title: Determinants of anemia in postpartum HIV-negative women in Dar es Salaam, Tanzania.
abstract: OBJECTIVE
  The determinants of anemia during both pregnancy and postpartum recovery remain incompletely understood in sub-Saharan African women.
  
  
  METHODS
  In a prospective cohort study among pregnant women, we assessed dietary, biochemical, anthropometric, infectious and sociodemographic factors at baseline. In multivariate Cox proportional hazards models, we examined predictors of incident anemia (hemoglobin <11 g/dl) and iron deficiency anemia (anemia plus mean corpuscular volume <80fL), and recovery from anemia and iron deficiency anemia through 18 months postpartum at antenatal clinics in Dar es Salaam, Tanzania between 2001 and 2005. A total of 2364 non-anemic pregnant women and 4884 anemic women were enrolled between 12 and 27 weeks of gestation.
  
  
  RESULTS
  In total, 292 women developed anemia during the postpartum period and 165 developed iron deficiency anemia, whereas 2982 recovered from baseline anemia and 2044 from iron deficiency anemia. Risk factors for postpartum anemia were delivery complications (RR 1.6, 95% confidence interval (CI) 1.13, 2.22) and low postpartum CD4 cell count (RR 1.73, 95% CI 0.96, 3.17). Iron/folate supplementation during pregnancy had a protective relationship with the incidence of iron deficiency anemia. Absence of delivery complications, education status and iron/folate supplementation were positively associated with time to recovery from iron deficiency.
  
  
  CONCLUSIONS
  Maternal nutritional status during pregnancy, prenatal iron/folate supplementation, perinatal care, and prevention and management of infections, such as malaria, are modifiable risk factors for the occurrence of, and recovery from, anemia.
authors.affiliation: Department of Nutrition, Harvard School of Public Health, Boston, MA, USA. pvp863@mail.harvard.edu
authors.forename: P
authors.initials: P
authors.lastname: Petraro
authors.forename: C
authors.initials: C
authors.lastname: Duggan
authors.forename: W
authors.initials: W
authors.lastname: Urassa
authors.forename: G
authors.initials: G
authors.lastname: Msamanga
authors.forename: A
authors.initials: A
authors.lastname: Makubi
authors.forename: D
authors.initials: D
authors.lastname: Spiegelman
authors.forename: W W
authors.initials: WW
authors.lastname: Fawzi
mesh_terms: D018798:Anemia, Iron-Deficiency / Q000097:blood / Q000453:epidemiology*; D018791:CD4 Lymphocyte Count; D004032:Diet; D019587:Dietary Supplements; D004909:Erythrocyte Indices / Q000502:physiology; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage*; D015658:HIV Infections; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D019266:Iron, Dietary / Q000008:administration & dosage*; D039382:Maternal Nutritional Physiological Phenomena; D015999:Multivariate Analysis; D049590:Postpartum Period / Q000097:blood*; D011247:Pregnancy; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D013636:Tanzania / Q000453:epidemiology
chemical_list: D006454:Hemoglobins; D019266:Iron, Dietary; D005492:Folic Acid