (12.5%) and ferritin (6.5%) levels. Five percent of the women had mean corpuscular hemoglobin concentrations < 31g/dL. The most common deficiency in the infants was α-tocopherol (81%) at birth; however, only 18.5% of infants had deficient levels at six months of age. Large percentages of infants had zinc (36.8%) and retinol (29.5%) deficiencies at birth; however, these percentages decreased to 17.5% and 18.5%, respectively, by six months of age. No associations between infant micronutrient deficiencies and either the maternal adjBMI category or maternal micronutrient deficiencies were found. Conclusions Micronutrient deficiencies were common in HIV-infected women and their infants. Micronutrient deficiencies were less prevalent in the infants at six months of age. Neither underweight women nor their infants at birth were at increased risk for micronutrient deficiencies.

Background Given the potential of cotrimoxazole preventive therapy (CPT) to prevent bacterial and malarial infections in HIV-exposed, uninfected (HEU) infants, it is important to evaluate the effects of its concurrent use with antiretroviral agents that have overlapping toxicity profiles. Methods We used data from the Breastfeeding, Antiretrovirals, and Nutrition study (2004-2010) to evaluate the association of CPT and antiretrovirals with hematologic measures (hemoglobin, neutrophil, and alanine aminotransferase levels) from 6 to 48 weeks of age in 2006 HEU infants in Lilongwe, Malawi. Hazards of severe outcomes (anemia, neutropenia, and elevated alanine aminotransferase), as defined by the National Institutes of Health, were compared using Cox regression models, according to time-varying CPT (implemented June 2006), antiretroviral treatment arm (maternal triple antiretroviral, infant nevirapine, or none during 6 months of breastfeeding), and their interaction. The effects of these treatments on hemoglobin, neutrophil, and alanine aminotransferase levels were assessed using linear mixed models. Results In Cox models, CPT was associated with an increase in severe neutropenia [hazard ratio 1.97 (1.01, 3.86)] and a decrease in severe anemia (hazard ratio 0.65 (0.48, 0.88)]. Interactions between CPT and antiretroviral treatment were not significant. By 36 weeks, there was a significant association of CPT with increased hemoglobin levels regardless of antiretroviral drug exposure. Conclusions In addition to expected associations with increased hazard of severe neutropenia and decreased neutrophil count, CPT was associated with reduced hazard of severe anemia and higher infant blood hemoglobin. This provides further support for CPT use in HEU infants in malaria-endemic resource-limited settings where anemia is prevalent.

BACKGROUND: Pregnant women living in unstable malaria transmission settings may develop severe malaria (SM). The pathogenesis of SM in pregnancy is poorly understood. METHODS: To determine whether SM in pregnancy is associated with lower malarial antibody responses and higher cytokine responses, plasma samples were collected from 121 Sudanese pregnant women of whom 39 were diagnosed with SM. Antibodies to pregnancy-specific and non-pregnancy-specific Plasmodium falciparum variant surface antigens (VSA) and concentrations of cytokines TNF, IFNγ, IL-1β, IL-6, IL-8 and IL-10 were measured. RESULTS: Pregnant women with SM demonstrated significantly lower antibody levels to pregnancy-specific VSA (P = .020) and higher plasma IFNγ (P = .020), IL-10 (P = .0002) and IL-6 levels (P < .0001) than uninfected pregnant women. Concentrations of inflammatory cytokines IL-1β (P = .001), IL-6 (P = .004) and IL-8 (P = .020) were inversely correlated with antibodies to VAR2CSA-DBL5 in pregnant women with SM. Lower haemoglobin levels and higher parasite densities were associated with lack of pregnancy-specific antibodies (P = .028) and higher levels of inflammatory cytokines, in particular IL-6 and IL-8. CONCLUSIONS: Pregnant women with SM lack pregnancy-specific malaria immunity, and this correlates with heightened inflammatory cytokine concentrations, low haemoglobin levels and high parasite density, suggesting that failure of antibody to control parasitaemia may contribute to SM pathogenesis.

Human reticulocytes are one of the fundamental components needed to study the in vitro invasion processes of the human malaria parasite Plasmodium vivax. Additionally examinations of reticulocytes and their binding proteins are difficult in areas of the world that do not have access to advanced equipment or stem cell lines. These issues are particularly relevant to malaria vaccine candidate studies that are directed against surface proteins that the parasites use to gain entry into erythrocytes. Described here is a simple and inexpensive method to increase the reticulocyte count of cord blood samples. Exposure of cord blood to hypotonic saline (0.2%) for 5 min selectively lyses the non-reticulocytes resulting in an average 3.6-fold increase in reticulocyte count. Our studies show that this enrichment process does not damage the hemoglobin of the remaining erythrocytes which are still capable of supporting Plasmodium falciparum invasion and growth. This economical and rapid method of enrichment could facilitate studies of in vitro laboratory culturing of other malaria parasite species which preferentially invade reticulocytes such as P. vivax.

Pregnancy-associated malaria (PAM) is an important, preventable cause of poor birth outcomes in malaria-endemic areas in sub-Saharan Africa [1]. Intermittent preventive therapy with antimalarials during pregnancy (IPTp) is a critical tool for reducing the incidence of PAM-attributable adverse birth outcomes [2]. Sulfadoxine-pyrimethamine (SP) is the most commonly administered drug for IPTp owing to its long half-life, favorable side-effect profile, and safety during pregnancy. However, Plasmodium falciparum strains harboring mutations associated with SP resistance are increasingly prevalent throughout sub-Saharan Africa. The outcome of antimalarial therapy results from complex interactions between parasite pathogenicity, host immunity, drug characteristics, and parasite susceptibility to drug therapy. Recent in vitro studies have suggested that the removal of susceptible parasites from heterogeneous parasitemias by antimalarial therapy may facilitate the relative overgrowth of the remaining resistant parasites and therefore potentiate their pathogenicity [3]. A recent study in Tanzania documented increases in placental inflammation that were associated with SP receipt, suggesting that SP may potentiate placental pathology when applied to partially susceptible infections [4]. However, the effect of these placental findings upon birth outcomes was unclear. Given the prevalence of SP resistance and the current lack of appropriate, safe alternatives for use as IPTp, it is critical to explore the associations between IPTp-SP, SP resistance, and delivery outcomes in further contexts to inform malaria control policies. Malawi adopted a policy of IPTp with SP in 1993, and despite the subsequent development of widespread SP resistance [5], a sustained decline in the prevalence of PAM was observed from 1997 to 2005 [6]. In view of the evidence from Tanzania [4], we hypothesized that the emergence of SP-resistant parasites would modify the effect of IPTp-SP and thereby potentiate placental inflammation and parasite densities and worsen birth outcomes. The Queen Elizabeth Central Hospital Epidemiology of Resistance in Pregnancy-Associated Malaria (QuEERPAM) study [7] was a serial cross-sectional analysis in which we explored the relationships between IPTp-SP, the presence of resistant parasites at delivery, and multiple measures of adverse delivery outcome, including parasite densities, placental histology, maternal hemoglobin concentration, and birth weight.

This study examined the predictors of haemoglobin (Hb) concentration and serum ferritin (SF) levels in pregnant women in an area of stable malaria transmission and high prevalence of intestinal helminth infections. In total, 834 women attending antenatal care for the first time were examined. Blood slides for malaria parasites were prepared for 802, of which 154 were primigravidae (PG) and 648 were multigravidae (MG). Malaria parasitaemia rate was 42.6% (66) in PG and 33.3% (216) in MG (P=0.04). The geometric mean parasite density was 1695.8 (95% CI 1005.0-2386.5) in PG and 922.7 (95% CI 626.7-1382.6) in MG (P=0.02). Anaemia (Hb

Summary It is suggested that helminths, particularly hookworm and schistosomiasis, may be important causes of anaemia in pregnancy. We assessed the associations between mild-to-moderate anaemia (haemoglobin >8.0 g/dl and

Background. With the increasing use of antiretroviral (ARV) drugs to prevent mother-to-child transmission of human immunodeficiency virus (HIV), large numbers of infants are exposed, with possible consequent toxicity. Methods. Hematologic values in 1820 uninfected HIV- and ARV-exposed children were compared with those in 351 ARV-unexposed children from the Women and Infants Transmission Study. Hemoglobin concentrations and platelet, neutrophil, lymphocyte, and CD4 + and CD8 + cell counts were analyzed at birth and ages 2, 6, 12, 18, and 24 months. Multivariate analysis was conducted age 0-2 and 6-24 months, with adjustment for multiple cofactors. Results. Hemoglobin concentrations and neutrophil, lymphocyte, and CD4 + cell counts were significantly lower at age 0-2 months in infants exposed to ARV drugs than in those who were not. At 6-24 months, differences in hemoglobin concentrations and neutrophil counts were no longer significant, whereas differences in platelet, lymphocyte, and CD4 + cell counts persisted and CD8 + cell counts became significantly lower. In comparison with ARV monotherapy, combination therapy was associated with larger decreases in neutrophil, lymphocyte, and CD8 + cell counts at age 0-2 months but with only differences in CD8 + cell counts at age 6-24 months. Clinically significant abnormalities were rare and did not differ by exposure to ARV drugs. Conclusion. Infants exposed to ARV drugs have small but significant differences in several hematologic parameters for the first 24 months of life. These results indicate the need for long-term follow-up of uninfected infants with ARV exposure.

A direct relationship exists between the intensity of hookworm infection and blood loss. Other parasites may also contribute to blood loss. Our objective was to assess the relationship between the intensity of soil-transmitted helminth infections and anemia in pregnant women in a highly endemic area of Peru. Recruitment occurred between April and November 2003. Overall, 47.31% of 1,042 women had anemia (hemoglobin < 11 g/dL), 47.22% were infected with hookworm and 82.25% with Trichuris. Prevalences of infections were not associated with anemia. However, those infected with moderate and heavy intensities of hookworm infection (OR = 1.84; 95% CI: 1.06, 3.17) and those with moderate and heavy intensities of both hookworm and Trichuris infections (OR = 2.13; 95% CI: 1.10, 4.13) were more likely to suffer from anemia than women having no or light intensities. These results support routine anthelminthic treatment within prenatal care programs in highly endemic areas.

The objective of this study was to compare the iron status of 356 mother-baby pairs who had intrauterine growth retardation (IUGR) with 356 mother-baby pairs who had appropriate weight for gestational age (AGA). Mothers were selected in 1991/92 from 4 hospitals in Campinas city, Brazil, where 95% of deliveries take place. Gestational age of the newborns was determined by the Capurro method. Newborns were classified as having IUGR according to the Lubchenco birthweight for gestational age standard. Haemoglobin (Hb), haematocrit (Ht) and ferritin were determined, respectively, by the cyanmethaemoglobin method, an haematocrit centrifuge, and an immunoenzymetric assay. Mean levels of Hb and Ht were higher in IUGR (16.4 g/dL; 51.7%) than in AGA babies (15.7 g/dL; 49.7%) (P0.001), as a consequence of intrauterine hypoxia. Higher maternal levels of ferritin (50 micrograms/L) were more common in IUGR than in AGA mothers (P0.001). Forty-seven percent (335/712) of the IUGR and AGA mothers were anaemic (Hbor = 11.0 g/dL), but only 4.4% (31/356) of them had low levels of ferritin (or = 10 micrograms/L). We advise further large epidemiological studies involving IUGR and AGA mother-baby pairs, elucidating the mechanisms underlying the plasma-volume changes in pregnancy, and the prevalence of iron-deficiency anaemia assessed by different indicators, in view of the fact that ferritin can be affected by inflammation and infection, important risk factors for IUGR in developing countries.

The relationship between asymptomatic human immunodeficiency virus (HIV) infection and blood hemoglobin (Hb) concentration was examined in anemic pregnant women from a population with high prevalence of both anemia (60%) and HIV seropositivity (30%). Sera from 155 pregnant women with Hb levels10.5 g/dL were tested for HIV status, C-reactive protein (CRP), vitamin B12, retinol, and folate levels. The observed prevalence of HIV seropositivity in the group of women with anemia was 47.1% (95% confidence interval=39.2-55.0%). This is significantly higher than the HIV prevalence in the whole population (30.1%; P0.001). Median Hb values in HIV-seropositive and -seronegative women with anemia were 8.40 g/dL and 8.95 g/dL, respectively. Serum retinol, vitamin B12, and folate levels were not significantly different in the HIV-seropositive and -seronegative groups. In women who were HIV-seropositive with normal levels of CRP, a median decrease in Hb of 0.4 g/dL was observed. For those with serum CRP levels25 mg/l, the median decrease in Hb was 0.7 g/dL. Results indicate that asymptomatic HIV infection is associated with increased prevalence and severity of anemia in pregnancy in this population.

In a cross sectional survey based in an antenatal clinic at Kilifi District Hospital, Coast Province, Kenya, 154 of 275 pregnant women (56%) reported eating soil regularly. Geophagous women had lower haemoglobin and serum ferritin concentrations than non-geophagous women (mean haemoglobin level 9.1 vs. 10.0 g/dL, P < 0.001; median ferritin level 4.5 vs. 9.0 micrograms/L, P < 0.001). In multiple linear regression analyses, geophagy was a significant predictor of haemoglobin (beta = -6.4, P = 0.01) and serum ferritin concentrations (beta = -6.6, P = 0.002), while controlling for gestational age and malaria and hookworm infection. Another 38 pregnant women, who reported eating soil regularly, participated in focus group discussions and were interviewed on geophagy. The most commonly eaten soil was from the walls of houses. The median estimated daily intake was 41.5 g (range 2.5-219.0 g). Twenty-seven of these women assisted in the collection of soil samples which were then analysed for their content of iron, zinc and aluminium after extraction with 0.1 M HC1. The average daily soil intake supplied the geophagous women with 4.3 mg of iron, corresponding to 14% of the recommended dietary allowance of iron for pregnant women. The study revealed a strong negative association between geophagy and both haemoglobin and ferritin status. At the same time it demonstrated the potential of soil as a source of dietary iron for geophagous women. These seemingly contradictory results might be due to other components in the soil interfering with iron uptake or metabolism. Alternatively, it may be that the geophagous women had extremely depleted iron stores before starting to eat soil. From these cross-sectional data, no inference about causality could be made.

This study was aimed at delineating characteristics of naturally acquired immunity against the merozoite surface antigen-1 (MSP-1) of Plasmodium falciparum, a candidate malaria vaccine antigen. A case/control study was performed on 75 case/control pairs of infants with febrile illness at the time of the first detected infection indicating a clinical case. The presence and level of antibodies at one month prior to the first infection and at the time of the first infection in the afebrile group was significantly higher than in the febrile group. Decreased parasite density and decreased infection-related loss of hemoglobin was seen in infants with anti-MSP-1(19kD) IgG antibodies. In addition, mothers who were positive for the presence of these antibodies conferred protection against placental infection and infection in their infants. In this study, development of anti-MSP-1(19kD) antibody responses in 24 infants were studied longitudinally using monthly serum samples collected from birth until approximately one year of age. In addition, umbilical cord blood sera and respective mothers' sera were analyzed. Longitudinal studies of antibody responses revealed several short-lived IgG and IgM peaks throughout an infant's first year that correlated with detection of parasitemia. The protection against parasitemia and febrile illness was observed in infants when anti-MSP-1(19kD) antibodies were present; when infants were negative for IgG, they had a 10-times greater risk of becoming parasitemic. These data from a longitudinal and prospective study of malaria suggest a protective role for anti-MSP-1(19kD) antibodies in infants and pregnant women.

Summary The effects of pregnancy, lactation, and socio-economic status on maternal haemoglobin levels among the Au, a foraging and small-scale horticultural population of Papua New Guinea, are examined. The sample consists of 259 parous women, 41 of whom reside in wage-earning households and 218 of whom reside in households practicing traditional subsistence activities. The haemoglobin level among the total sample averages an extraordinarily low 8.6 g/dl and the prevalence of anaemia as defined using current WHO standards is just over 98%. Wage-earning Au, however, have significantly higher haemoglobin levels and lower rates of anaemia than their traditional counterparts. Haemoglobin levels decline significantly during pregnancy by just over 1 g/dl among both socioeconomic groups, but soon return to pre-gravid levels postpartum. No significant effects of lactation on haemoglobin levels are found, nor does the population show any long-term, parity-specific trends in haemoglobin levels.

Polymorphisms of ATP2B4 encoding an ubiquitous Ca(2+) pump protect against severe childhood malaria. We assessed the influence of a main polymorphism (rs10900585) on malaria among 834 delivering Ghanaian women. In homozygous primiparae, the odds of placental Plasmodium falciparum infection were reduced by 64%. No influence of the polymorphism on parasite density, low birth weight, or preterm delivery was discernible. However, malarial anemia was greatly reduced in primiparous carriers of the variant allele, paralleling the reduced impact of malaria on hemoglobin levels in this group. A common ATP2B4 polymorphism protects against malaria in pregnancy and related maternal anemia, suggesting ATP2B4 variant associated protection not to be limited to severe childhood malaria.

In Plasmodium falciparum malaria, activation of monocytes and macrophages (monocytes/macrophages) can result in the production of various inflammatory mediators that contribute to immunopathology. Soluble CD163 (sCD163) is a specific marker of monocyte/macrophage activation typically found at increased levels during various inflammatory conditions and can be associated with poor clinical outcomes. To better understand the relationships between levels of sCD163 and clinical parameters in women with placental malaria, we measured plasma sCD163 levels in maternal peripheral and placental blood compartments at delivery and determined their correlations with birth weight and maternal haemoglobin concentrations. sCD163 levels were negatively correlated with birth weight only in the placental compartment (r = -0.145, p = 0.03) and were inversely correlated with maternal haemoglobin concentrations, both in peripheral blood (r = -0.238, p = 0.0004) and in placental blood (r = -0.259, p = 0.0001). These inverse relationships suggest a potential role for monocyte/macrophage activation in the pathogenesis of malaria in pregnancy, particularly in relation to malaria-associated anaemia.

A study was undertaken in order to determine the prevalence and aetiology of anaemia in pregnancy in coastal Kenya, so as to establish locally important causes and enable the development of appropriate intervention strategies. 275 women attending the antenatal clinic at Kilifi district hospital, Kenya, were recruited in November 1993. The prevalence of anaemia (haemoglobin [Hb] < 11 g/dL) was 75.6%, and the prevalence of severe anaemia (Hb < 7g/dL) was 9.8% among all parities; 15.3% of 73 primigravidae were severely anaemic, compared with 7.9% of 202 multigravidae (P = 0.07). In primigravidae, malaria infection (Plasmodium falciparum) was strongly associated with moderate and severe anaemia (chi 2 test for trend, P = 0.003). Severe anaemia was more than twice as common in women with peripheral parasitaemia as in those who were aparasitaemic, and parasitaemia was associated with a 2.2g/dL decrease in mean haemoglobin level (P < 0.001). In multigravidae, iron deficiency and hookworm infection were the dominant risk factors for anaemia. Folate deficiency and human immunodeficiency virus infection were not strongly associated with anaemia. It is suggested that an intervention that can effectively reduce malaria infection in primigravidae could have a major impact on the health of these women and their infants.

The problem of malaria in adolescence has been surpassed by the immense burden of malaria in children, most especially less than 5. A substantial amount of work done on malaria in pregnancy in endemic regions has not properly considered the adolescence. The present study therefore aimed at evaluating the prevalence of Plasmodium falciparum and anaemia infection in adolescent pregnant girls in the Sekondi-Takoradi metropolis, Ghana. The study was carried out at four hospitals in the Sekondi-Takoradi metropolis of the western region of Ghana from January 2010 to October 2010. Structured questionnaires were administered to the consenting pregnant women during their antenatal care visits. Information on education, age, gravidae, occupation and socio-demographic characteristics were recorded. Venous bloods were screened for malaria using RAPID response antibody kit and Geimsa staining while haemoglobin estimations were done by cyanmethemoglobin method. The results revealed that adolescent pregnant girls were more likely to have malaria infection than the adult pregnant women (34.6% verses 21.3%, adjusted OR 1.65, 95% CI, 1.03-2.65, P=0.039). In addition, adolescent pregnant girls had higher odds of anaemia than their adult pregnant women equivalent (43.9% versus 33.2%; adjusted OR 1.63, 95% CI, 1.01-2.62, P=0.046). Taken together, these data suggest that adolescent pregnant girls were more likely to have malaria and anaemia compared to their adult pregnant counterpart. Results from this study shows that proactive adolescent friendly policies and control programmes for malaria and anaemia are needed in this region in order to protect this vulnerable group of pregnant women.

HIV infection increases the burden of disease of malaria in pregnancy, in part by impairing the development of immunity. We measured total IgG and phagocytic antibodies against variant surface antigens of placental-type CS2 parasites in 187 secundigravidae (65% HIV infected). In women with placental malaria infection, phagocytic antibodies to CS2(VSA) were decreased in the presence of HIV (p = 0.011) and correlated positively with infant birth weight (coef = 3.57, p = 0.025), whereas total IgG to CS2(VSA) did not. Phagocytic antibodies to CS2(VSA) are valuable tools to study acquired immunity to malaria in the context of HIV co-infection. Secundigravidae may be an informative group for identification of correlates of immunity.

BACKGROUND: The prevalence of anaemia and iron deficiency in women remains high worldwide. WHO recommends weekly iron-folic acid supplementation where anaemia rates in non-pregnant women of reproductive age are higher than 20%. In 2006, a demonstration project consisting of weekly iron-folic acid supplementation and regular de-worming was set up in two districts in a northern province in Vietnam where anaemia and hookworm rates were 38% and 76% respectively. In 2008 the project was expanded to all districts in the province, targeting some 250,000 women. The objectives of this study were to: 1) examine changes in haemoglobin, iron stores and soil transmitted helminth infection prevalence over three years and 2) assess women's access to and compliance with the intervention. METHODS AND FINDINGS: The study was a semi-cross-sectional, semi-longitudinal panel design with a baseline survey, three impact surveys at three-, twelve- and thirty months after commencement of the intervention, and three compliance surveys after ten weeks, eighteen and thirty six months. RESULTS: After thirty months, mean haemoglobin stabilised at 130.3 g/L, an increase of 8.2 g/L from baseline, and mean serum ferritin rose from 23.9 µg/L to 52 µg/L. Hookworm prevalence fell from 76% to 22% over the same period. After thirty six months, 81% of the target population were receiving supplements and 87% were taking 75% or more of the supplements they received. CONCLUSIONS: Weekly iron-folic acid supplementation and regular de-worming was effective in significantly and sustainably reducing the prevalence of anaemia and soil transmitted helminth infections and high compliance rates were maintained over three years.

Haemoglobin and ferritin estimations employing the micro-ELISA technique were done in 308 random selected mothers in labour and their newborns. The values of haemoglobin and serum ferritin as well as birth weight and gestation of babies born to iron depleted, and mildly and moderately anaemic mothers were no different from those of newborns of non-anaemic women. However, the values of serum ferritin per se in all these newborns were much lower than what are generally reported from the western countries. Babies born to severely anaemic women, on the other hand, showed elevated levels of haemoglobin and serum ferritin, and lower birth weights and gestation. Thus, mild to moderate iron deficiency in the mother does contribute to lower iron reserves in the foetus, if not frank iron depletion, and severe iron deficiency anaemia to lower birth weight and gestation.

Between 2000 and 2004, a cross-sectional survey was conducted, as part of a prospective cohort study, among the women attending antenatal-care clinics in Bondo district, a malaria-endemic area of western Kenya. The aim was to assess the prevalence of iron deficiency and determine the predictors of haemoglobin and serum ferritin concentrations in the women who had a gestational age between 14 and 24 weeks. A standardized questionnaire was used to collect and store the relevant bio-data for the study. Haemoglobin and ferritin concentrations were evaluated, sickle-cell status was determined, and malarial parasitaemias were detected and evaluated, using blood samples collected at enrollment. Multiple regression analysis was then used to test for significant predictors of the haemoglobin and serum ferritin concentrations. Although 842 women were enrolled in the prospective cohort study, haemoglobin concentrations were evaluated for only 828 of them, serum ferritin levels for 621, and levels of parasitaemia for 812. The mean haemoglobin concentration recorded was 10.9 g/dl. Although 37.9% of the subjects had mild-moderate anaemia (7.0-10.5 g haemoglobin/dl), only 0.5% were severely anaemic (

Relapsing-fever borreliosis caused by Borrelia duttonii is a common cause of complications of pregnancy, miscarriage, and neonatal death in sub-Saharan Africa. We established a murine model of gestational relapsing fever infection for the study of the pathological development of these complications. We demonstrate that B. duttonii infection during pregnancy results in intrauterine growth retardation, as well as placental damage and inflammation, impaired fetal circulation, and decreased maternal hemoglobin levels. We show that spirochetes frequently cross the maternal-fetal barrier, resulting in congenital infection. Furthermore, we compared the severity of infection in pregnant and nonpregnant mice and show that pregnancy has a protective effect. This model closely parallels the consequences of human gestational infection, and our results provide insight into the mechanisms behind the complications of pregnancy that have been reported in human relapsing-fever infection.

Summary background Comparing two surveys performed in Bolivia in 1992–1994 and 1999–2001, we reported a significant decrease in the proportions of severe and mortal forms of congenital Chagas disease. This might be due to a reduction of vectorial density (VD) in maternal residence area, raising the question of a possible causal relationship between such VD, maternal parasitaemia and prognosis of congenital infection with Trypanosoma cruzi. method Comparisons of haematological and parasitological data obtained from Bolivian mothers infected with T. cruzi, and of clinical and biological data obtained from their infected and uninfected newborns, stratified according to VD in the area of maternal residence. results i) Blood hematocrit rates or hemoglobin amounts were within the normal ranges and similar in all the maternal groups, whatever the VD in their areas of residence; ii) mothers living in high VD areas displayed a higher frequency of hemocultures positive for T. cruzi; iii) newborns congenitally infected with T. cruzi, but not uninfected babies born from infected mothers, displayed higher frequencies of very low Apgar scores, low birth weights, prematurity, respiratory distress syndrome or anasarca, as well as higher mortality rates when their mothers lived in areas of high VD. conclusion Frequent bites of blood sucking Reduvidae during pregnancy do not induce maternal anaemia, but, likely through multiple maternal re-infections with T. cruzi, increase maternal parasitemia and worsen congenital Chagas disease. Maternal dwelling in areas of high VD is associated with a serious increased risk of severe and mortal congenital Chagas disease.

There are few published studies on the burden of malaria during pregnancy from areas of sub-Saharan Africa where the intensity of malarial transmission is low, and few on submicroscopic malarial infections in pregnant women. The present study was conducted in New Halfa, an area of low-intensity transmission in eastern Sudan, between August 2003 and July 2004. The main aims were to assess the prevalences of submicroscopic and multiple Plasmodium falciparum infections in pregnant women (using the P. falciparum merozoite surface protein-2 as a polymorphic marker in PCR-based assays) and to determine the effects of such infections on anaemia during pregnancy. Of the 142 pregnant women who were recruited, only 17 (11.9%) were found smear-positive for P. falciparum by microscopy. The results of the PCR-based assays revealed, however, that 40 (32%) of the 125 smear-negative women had submicroscopic P. falciparum infections. Blood samples from 32 (80%) of those with submicroscopic infections showed only the FC 27 allele (of merozoite surface protein-2), six (15%) showed only the ICI allele, and two (5%) showed both of these alleles. Although the age, parity, gestational age and haemoglobin concentrations of the women with submicroscopic P. falciparum infections were not significantly different from those of the women who were smear- and PCR-negative, such infections may have a significant impact on materno-foetal health.

Background Pregnant women are more susceptible to malaria, which is associated with serious adverse effects on pregnancy. The presentation of malaria during pregnancy varies according to the level of transmission in the area. Our study aimed to demonstrate the prevalence and risk factors for malaria (age, parity and gestational age) among pregnant women of eastern Sudan, which is characterized by unstable malaria transmission. Methods The prevalence and possible risk factors for Plasmodium falciparum malaria were investigated in 744 pregnant Sudanese women attending the antenatal clinic of New Haifa Teaching Hospital, eastern Sudan, during October 2003-April 2004. Results A total 102 (13.7%) had P. falciparum malaria, 18(17.6%) of these were severe cases (jaundice and severe anaemia). Univariate and multivariate analysis showed that, age and parity were not associated with malaria. Women who attended the antenatal clinic in the third trimester were at highest risk for malaria (OR = 1.58, 95% CI = 1.02–2.4; P < 0.05). Women with malaria had significantly lower mean haemoglobin (9.4 g/dl, 95% CI 9.1–9.7 versus 10.7, CI 10.6–10.8, P < 0.05). A significantly lower haemoglobin was observed in those with severe falciparum malaria compared to non-severe form (8.3 g/dl, 95% CI 7.6–9.1 versus 9.4, 95% CI 9.1–9.7, P = < 0.05). Conclusion The results suggest that P. falciparum malaria is common in pregnant women attending antenatal care and that anaemia is an important complication. Preventive measures (chemoprophylaxis and insecticide-treated bednets) may be beneficial in this area for all women irrespective of age or parity.

Tanzania is an area of moderate to high risk for severe anaemia during pregnancy. There is extensive literature examining the consequences of severe anaemia for pregnant women, but the impact this problem has on their infants in malaria-endemic regions is poorly understood. Between 1999 and 2001 we used a demographic surveillance system in the Kilombero Valley, Tanzania to link morbidity and socio-economic status data for 301 pregnant women to the survival of 365 days of their singleton babies, looking for evidence of an association between infant mortality and maternal haemoglobin (Hb). The hazards ratio for infant mortality amongst women who had been severely anaemic in pregnancy (Hb < 8 g/dl) was 3.1 [95% confidence interval (CI) 1.1-9.1, P = 0.04] compared with women with Hb above this level after controlling for other factors. Prevention of anaemia in pregnancy may lead to an improvement in infant survival.

Background: The perinatal prophylactic administration of zidovudine is associated with rapidly reversible macrocytic anemia in infants. However, a recent study suggests that there may be more persistent inhibition of hematopoietic stem cells. Objective: To study hematopoiesis in uninfected infants, born to HIV-1 seropositive mothers, including those exposed and those not exposed to perinatal zidovudine alone or in combination. Methods: Longitudinal study, from 0 to 18 months, of hemoglobin, platelets, poly- nuclear neutrophils, total lymphocytes, and CD4+ and CD8+ lymphocytes in more than 4000 infants of the French Perinatal Study. Modeling of repeated measures and non-linear evolution with age, with models combining natural cubic B-splines and random effects. Results: The hemoglobin level was transiently reduced in newborns exposed to zidovudine. Multivariate analysis taking into account age, prematurity, geographical origin, maternal drug use and maternal CD4 cell count, indicated that levels of the three other lineages were slightly lower until age 18 months in exposed than not exposed infants (P , 0.0001 for each lineage).There was a negative relationship between the duration of exposure and each hematological variable. Combinations of antiretroviral treatments were associated with larger decreases than monotherapy up to 15 months of age. Similar, but less pronounced, patterns were found for the CD4+ and CD8+ subpopulations of lymphocytes. Conclusions: Zidovudine administered during the perinatal period may result in a small but significant and durable effect on hematopoiesis up to the age of 18 months.

The authors aim was to determine the effectiveness of chloroquine prophylaxis in reducing the frequency of malaria-induced anemia at delivery. The authors estimated the hemoglobin levels of 207 parturients; 82 (39.6%) had been on chloroquine prophylaxis [treatment group (TG)] while 125 (60.4%) did not take any malaria preventive medication antenatally [control group (CG)]. The proportion of women with malaria parasitemia was significantly higher in CG than in TG [risk ratio (RR) = 1.57 confidence interval (CI) = 1.05-2.34)]. The dose-response relationship between the severity of parasitemia and the risk of being anemic (P < 0.001) confirms a strong correlation between gestational malaria and maternal anemia. There was 35% reduction in risk for anemia in the TG compared with the CG (RR = 0.65 0.40-1.06). The difference in risk was more pronounced after adjusting for disparity in place of residence educational status and obstetric history (adjusted RR = 0.54 CI = 0.21-0.98). Primiparous mothers appeared to have benefited more from the anti-anemic effects of malaria chemoprevention than mothers of higher parity (protective effectiveness 43% compared with 33% respectively). In conclusion despite reports of widespread Plasmodium falciparum resistance to chloroquine on the African continent malaria chemosuppression with the drug was found beneficial in reducing the risk of anemia at delivery among Cameroonian women. (authors)

A multistage sampling technique was used to select 845 pregnant women from two blocks in Vellore district. Haematological measurement of haemoglobin (Hb) was done on all women and serum ferritin (SF) on a subsample of 445. The prevalence of anaemia (Hb

Six hundred eighty-nine #Plasmodium falciparum$ malaria attacks were observed during a three-year period among 226 habitants of the village of Dielmo, Senegal, an area of high malaria transmission. Malaria attacks were defined as clinical episodes with fever (body temperature is greater than or equal to 38.0° C) or reporting of fever or headache or vomiting, associated with a parasite:leukocyte ratio above an age-dependent pyrogenic threshold identified in this population. The symptom frequencies were tested against age, gender, and parasite density using a random-effect logistic regression model and the study of distinguishable clinical presentations was carried out by multi-correspondence analysis. There was little difference between the severity of symptoms during the initial course of attacks in young children and adults, and this severity was not correlated with the duration of the pathologic episode. It was not possible to distinguish objectively different malaria attack types according to the severity of clinical manifestations. In contrast, the duration of fever, symptoms, and parasite clearance were significantly longer among the youngest children than among the oldest children and adults. These findings suggest that of the two components of protective immunity, anti-parasite immunity and anti-toxic immunity, only the first would play a major role as age increases. They suggest also that the initial clinical presentation of malaria attacks is not predictive of the level of protective immunity. (Résumé d'auteur)

A cohort of 117 newborns was followed longitudinally for 12 months to determine the age of onset of clinical malaria and the subsequent episodes of malaria, and to investigate the possible existence of a correlation between level of transplacentally acquired Plasmodium falciparum-specific antibodies and age of onset of malaria in the infant. The mean age of onset of malaria in 49 infants was 4.48 +/- 1.54 months. Mean (+/- S.D.) age of onset of clinical malaria in haemoglobin AA infants (4.38 +/- 1.14) was significantly (P < 0.05) lower compared with haemoglobin AS (5.58 +/- 2.43) infants. No correlation was obtained between the age of onset of malaria and the level of cord serum total IgG, IgM and antibodies to P. falciparum antigens. Cord blood seropositivity for antibodies to the blood stage antigen Pf155/RESA and its C-terminal repeat sequence (EENV)6 or to the (NANP)6 peptide representing repeats of the circumsporozoite protein (CSP) did not influence the age of onset of clinical malaria. However, infants with haemoglobin AS whose cord blood was seropositive for antibodies to the (EENV)6 or (NANP)6 peptide showed delayed onset (P < 0.001) of malaria compared with AA seropositive infants. Although our results indicate that transplacentally acquired antibodies to the studied antigens alone offer no significant protection against malaria during the first few months of life, antibodies in concert with other factors such as haemoglobin genotype may contribute to the protection of the newborn.

Summary: Serum ferritin, iron, and haemoglobin (Hb) values of 27 pregnant women who did not receive oral iron therapy during pregnancy, and Hb of their normal full-term babies were determined. Maternal blood samples were obtained at 16 and 34 weeks of pregnancy and infants' blood samples were obtained at the first day and 3 months of life. Mothers were divided into two groups according to their serum ferritin values. By analysing the results we were not able to detect any correlation between maternal ferritin, Hb and newborn gestational age, and Hb and birth weight. The same was found when the groups were compared by a maternal serum ferritin above and below 12 ng/ml. © 1995 Oxford University Press.

Background The intensity categories, or thresholds, currently used for Trichuris trichiura (ie. epg intensities of 1–999 (light); 1,000–9,999 epg (moderate), and ≥10,000 epg (heavy)) were developed in the 1980s, when there were little epidemiological data available on dose-response relationships. This study was undertaken to determine a threshold for T. trichiura-associated anemia in pregnant women and to describe the implications of this threshold in terms of the need for primary prevention and chemotherapeutic interventions. Methodology/Principal Findings In Iquitos, Peru, 935 pregnant women were tested for T. trichiura infection in their second trimester of pregnancy; were given daily iron supplements throughout their pregnancy; and had their blood hemoglobin levels measured in their third trimester of pregnancy. Women in the highest two T. trichiura intensity quintiles (601–1632 epg and ≥1633 epg) had significantly lower mean hemoglobin concentrations than the lowest quintile (0–24 epg). They also had a statistically significantly higher risk of anemia, with adjusted odds ratios of 1.67 (95% CI: 1.02, 2.62) and 1.73 (95% CI: 1.09, 2.74), respectively. Conclusions/Significance This analysis provides support for categorizing a T. trichiura infection ≥1,000 epg as ‘moderate’, as currently defined by the World Health Organization. Because this ‘moderate’ level of T. trichiura infection was found to be a significant risk factor for anemia in pregnant women, the intensity of Trichuris infection deemed to cause or aggravate anemia should no longer be restricted to the ‘heavy’ intensity category. It should now include both ‘heavy’ and ‘moderate’ intensities of Trichuris infection. Evidence-based deworming strategies targeting pregnant women or populations where anemia is of concern should be updated accordingly., Author Summary Infection by the soil-transmitted helminth Trichuris trichiura is defined as ‘light’, ‘moderate’ and ‘heavy’ depending on its intensity. However, these intensity categories were developed in the 1980s, before any epidemiological data were available on the association between specific T. trichiura infection intensities and adverse health outcomes. Here, we re-analyzed data from a study of T. trichiura infection and anemia in pregnant women to determine the threshold (i.e. the lowest infection intensity) associated with an increased risk of anemia. Women with T. trichiura infections of intensities ranging from 601 to 1632 eggs per gram of feces (epg) (ie. a ‘moderate’ level of intensity) had a significantly higher prevalence of anemia and a significantly lower hemoglobin level than the reference group (i.e. women with T. trichiura infections of intensities ranging between 0 and 24 epg). This finding contrasts with the common belief that only ‘heavy’ T. trichiura infection (10,000 epg and above) can cause anemia.

Severe anaemia in pregnancy is a major obstetric problem in malaria-endemic areas. This study reports a cross-sectional investigation of malaria infection and haematological values at delivery in 440 women from urban Zanzibar. Severe anaemia [with haemoglobin (Hb)or = 7 g/dl] was identified in 36 women (9.3%) and mild anaemia (7Hb10 g/dl) in 269 (69.7%) while 81 women (21.0%) had normal Hb values. Malaria infection was diagnosed in 187/385 women (48.6%) on the basis of either peripheral blood examination or placental histology. Univariate analysis indicated that the proportion of women with anaemia was similar in those with (85%) and without (80%) malaria infection. However, when primigravidae were considered alone, malaria infection was significantly more frequent among anaemic women (65.2%) than in those with normal Hb values (40.0%). In the logistic regression analysis, including age, parity, education level, malaria and free serum iron as independent variables and anaemia (Hbor = 10 g/dl) as response variable, the odds ratio (OR) for malaria infection was 1.2 (P0.1). However, a similar analysis indicated that malaria was significantly associated with anaemia in the primigravidae, with an OR of 3.2 (95% confidence interval: 1.1-9.6; P0.05). In conclusion, this cross-sectional investigation indicated that malaria plays a significant role in the determination of anaemia in primigravidae, but not in multiparae, in the urban study area.

The haemoglobin levels of 787 Somali people in north-eastern Kenya were measured. Severe anaemia was very common in both sexes of all ages. Possible causative factors are discussed. Adolescent boys had particularly low haemoglobin values (in one area 43% had levels below 8 g/dl) and this was related to Schistosoma haematobium infection. Such a clear relationshiop has not been shown before.

After a haemoglobin survey of two Gambian villages, 112 women were studied further, by using a small battery of tests in which a comparison was made of the 55 women with haemoglobin below 9·5 g. per 100 ml. and the 57 less anaemic women. A controlled trial was carried out of 3 months' Imferon treatment given either at once or delayed for 3 months. Within the same controlled trial a comparison was made of the total dose of Imferon given as 3 injections at monthly intervals, or as 12 injections at weekly intervals. A prevalent iron deficiency was found which was the major cause of anaemia. It was associated with pregnancy and menorrhagia but not with hookworm infection. The results among women have been contrasted with those published earlier on men in the same villages. The differences include the part played by hookworm infection and by splenomegaly. The management of the common iron deficiency anaemia in adults in rural Gambia is discussed in the light of these findings.

BACKGROUND: Malaria antibody responses measured at delivery have been associated with protection from maternal anaemia and low birth weight deliveries. Whether malarial antibodies present in the first half of pregnancy may protect from these or other poor birth outcomes is unclear. To determine whether malaria antibodies in the first half of pregnancy predict pregnancy outcomes, antibodies were measured to a range of merozoite antigens and to antigens expressed on the surface of parasitized red blood cells (pRBCs) in plasma samples collected at 14-20 weeks of gestation from Malawian women. The latter antibodies were measured as total IgG to pRBCs, and antibodies promoting opsonic phagocytosis of pRBCs. Associations between antibodies and maternal haemoglobin in late pregnancy or newborn size were investigated, after adjusting for potential covariates. RESULTS: Antibodies to pRBC surface antigens were associated with higher haemoglobin concentration at 36 weeks. Total IgG to pRBCs was associated with 0.4 g/l [(95% confidence interval (0.04, 0.8)] increase in haemoglobin, and opsonizing antibody with 0.5 (0.05, 0.9) increase in haemoglobin for each 10% increase in antibody. These antibodies were not associated with birthweight, placental malaria, or newborn anthropometrics. Antibodies to merozoite antigens and non-placental-binding IEs were not associated with decreased risk of any of these outcomes. In some instances, they were negatively associated with outcomes of interest. CONCLUSION: Antibodies to placental-binding infected erythrocytes may be associated with higher haemoglobin levels in pregnancy, whereas antibodies to other malaria antigens may instead be markers of malaria exposure. Trial registration clinicaltrials.gov NCT01239693. Registered Nov 10, 2010. BioMed Central open access

Background Understanding the pathogenesis of malaria in pregnancy and its consequences for both the mother and the baby is fundamental for improving malaria control in pregnant women. Aim The study aimed to investigate the role of ABO blood groups on pregnancy outcomes in an area of unstable malaria transmission in eastern Sudan. Methods A total of 293 women delivering in New Half teaching hospital, eastern Sudan during the period October 2006–March 2007 have been analyzed. ABO blood groups were determined and placental histopathology examinations for malaria were performed. Birth and placental weight were recorded and maternal haemoglobin was measured. Results 114 (39.7%), 61 (22.1%) and 118 (38.2%) women were primiparae, secundiparae and multiparae, respectively. The ABO blood group distribution was 82(A), 59 (B), 24 (AB) and 128 (O). Placental histopathology showed acute placental malaria infections in 6 (2%), chronic infections in 6 (2%), 82 (28.0%) of the placentae showed past infection and 199 (68.0%) showed no infection. There was no association between the age (OR = 1.02, 95% CI = 0.45–2.2; P = 0.9), parity (OR = 0.6, 95% CI = 0.3–1.2; P = 0.1) and placental malaria infections. In all parity blood group O was associated with a higher risk of past (OR = 1.9, 95% CI = 1.1–3.2; P = 0.01) placental malaria infection. This was also true when primiparae were considered separately (OR = 2.6, 95% CI = 1.05–6.5, P = 0.03). Among women with all placental infections/past placental infection, the mean haemoglobin was higher in women with the blood group O, but the mean birth weight, foeto-placental weight ratio was not different between these groups and the non-O group. Conclusion These results indicate that women of eastern Sudan are at risk for placental malaria infection irrespective to their age or parity. Those women with blood group O were at higher risk of past placental malaria infection.