Anaemia during pregnancy in Burkina Faso, west Africa, 1995-96: prevalence and associated factors. DITRAME Study Group

We report the results of a cross-sectional study carried out in 1995-96 on anaemia in pregnant women who were attending two antenatal clinics in Bobo-Dioulasso, Burkina Faso, as part of a research programme including a clinical trial of zidovudine (ZDV) in pregnancy (ANRS 049 Clinical Trial). For women infected with human immunodeficiency virus (HIV) in Africa, anaemia is of particular concern when considering the use of ZDV to decrease mother-to-child transmission of HIV. The objectives were to determine the prevalence of and risk factors for maternal anaemia in the study population, and the effect of HIV infection on the severity of maternal anaemia. HIV counselling and testing were offered to all women, and haemograms were determined for those women who consented to serological testing. Haemoglobin (Hb) levels were available for 2308 of the 2667 women who accepted HIV testing. The prevalence of HIV infection was 9.7% (95% confidence interval (CI): 8.6-10.8%). The overall prevalence of anaemia during pregnancy (Hb level < 11 g/dl) was 66% (95% CI: 64-68%). The prevalence of mild (10 g/dl < or = Hb < 11 g/dl), moderate (7 g/dl < or = Hb < 10 g/dl) and severe (Hb < 7 g/dl) anaemia was 30.8%, 33.5% and 1.7%, respectively. The prevalence of anaemia was 78.4% in HIV-infected women versus 64.7% in HIV-seronegative women (P < 0.001). Although the relative risk of HIV-seropositivity increased with the severity of anaemia, no significant association was found between degree of anaemia and HIV serostatus among the study women with anaemia. Logistic regression analysis showed that anaemia was significantly and independently related to HIV infection, advanced gestational age, and low socioeconomic status. This study confirms the high prevalence of anaemia during pregnancy in Burkina Faso. Antenatal care in this population must include iron supplementation. Although HIV-infected women had a higher prevalence of anaemia, severe anaemia was infrequent, possibly because few women were in the advanced stage of HIV disease. A short course regimen of ZDV should be well tolerated in this population.     

Haematological characteristics and HIV status of pregnant women in Abidjan, Côte d'Ivoire, 1995-96

To describe the haematological profile of pregnant women and to compare these characteristics according to HIV serostatus in Abidjan, C?te d'Ivoire, a cross-sectional study was made in the context of a research intervention programme to reduce mother-to-child transmission (MTCT) of HIV (ANRS 049 trial). HIV testing was systematically proposed to pregnant women attending the mother and child health clinic of a community health centre. Blood samples were tested for HIV antibodies using Genelavia and Peptilav. The haematological parameters were measured with a Coulter counter. From May 1995 to March 1996, 1646 pregnant women accepted HIV testing and had a full blood count available. The prevalence of HIV infection was 12.0% (n = 197). The prevalence of anaemia (haemoglobin [Hb] < 11 g/dL) was 70.1%, n = 1155 (95% confidence interval 68-72%) and significantly higher in HIV+ (81.7%, n = 161) than in HIV- women (68.9%, n = 994) (P < 0.001). Severe anaemia (Hb < 7 g/dL) was present in 1.9% of the women (n = 31), 4.6% (n = 9) in HIV+ and 1.5% (n = 22) in HIV- women (P < 0.001). HIV infection, primigravidae and secundigravidae were factors independently associated with anaemia. Anaemia was highly prevalent in this population while severe anaemia was rare. HIV infection was a contributor to anaemia in pregnancy. As zidovudine, with its known haematological toxicity, has recently been introduced to prevent MTCT of HIV in developing countries, screening HIV+ women for severe anaemia is necessary.     

Prevalence and risk factors for anaemia in pregnant women of eastern Sudan

The prevalence and possible risk factors for anaemia were investigated in 744 pregnant Sudanese women attending the antenatal clinic of New Halfa teaching hospital, eastern Sudan between October 2003 and April 2004. Of those, 466 (62.6%) had anaemia (haemoglobin [Hb]: <11 gm/dl); 52.4% had mild anaemia (Hb: 9.0-10.9 gm/dl); 8.1% had moderate anaemia (Hb: 7.0-8.9 gm/dl); and 2.2% had severe anaemia (Hb: <7 gm/dl), respectively. The prevalence of anaemia (73.2%) was significantly high in grandmultigravidae. Univariate and multivariate analysis showed that age and parity were not significantly associated with anaemia. Malaria (OR = 4.5, 95% CI 2.5-8.1; P < 0.0001) and pica (OR = 1.6, 95% CI 1.05-2.6; P = 0.03) were the risk factors for anaemia. Thus, preventive measures against malaria (chemoprophylaxis and insecticide-treated bednets) may be needed for all pregnant women irrespective of their age or parity.     

Risk factors for malaria in pregnancy in an urban and peri-urban population in western Kenya

To assess risk factors for malaria in pregnancy in Kisumu, western Kenya, we studied healthy women with an uncomplicated pregnancy of > or = 32 weeks attending the antenatal clinic in the Provincial Hospital. Between June 1996 and March 1999, malaria and human immunodeficiency virus (HIV) infection were examined in 5093 pregnant women: 20.1% of the women were parasitaemic and 24.9% were HIV-seropositive. 2502 women delivered in the hospital and a smear was obtained: the prevalence of placental malaria, maternal peripheral parasitaemia, and HIV infection was respectively 19.0%, 15.2% and 24.5%. HIV infection (risk ratio [RR] 1.58, 95% confidence interval [95% CI] 1.32-1.89), young age (< 21 years: RR 1.51, 95% CI 1.19-1.91), being a primigravidae (RR 1.41, 95% CI 1.05-1.88), a peri-urban residence (RR 1.50, 95% CI 1.21-1.88), and Luo ethnicity (RR 1.74, 95% CI 1.35-2.24) were risk factors for malaria at delivery. Use of sulfadoxine-pyrimethamine (SP), reported by 2.1% of the women, was a protective factor (RR 0.44, 95% CI 0.18-1.06). Results were similar in the third trimester. In this urban/peri-urban setting, preventing HIV infection, delaying the first pregnancy until after adolescence, and applying an effective antimalarial strategy such as intermittent therapy with SP will reduce the prevalence of malaria in pregnancy.     

Anaemia in pregnant, postpartum and non pregnant women in Lak district, Daklak province of Vietnam

OBJECTIVES: To determine anaemia prevalence and related factors in pregnant women (PW), post partum women (PPW) and non pregnant women (NPW) in a remote mountainous district. METHODS: A cross-sectional survey was conducted in 2001. All PW, all PPW within 6 months of delivery and a random number of NPW equivalents to the number of PW in each commune were selected. Hemoglobin (Hb) was measured using Hemocue method. Mild anaemia was defined as Hb=7 g/dL-11 g/dL in PW, and 8 g/dL-12 g/dL in NPW and PPW. Severe anaemia was defined as Hb<7 g/dL in PW, and<8 g/dL in NPW and PPW. Pregnancy status was determined using urine pregnancy test and calculation of expected menstruum. RESULTS: There were 901 women surveyed: 281 PW, 348 PPW and 272 NPW. More than half (58%) were anaemic: 54% mild and 4% severe. Mean Hb was 11.1g/dL. More PPW had anaemia (62%; OR=1.4; 95%CI=1.1-2.1 compared to NPW) than NPW (54%) and PW (53%). Other related factors were being BoY, Ede and Koho ethnics (OR=2.7; 95%CI=1.4-5.0 compared to Kinh ethnic), having primary education or lower (OR=1.5; 95%CI=1.1-2.1 compared to secondary education or higher). Among PW, being pregnant during the third trimester increased anaemia (OR=2.2; 95%CI=1.3-3.8 compared to being pregnant during the second trimester). Among PPW, women aged 30 or older were more anaemic (OR=1.7, 95%CI=1.1-2.9 compared to women aged 20-29). CONCLUSION: Anaemia prevalence was very high. Interventions should be focused on PPW, PW during the last trimester, minority ethnic women, low-educated and older women.     

Malaria and hookworm infections in relation to haemoglobin and serum ferritin levels in pregnancy in Masindi district, western Uganda

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<100g/l) was found in 18.0% (94) of aparasitaemic women compared to 28.5% (80) among parasitaemic women (P<0.001). The prevalence of anaemia was 15.1% (42) in women without hookworm infection compared to 23.3% (129) among infected women (P=0.006). Malaria parasitaemia, hookworm infection, C-reactive protein, gravidity and gestational age were associated with Hb status. Malaria parasitaemia, Ascaris lumbricodes and Trichuris trichiura infections and age were associated with SF. Malaria, hookworm infections and iron deficiency were associated with anaemia in the study population.     

Associations between mild-to-moderate anaemia in pregnancy and helminth, malaria and HIV infection in Entebbe, Uganda

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 <11.2 g/dl) and helminths, malaria and HIV among 2507 otherwise healthy pregnant women at enrolment to a trial of deworming in pregnancy in Entebbe, Uganda. The prevalence of anaemia was 39.7%. The prevalence of hookworm was 44.5%, Mansonella perstans 21.3%, Schistosoma mansoni 18.3%, Strongyloides 12.3%, Trichuris 9.1%, Ascaris 2.3%, asymptomatic Plasmodium falciparum parasitaemia 10.9% and HIV 11.9%. Anaemia showed little association with the presence of any helminth, but showed a strong association with malaria (adjusted odds ratio (AOR) 3.22, 95% CI 2.43-4.26) and HIV (AOR 2.46, 95% CI 1.90-3.19). There was a weak association between anaemia and increasing hookworm infection intensity. Thus, although highly prevalent, helminths showed little association with mild-to-moderate anaemia in this population, but HIV and malaria both showed a strong association. This result may relate to relatively good nutrition and low helminth infection intensity. These findings are pertinent to estimating the disease burden of helminths and other infections in pregnancy. [Clinical Trial No. ISRCTN32849447].     

Anaemia prevention for reduction of mortality in mothers and children

The relationship of anaemia as a risk factor for child and maternal mortality is described. Maternal case fatality rates, mainly from hospital studies vary from < 1% to > 50%. These large differences in risk were related primarily to differences in available obstetric care for women living in areas with inadequate antenatal and delivery care facilities. The relative risk of mortality associated with moderate anaemia (haemoglobin [Hb] 40-80 g/L) was 1.35 (95% confidence interval [95% CI] 0.92-2.00) and for severe anaemia (Hb < 47 g/L) was 3.51 (95% CI 2.05-6.00). Nutritional-related anaemia mortality is likely to be greater than malarial anaemia-related mortality. With good antenatal and obstetric care most anaemia-related deaths are preventable, and policies to reduce anaemia prevalence should not be divorced from efforts to provide adequate antenatal and delivery facilities for women in developing countries. In children, although mortality was increased with anaemia (< 50 g/L), the evidence for increased risk with less severe anaemia was inconclusive. A survival analysis of Malawian infants indicated that if Hb decreased by 10 g/L after 6 months of age, the risk of dying before 12 months of age increased 1.72 times. Evidence from a number of studies suggests that mortality due to severe malarial anaemia in children is greater than that due to iron-deficiency anaemia. Primary prevention of nutritional and malarial anaemia in young children could lead to reductions in child mortality.     

Is International or Asian Criteria-based Body Mass Index Associated with Maternal Anaemia,Low Birthweight,and Preterm Births among Thai Population?—An Observational Study

An observational study was conducted in the four southernmost provinces of Thailand aiming at determining the effect of international or Asian criteria-based body mass index (BMI) in predicting maternal anaemia, low birthweight (LBW), and preterm births among pregnant Thai women and the change in haemoglobin (Hb) level during pregnancy. Maternal anaemia was defined as a haemoglobin (Hb) level of <11 g/dL. Anaemia was detected in 27.4% and 26.9% of 1,192 pregnant women at their first prenatal visit and the third trimester respectively. The proportions of overweight and obese women according to the Asian criteria-based pre-pregnancy BMI were higher than the international criteria-based BMI (22.4% and 10.1% vs 15.5% and 3.4% respectively). No significant difference between pre-pregnancy BMI and pregnancy BMI at the first prenatal visit was demonstrated (mean±standard deviation=21.8±4.0 vs 22.8±4.1). Underweight women had a significantly higher prevalence of maternal anaemia, LBW, and preterm birth compared to women with normal weight. Overweight and obese women at pre-pregnancy by the Asian criteria-based BMI had a lower prevalence of anaemia. The Hb levels did not change significantly over time. In addition to BMI, maternal age, parity, and late prenatal visit were independently associated with maternal anaemia, low birthweight, and preterm birth. Underweight pregnant women classified by international or Asian criteria-based BMI increased the risk of maternal anaemia, low birthweight, and preterm birth.Key words: Anaemia, Body mass index, Observational studies, Pregnancy, Thailand     

An analysis of intra-uterine growth retardation in rural Malawi

OBJECTIVE: (1) To describe the sex-specific, birth weight distribution by gestational age of babies born in a malaria endemic, rural area with high maternal HIV prevalence; (2) to assess the contribution of maternal health, nutritional status and obstetric history on intra-uterine growth retardation (IUGR) and prematurity. METHODS: Information was collected on all women attending antenatal services in two hospitals in Chikwawa District, Malawi, and at delivery if at the hospital facilities. Newborns were weighed and gestational age was assessed through post-natal examination (modified Ballard). Sex-specific growth curves were calculated using the LMS method and compared with international reference curves. RESULTS: A total of 1423 live-born singleton babies were enrolled; 14.9% had a birth weight <2500 g, 17.3% were premature (<37 weeks) and 20.3% had IUGR. A fall-off in Malawian growth percentile values occurred between 34 and 37 weeks gestation. Significantly associated with increased IUGR risk were primiparity relative risk (RR) 1.9; 95% CI 1.4--2.6), short maternal stature (RR 1.6; 95% CI 1.0--2.4), anaemia (Hb<8 g/dl) at first antenatal visit (RR 1.6; 95% CI 1.2--2.2) and malaria at delivery (RR 1.4; 95% CI 1.0--1.9). Prematurity risk was associated with primiparity (RR 1.7; 95% CI 1.3--2.4), number of antenatal visits (RR 2.2; 95% CI 1.6--2.9) and arm circumference <23 cm (RR 1.9; 95% CI 1.4--2.5). HIV infection was not associated with IUGR or prematurity. CONCLUSION: The birth-weight-for-gestational-age, sex-specific growth curves should facilitate improved growth monitoring of newborns in African areas where low birth weight and IUGR are common. The prevention of IUGR requires improved malaria control, possibly until late in pregnancy, and reduction of anaemia.     

Quality assessment of the antenatal program for anaemia in rural Tanzania.

OBJECTIVE: To assess the quality of antenatal care with respect to anaemia, a common health problem, in a developing country. DESIGN: Cross-sectional study. SETTING: Rufiji rural district, coastal Tanzania. STUDY PARTICIPANTS: Three hundred and seventy-nine consecutively enrolled pregnant women from 16 randomly selected antenatal clinics, including 10 dispensaries, four rural health centres and two hospitals. METHODS: We noted availability of infrastructure for management of anaemia, observed provider-client interaction, and interviewed women who attended antenatal clinics. An observer and health workers measured haemoglobin levels and their measurements were compared. MAIN OUTCOME MEASURES: Quality of antenatal care, anaemia in pregnancy, and maternal satisfaction. RESULTS: Half of the rural health clinics had no instrument to measure haemoglobin. The majority (58%) of pregnant women were not checked for anaemia at all, 10% were clinically examined, and 37% had haemoglobin assessed. The agreement between health workers' (using Tallqvist) and the observers' (using HemoCue) measurements of haemoglobin was poor to fair. The prevalence of anaemia (Hb < 10.5 g/dl) and severe anaemia (< 7.0 g/dl) was 58% and 6.2%, respectively, but overall only 4% of the anaemic pregnant women had specific action taken within the antenatal care program. CONCLUSION: Deficiencies in quality of screening, diagnostic information, and individual counselling need to be addressed before any impact of the antenatal care programme on anaemia can be expected.     

Anaemia in pregnant Ghanaian women: importance of malaria, iron deficiency, and haemoglobinopathies

In sub-Saharan Africa, anaemia in pregnancy results from multiple causes including malaria, iron deficiency and haemoglobinopathies. In a cross-sectional study among 530 pregnant women in Ghana in November-December 1998, red blood cell indices were analysed with respect to malaria, serum concentrations of ferritin and C-reactive protein (CRP), and the haemoglobin and alpha-globin genotypes. Anaemia (haemoglobin [Hb] < 11 g/dL) was found in 54% of the women; 63% harboured malaria parasites at predominantly low numbers. Ferritin levels were considerably influenced by malaria and inflammatory processes (CRP > 0.6 mg/dL). Depending on the definition applied, the prevalence of iron deficiency ranged between 5% and 46%. The HbAS trait was observed in 14%, HbAC and elevated HbF in 7% each, and sickle cell disease in 1%. Heterozygous beta-thalassaemia was present in 1% of the women and alpha(+)-thalassaemia in 33% (29% heterozygous, 4% homozygous). Women with HbAS had higher malaria parasite densities than those with HbAA. In individuals with highly elevated HbF (> 10%), parasitaemia occurred in 27% only. Low gravidity, second trimester of pregnancy, malaria, raised CRP levels, and homozygous alpha(+)-thalassaemia were independent risk factors for anaemia in multivariate analysis. alpha(+)-Thalassaemia, however, was associated with a lesser degree of malarial anaemia when compared to non-thalassaemic women. Iron deficiency appears not to be a major health problem in this population. Haemoglobinopathies are common but, except for homozygous alpha(+)-thalassaemia, do not substantially contribute to anaemia in pregnancy. alpha(+)-Thalassaemia ameliorates malarial anaemia in pregnant women.     

Estimation of effectiveness of interventions for malaria control in pregnancy using the screening method

BACKGROUND: The evaluation of the effectiveness of antimalarial drugs and bed net use in pregnant women is an important aspect of monitoring and surveillance of malaria control in pregnancy. In principle the screening method for assessing vaccine efficacy can be applied in non-vaccine settings for assessing interventions for malaria control in pregnancy. METHODS: In this analysis field data on the proportion of placental malaria cases treated with two doses of sulphadoxine-pyrimethamine (SP) and the uptake of two doses of SP in the antenatal clinic was used in a case-coverage method to assess the protective effectiveness (PE) of intermittent preventive treatment with SP for malaria control in pregnancy. PE was assessed using placental malaria, low birthweight and maternal anaemia at delivery as outcome variables. The method was also applied to an evaluation of the protective effectiveness of self-reported use of impregnated bed nets (ITNs). RESULTS: Effectiveness was highest for reduction of low birthweight in multigravidae (87.2%, 95% CI, 83.2-91.3%). PE was lower for placental malaria (61.6% primigravidae, 28.5% multigravidae), and maternal anaemia (Hb < 8.0 g/dl, 37.8% primigravidae, 29.6% multigravidae). Estimates for PE of self-reported use of ITNs gave values for all three outcome parameters that were much lower than for SP use. For women of all parties effectiveness estimates for reduction of low birthweight were 22% (95% CI, 17.7-26.4), prevention of placental malaria (all types) 7.1% (95% CI, 4.4-9.8), prevention of active placental infection 38.9% (95% CI, 27.4-50.4), and for maternal anaemia 8.8% (95% CI, 0-20.0). CONCLUSIONS: The case-coverage method could provide a useful and practical approach to routine monitoring and evaluation of drug interventions to control malaria in pregnancy and has potentially wide applications. Effectiveness estimates related to reported ITN use in pregnancy may be less reliable. The method should be further evaluated using currently available data sets.     

High Prevalence of Anemia and Poor Compliance with Preventive Strategies among Pregnant Women in Mwanza City,Northwest Tanzania: A Hospital-Based Cross-Sectional Study

Anemia in pregnancy is prevalent in Tanzania despite the implementation of existing prevention strategies. This study aims to determine the level of compliance with anemia preventive strategies among pregnant women and the factors associated with poor compliance. A cross sectional study was conducted among 768 pregnant women who attended the Bugando Medical Center, Sekou-Toure Regional Hospital, Nyamagana District Hospital, and Buzuruga Health Center in Mwanza, Northwest Tanzania. The prevalence of anemia at term was 68.8% (95% CI, 65.5–72.0%). The average hemoglobin level at term was 10.0 g/dL (95% CI, 9.8–10.1). Only 10.9% of pregnant women complied fully with anemia-preventive strategies. A decrease in mean hemoglobin level was observed across levels of compliance, with women who were non-compliant displaying a significantly lower mean hemoglobin level (8.3 g/dL) compared to women who were fully compliant (11.0 g/dL). Poor compliance was associated with no formal or primary education and initiating antenatal care in the 2nd or 3rd trimester. Anemia in pregnancy was commonly associated with lack of compliance with preventive strategies among participants. There is a need for community-based health education on the importance of complying with anemia-preventive strategies in order to reduce the burden during pregnancy and the consequences of anemia to the unborn baby.     

Postnatal anaemia: neglected problems and missed opportunities in Uganda

Anaemia is a neglected disorder that affects a huge proportion of women, particularly in developing countries. In a cross-sectional study among 349 mothers attending child clinics in Tororo District, eastern Uganda, who had delivered within 12 months prior to the study, the magnitude and prevalence of anaemia, important risk factors for anaemia and the usefulness of clinical examination and patient history as a screening tool were determined. Approximately two-thirds (64.4%) of the women were anaemic, with 55 (15.8%) suffering from moderate to severe anaemia (Hb < 10.0 g/dl) and 169 (48.6%) with mild anaemia (10.0-11.9 g/dl). Five (1.4%) women suffered from severe anaemia (Hb < 7.0 g/dl). Only iron supplementation and excessive bleeding during or after delivery emerged as risk factors using multinominal regression modelling. Lack of iron supplementation was a factor for mild anaemia (odds ratio (OR) 2.6; 95% confidence interval (CI) 1.5-4.2), but not for moderate to severe anaemia. Excessive bleeding was a risk factor for moderate to severe anaemia (OR 2.3; 95% CI 1.1-4.7), but not for mild anaemia. The sensitivity of using clinical signs to detect anaemia (hb < 12.0 g/dl) was relatively high (0.74; 95% CI 0.7-0.8), but with a low specificity (0.4; 95% CI 0.3-0.6). Although anaemia in postnatal women is widespread, the health care system had missed the opportunities to effectively address it, such as through the implementation of the WHO policy recommendation for iron and folic acid supplementation, improvement of obstetric services and, despite its imperfection, screening for anaemia using clinical signs.     

Seroprevalence of HIV infection in pregnant women in the Annaba region (Algeria)

BackgroundThe goal of the study is to assess the prevalence and the risk factors of the infection by the human immunodeficiency virus (HIV) among pregnant women in the area of Annaba (Algeria).MethodsWe performed a cross-sectional study with analytical purposes. The study included 3044 pregnant women admitted to two regional hospitals within a period of time of five months. Two Elisa tests were used to determine the prevalence of HIV infection. An analysis of medical history and serum tests for biomarkers hepatitis virus B infection, hepatitis virus C infection and syphilis to determine the possible mode of contamination, by blood or sexual transmission.ResultsHIV prevalence was 5.3/1000 (CI 95%; 3.12–8.37), HBV prevalence 24.7/1000 (CI 95%; 19.6–30.7), HCV prevalence 6.3/1000 (CI 95%; 3.8–9.5) and syphilis prevalence 2.6/1000 (CI 95%; 1.2–5). On average, pregnant women infected by HIV were 33 ± 5 years old, married, and had three children. The analysis of the markers of exposure risk investigated in our study showed that the pregnant women infected with HIV do not compose a specific risk group. Overall our results suggest that the more probable route of HIV transmission for women of the Annaba region is via heterosexual intercourse with spouse.ConclusionThe prevalence of HIV infection in Annaba remains high 5.3/1000, compared with the national average of 1/1000. In this region, pregnant women infected with HIV are not part of a group at particular risk. The HIV monitoring should be further strengthened in our country.     

Association between Maternal Anaemia and Postpartum Depression in an Urban Sample of Pregnant Women in Iran

The aim of this prospective study was to determine the relationship between anaemia during pregnancy and postpartum depression. Two hundred eighty-one non-anaemic mothers with singleton and low-risk pregnancy and no history of antidepressant-use were studied. Demographic and reproductive data at week 20 were obtained. Mothers were followed up and haemoglobin (Hb) was checked at delivery. Iranian version of Edinburgh Postpartum Depression Scale (EPDS) was completed 4-6 weeks after delivery. Mean age of the mothers was 26.6±4 years. The prevalence of postpartum depression according to EPDS was 5.5%. Binary logistic regression analysis showed that Hb <11 g/dL at delivery would increase the chance of postpartum depression (OR 4.64; 95% CI 1.33-16.08). The results show that diagnosis and treatment of physiologic factors, especially anaemia, would reduce the risk of postpartum depression.Key words: Anaemia, Edinburgh Postpartum Depression Scale, Haemoglobin, Postpartum depression, Iran     

云南省德宏州2005-2010年未婚孕产妇艾滋病病毒感染及其影响因素分析

目的:了解云南省德宏州未婚孕产妇艾滋病流行趋势,探讨影响未婚孕产妇感染艾滋病病毒(HIV)的危险因素。方法:收集2005-2010年间进入德宏州各级医院和计划生育服务站就诊的未婚孕产妇的社会人口学、行为学和HIV感染信息,对HIV阳性者血清进行BED-捕获酶联免疫试验(BED-CEIA)以检测其是否系新近感染者。结果:德宏州2005-2010年间共调查12 742例未婚孕产妇,HIV感染率和新近感染率分别为0.71%和0.25%。2007年HIV感染率和新近感染率最高,分别为1.13%和0.86%。多因素logistic回归分析结果显示,缅甸籍(AOR:2.57;95%CI:1.13～5.84)未婚孕产妇HIV感染率较高,而高中/中专文化程度(AOR:0.19;95%CI:0.06～0.58)、"丈夫"/男朋友无吸毒史(AOR:0.18;95%CI:0.04～0.75)未婚孕产妇HIV感染率较低。结论:德宏州未婚孕产妇HIV感染率及新近感染率较高。缅甸籍、"丈夫"/男朋友吸毒史、文化水平低是导致未婚孕产妇感染HIV的高危因素。有必要加强未婚孕产妇人群艾滋病防控工作。     

Prevalence and risk factors for anaemia in pregnant women: a population-based prospective cohort study in China

Maternal anaemia is a common pregnancy complication in developing countries; however, its epidemiology remains largely unexplored in China. This study was designed to explore the epidemiology and risk factors of anaemia during pregnancy. A prospective cohort study was conducted, using data from a population-based pregnancy-monitoring system in 13 counties in East China (1993–96). Women who delivered singleton infants at 20–44 weeks with at least one haemoglobin assessment during pregnancy were included ( n  = 164 667). The prevalence of anaemia (haemoglobin < 10 g/dL) during pregnancy as well as in each trimester was estimated. Multivariable log-binomial regression models were used to evaluate risk factors.
The overall prevalence of anaemia in pregnancy was 32.6%, with substantial variations across trimesters (11.2%, 20.1% and 26.2% in the 1st, 2nd and 3rd trimesters respectively). Risk factors for anaemia included older maternal age, education below junior high school (prevalence rate ratio [RR] 1.10, 95% confidence interval [CI] 1.08, 1.12), farming occupation (1.05, 95% CI 1.03, 1.06), and mild pregnancy-induced hypertension (PIH) (RR 1.09, 95% CI 1.05, 1.13) and severe PIH (RR 1.13, 95% CI 1.06, 1.19). Peri-conception folic acid use was associated with a reduced risk for anaemia in the 1st trimester (RR 0.75, 95% CI 0.72, 0.78). Initiating prenatal care after the 1st trimester was associated with increased risk of anaemia in the 2nd and 3rd trimesters. Our study found anaemia during pregnancy is highly prevalent in this indigenous Chinese population. The risk increases with the severity of hypertensive disorders. Folic acid supplementation during the peri-conception period is associated with reduced risk of 1st trimester anaemia.