Haematinic treatment of anaemia increases the risk of Plasmodium vivax malaria in pregnancy.
Nutritional deficiency and malaria are 2 major causes of anaemia during pregnancy in tropical areas. The relationship between anaemia, its treatment with iron and folate, and malaria was studied in a prospective cohort of 2112 pregnant Karen women on the north-western border of Thailand between 1993 and 1997. The development of Plasmodium vivax malaria was associated with a past mean haematocrit > 30% (hazard ratio = 1.5, 95% CI 1.2-2, P = 0.001) and recent (< or = 30 d) iron and folate supplementation (hazard ratio = 1.7, 95% CI 1.1-2.6, P = 0.01). There were no associations with P. falciparum infections. Plasmodium vivax has a predilection for young erythrocytes, and these results suggest that pregnant women with larger numbers of circulating young red cells are at greater risk of developing P. vivax malaria. In P. vivax-endemic areas, systematic iron and folate supplementation confers both benefit and risk in pregnancy.
Nacher
Mathieu
M
Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Bangkok 10400, Thailand.
McGready
Rose
R
Stepniewska
Kasia
K
Cho
Thein
T
Looareesuwan
Sornchai
S
White
Nicholas J
NJ
Nosten
François
F
D000328:Adult; D000740:Anemia / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D006397:Hematinics / Q000009:adverse effects*; D006400:Hematocrit; D006801:Humans; D016778:Malaria, Falciparum / Q000097:blood / Q000139:chemically induced; D016780:Malaria, Vivax / Q000097:blood / Q000139:chemically induced* / Q000453:epidemiology; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000188:drug therapy*; D015597:Pregnancy Complications, Parasitic / Q000097:blood / Q000139:chemically induced* / Q000453:epidemiology; D012307:Risk Factors; D013785:Thailand / Q000453:epidemiology
D006397:Hematinics