title: Zinc, gravida, infection, and iron, but not vitamin B-12 or folate status, predict hemoglobin during pregnancy in Southern Ethiopia.
abstract: The etiology of anemia during pregnancy in rural Southern Ethiopia is uncertain. Intakes of animal-source foods are low and infections and bacterial overgrowth probably coexist. We therefore measured the dietary intakes of a convenience sample of Sidama women in late pregnancy who consumed either maize (n = 68) or fermented enset (Enset ventricosum) (n = 31) as their major energy source. Blood samples were analyzed for a complete blood count, vitamin B-12 and folate status, plasma ferritin, retinol, zinc, albumin, and C-reactive protein (CRP). The role of infection and gravida was also examined. Dietary intakes were calculated from 1-d weighed records. No cellular animal products were consumed. Of the women, 29% had anemia, 13% had iron deficiency anemia, 33% had depleted iron stores, and 74 and 27% had low plasma zinc and retinol, respectively. Only 2% had low plasma folate (< 6.8 nmol/L) and 23% had low plasma vitamin B-12 (< 150 pmol/L), even though 62% had elevated plasma methylmalonic acid (MMA) (> 271 nmol/L). None had elevated plasma cystathionine or total homocysteine (tHcys). Women with enset-based diets had higher (P = 0.052) plasma vitamin B-12 concentration and lower (P < 0.05) cell volume, plasma cystathionine, and retinol than women consuming maize-based diets, but mean hemoglobin, plasma ferritin, MMA, tHcys, and folate did not differ. Plasma zinc, followed by CRP (< or = 5 mg/L), gravida (< or = 4), and plasma ferritin (> or = 12 microg/L) status were major positive predictors of hemoglobin. Despite some early functional vitamin B-12 deficiency, there was no macrocytic anemia. Consumption of fermented enset may have increased vitamin B-12 levels in diet and plasma.
authors.affiliation: Department of Human Nutrition, University of Otago, Dunedin, New Zealand 9015. rosalind.gibson@stonebow.otago.ac.nz
authors.forename: Rosalind S
authors.initials: RS
authors.lastname: Gibson
authors.forename: Yewelsew
authors.initials: Y
authors.lastname: Abebe
authors.forename: Sally
authors.initials: S
authors.lastname: Stabler
authors.forename: Robert H
authors.initials: RH
authors.lastname: Allen
authors.forename: Jamie E
authors.initials: JE
authors.lastname: Westcott
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Stoecker
authors.forename: Nancy F
authors.initials: NF
authors.lastname: Krebs
authors.forename: K Michael
authors.initials: KM
authors.lastname: Hambidge
mesh_terms: D000740:Anemia / Q000097:blood / Q000453:epidemiology / Q000209:etiology; D004032:Diet; D002149:Energy Intake; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D005492:Folic Acid / Q000097:blood*; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D007501:Iron / Q000097:blood*; D010298:Parity; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000097:blood*; D014805:Vitamin B 12 / Q000097:blood*; D003313:Zea mays; D015032:Zinc / Q000097:blood*
chemical_list: D006454:Hemoglobins; D005492:Folic Acid; D007501:Iron; D015032:Zinc; D014805:Vitamin B 12