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Original Research Communication |
1 From the Research Department of Human Nutrition, The Royal Veterinary and Agricultural University, Frederiksberg, Denmark; the Danish Bilharziasis Laboratory, Charlottenlund, Denmark; the Blair Research Laboratory, Ministry of Health, Harare, Zimbabwe; the Department of Clinical Pharmacology, University of Zimbabwe, Harare, Zimbabwe; and the Department of Clinical Chemistry, Aalborg University Hospital, Aalborg, Denmark.
Background: Folate and iron status and hemoglobin concentrations are important to maternal and infant health.
Objective: Our goal was to identify predictors of serum folate, serum ferritin, and hemoglobin.
Design: This was a cross-sectional study of 1669 pregnant women (22–35 wk of gestation) in Harare, Zimbabwe, who were receiving prenatal care. The statistical effects of age, season, gestational age, gravidity, HIV-1 infection, malaria parasitemia, and serum 
1-antichymotrypsin (ACT) on serum folate, serum ferritin (log10 transformed), and hemoglobin were estimated by using multiple linear regression analyses.
Results: Serum folate (
: 11.4 µmol/L) was 0.52-nmol/L (95% CI: 0.04, 1.0) lower in HIV-infected women than in uninfected women and 0.65-nmol/L (0.014, 1.28) lower in weeks 25–35 than in weeks 22–25. Serum ferritin (geometric : 11.6 µg/L) was 0.93 times (0.86, 0.99) lower in HIV-infected women and 2.25 times (1.41, 3.61) higher in women with malaria parasitemia than in uninfected women. Similarly, serum ferritin was 0.71 times (0.63, 0.79) higher in weeks 32–35 than in weeks 22–25 and 1.21 times (1.12, 1.29) higher in gravida 
3 than in gravida 1. Elevated serum ACT was a strong predictor of serum folate, serum ferritin, and hemoglobin. HIV infection was associated with a 12.9-g/L (8.9, 16.8) lower hemoglobin concentration in women with nondepleted iron stores but low serum retinol and a 7–8-g/L lower hemoglobin concentration in women with other combinations of serum ferritin and retinol (P for interaction = 0.038). Season, age, gestational age, and gravidity were not significant predictors of hemoglobin. Low serum folate, ferritin, and retinol were associated with low hemoglobin.
Conclusions: HIV was associated with lower serum folate, serum ferritin, and hemoglobin. HIV infection was also associated with lower hemoglobin, particularly in women with stored iron and low serum retinol. Low serum folate, ferritin, and retinol were associated with low hemoglobin.
Key Words: Hemoglobin • ferritin • folate • reproduction • pregnancy • gestational age • parity • HIV • acute phase response • malaria • Zimbabwe • women • 1-antichymotrypsin
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