title: The association of parasitic infections in pregnancy and maternal and fetal anemia: a cohort study in coastal Kenya.
abstract: BACKGROUND
  Relative contribution of these infections on anemia in pregnancy is not certain. While measures to protect pregnant women against malaria have been scaling up, interventions against helminthes have received much less attention. In this study, we determine the relative impact of helminthes and malaria on maternal anemia.
  
  
  METHODS
  A prospective observational study was conducted in coastal Kenya among a cohort of pregnant women who were recruited at their first antenatal care (ANC) visit and tested for malaria, hookworm, and other parasitic infections and anemia at enrollment. All women enrolled in the study received presumptive treatment with sulfadoxine-pyrimethamine, iron and multi-vitamins and women diagnosed with helminthic infections were treated with albendazole. Women delivering a live, term birth, were also tested for maternal anemia, fetal anemia and presence of infection at delivery.
  
  
  RESULTS
  Of the 706 women studied, at the first ANC visit, 27% had moderate/severe anemia and 71% of women were anemic overall. The infections with highest prevalence were hookworm (24%), urogenital schistosomiasis (17%), trichuria (10%), and malaria (9%). In adjusted and unadjusted analyses, moderate/severe anemia at first ANC visit was associated with the higher intensities of hookworm and P. falciparum microscopy-malaria infections. At delivery, 34% of women had moderate/severe anemia and 18% of infants' cord hemoglobin was consistent with fetal anemia. While none of the maternal infections were significantly associated with fetal anemia, moderate/severe maternal anemia was associated with fetal anemia.
  
  
  CONCLUSIONS
  More than one quarter of women receiving standard ANC with IPTp for malaria had moderate/severe anemia in pregnancy and high rates of parasitic infection. Thus, addressing the role of co-infections, such as hookworm, as well as under-nutrition, and their contribution to anemia is needed.
authors.affiliation: Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America ; Research Triangle Institute, Durham, North Carolina, United States of America.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: McClure
authors.affiliation: Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.
authors.forename: Steven R
authors.initials: SR
authors.lastname: Meshnick
authors.affiliation: Center for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio, United States of America.
authors.forename: Peter
authors.initials: P
authors.lastname: Mungai
authors.affiliation: Center for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio, United States of America.
authors.forename: Indu
authors.initials: I
authors.lastname: Malhotra
authors.affiliation: Center for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio, United States of America.
authors.forename: Christopher L
authors.initials: CL
authors.lastname: King
authors.affiliation: Department of Obstetrics and Gynecology, Columbia University School of Medicine, New York, New York, United States of America.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Goldenberg
authors.affiliation: Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Hudgens
authors.affiliation: Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Siega-Riz
authors.affiliation: Center for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio, United States of America.
authors.forename: Arlene E
authors.initials: AE
authors.lastname: Dent
mesh_terms: D000328:Adult; D000724:Ancylostomiasis / Q000150:complications / Q000453:epidemiology; D000740:Anemia / Q000150:complications* / Q000453:epidemiology*; D000818:Animals; D005260:Female; D005312:Fetal Blood / Q000737:chemistry; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008288:Malaria / Q000150:complications / Q000453:epidemiology; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000453:epidemiology*; D011446:Prospective Studies; D012552:Schistosomiasis / Q000150:complications / Q000453:epidemiology; D055815:Young Adult
chemical_list: D006454:Hemoglobins