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Iron increases malaria risk during pregnancy
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Pregnant women with high levels of iron were at significantly increased risk for contracting malaria, according to results of an intermittent preventive treatment in pregnancy clinical trial.
“Benefits of iron supplementation during pregnancy for reducing iron-related diseases are undeniable,” Violeta Moya-Alvarez, MD, MPH, of the Institut de Recherche pour le Dévelopment in Paris,and colleagues wrote in Open Forum Infectious Disease. “However, epidemiological studies have questioned the benefits of iron supplementation in the context of malaria-endemic countries.”
The researchers monitored 1,005 HIV-negative pregnant women enrolled in the Anemia in Pregnancy: Etiology and Consequences, or APEC, observational study from January 2010 to May 2011. Participants were assessed during two antenatal visits, and were then followed until delivery. At their first antenatal visit, all participants received an insecticide-treated net and a two-dose intermittent preventative treatment in pregnancy, administered 1 month apart; the first dose was given to the women after week 15 of pregnancy. Patients also were assigned 600 mg Albenza (albendazole, GlaxoSmithKline) on a systematic basis, as well as daily doses of 200 mg oral ferrous sulfate and 5 mg folic acid.
The results showed that 29% of the women had at least one malarial episode during the follow-up period. The participants had an average of .52 positive smears (95% CI, 0.44-0.60).
Of the 751 placentas that the researchers analyzed, 9.2% had placental malaria. Women in their first and second pregnancies were more likely to have a positive blood smear than women who had been pregnant multiple times (P < .01).
There was a positive association between iron levels and risk of a positive blood smear (adjusted OR = 1.75; 95% CI, 1.46-2.11) as well as high P. falciparum density (beta estimate = 0.16; 95% CI, .018-0.27). In addition, the researchers also found that iron-deficient women were significantly less likely to have a positive blood smear and high P. falciparum density (P < .001 in both cases).
“Possible explanations for the increased malarial risk associated with iron levels found in our study are related to malaria pathophysiology in both the host and the parasite…” the researchers wrote. “These results warrant additional epidemiological studies to evaluate the effect of different doses of iron and folate supplementation on maternal and infant health outcomes in malaria-endemic regions.”
Disclosure: The researchers report no relevant financial disclosures.
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