title: HIV and other predictors of serum folate, serum ferritin, and hemoglobin in pregnancy: a cross-sectional study in Zimbabwe.
abstract: 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.
  
  
  METHODS
  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 alpha1-antichymotrypsin (ACT) on serum folate, serum ferritin (log10 transformed), and hemoglobin were estimated by using multiple linear regression analyses.
  
  
  RESULTS
  Serum folate (x: 11.4 micromol/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 x: 11.6 microg/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 > or =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.
authors.affiliation: Research Department of Human Nutrition, The Royal Veterinary and Agricultural University, Frederiksberg, Denmark. hfr@kvl.dk
authors.forename: H
authors.initials: H
authors.lastname: Friis
authors.forename: E
authors.initials: E
authors.lastname: Gomo
authors.forename: P
authors.initials: P
authors.lastname: Koestel
authors.forename: P
authors.initials: P
authors.lastname: Ndhlovu
authors.forename: N
authors.initials: N
authors.lastname: Nyazema
authors.forename: H
authors.initials: H
authors.lastname: Krarup
authors.forename: K F
authors.initials: KF
authors.lastname: Michaelsen
mesh_terms: D000210:Acute-Phase Reaction; D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D005293:Ferritins / Q000378:metabolism*; D005492:Folic Acid / Q000097:blood*; D005865:Gestational Age; D015658:HIV Infections / Q000097:blood*; D006454:Hemoglobins; D006801:Humans; D011237:Predictive Value of Tests; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000097:blood*; D012621:Seasons; D015842:Serine Proteinase Inhibitors / Q000097:blood; D015030:Zimbabwe; D000514:alpha 1-Antichymotrypsin / Q000097:blood
chemical_list: D006454:Hemoglobins; D015842:Serine Proteinase Inhibitors; D000514:alpha 1-Antichymotrypsin; D005293:Ferritins; D005492:Folic Acid