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Etiology of anemia in pregnancy in south Malawi^1,2,3,4

¹ From the Departments of Obstetrics and Gynaecology, College of Medicine Blantyre, Malawi, and the University of Liverpool, Liverpool, United Kingdom, and the Department of Hematology, Queen Charlotte's Hospital, London.

Background: Anemia in pregnancy is a major public health problem in developing countries. In sub-Saharan Africa, such anemia is generally accepted as resulting from nutritional deficiencies, particularly iron deficiency.

Objective: We comprehensively assessed the full spectrum of nutritional and nonnutritional factors associated with pregnancy anemia.

Design: Iron, folate, vitamin B-12, and vitamin A were measured in serum in a cross-sectional study of 150 pregnant women in Blantyre, Malawi. Bone marrow aspirates were evaluated, peripheral blood films were examined for malaria parasites, stool and urine samples were examined for helminthic infection, and tests were done for genetic disorders and for HIV infection. C-reactive protein (CRP) concentrations and erythrocyte sedimentation rates were measured as markers of inflammation.

Results: Of the 150 anemic women, 23% were iron deficient with no evidence of folate, vitamin B-12, or vitamin A deficiencies; 32% were deficient in iron and one or more of the other micronutrients; 26% were not iron deficient but had evidence of one of the other micronutrient deficiencies, most often vitamin A; and 19% were not deficient in any of the micronutrients studied. CRP concentrations were notably high in 54% of the anemic women with no nutritional deficiencies and in 73.5% of the anemic women who were iron replete by bone marrow assessment.

Conclusion: The role of chronic inflammation as a possible contributing factor to anemia in pregnancy has important implications for the clinical evaluation and treatment of women.

Key Words: Anemia • pregnancy • nutritional deficiency • infection • Malawi • iron • vitamin B-12 • folate • vitamin A • women

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