title: Iron Supplementation Alters Heme and Heme Oxygenase 1 (HO-1) Levels In Pregnant Women in Ghana.
abstract: BACKGROUND
  Iron supplementation is recommended for pregnant women to meet their iron requirement for a healthy pregnancy. The benefits and risks of universal iron supplementation during pregnancy in malaria endemic countries are currently being debated. As part of a broader study that focused on the effect of heme/HO-1 on pregnancy outcomes in malaria in pregnancy, we determined the association between iron supplementation and free heme levels in blood of pregnant women with and without malaria in Ghana. We hypothesized that pregnant women with malaria who took iron supplements will have higher levels of Heme/HO-1 than those who did not take iron supplements.
  
  
  METHODS
  A total of 337 women were recruited for this study. Blood samples were collected for malaria diagnosis and heme/HO-1 measurement. Quantification of heme was done using a heme colorimetric assay kit and HO-1 levels were performed using Enzyme-Linked Immunosorbent Assay (ELISA) on plasma samples.
  
  
  RESULTS
  Malaria positive iron supplemented women, in their third trimester, had significantly higher median levels of heme 59.3(43.1 - 60.4) than non-malaria iron supplemented women 35.7(33.0 - 62.2),p = 0.026. Also, malaria positive iron supplemented women had significant higher median levels of HO-16.2(IQR 4.9 - 8.1) than pregnant women who did not take iron supplements 2.9 (IQR 2.1 - 3.8),p = <0.001.
  
  
  CONCLUSIONS
  Although iron supplementation may be highly beneficial and improve pregnancy outcomes for iron deficient or anemic mothers, it is also likely that iron supplementation for pregnant women who are not iron deficient may put this group of women at risk for adverse pregnancy outcomes. Findings from this study sheds light on the effect of iron supplementation on malaria derived heme in pregnancy, which may inform how iron supplementation is recommended for pregnant women who are not iron deficient.
authors.affiliation: Department of Microbiology, Biochemistry and Immunology, Morehouse School of Medicine.
authors.forename: Hassana
authors.initials: H
authors.lastname: Salifu
authors.affiliation: Department of Microbiology, Biochemistry and Immunology, Morehouse School of Medicine.
authors.forename: Nana O
authors.initials: NO
authors.lastname: Wilson
authors.affiliation: Department of Microbiology, Biochemistry and Immunology, Morehouse School of Medicine.
authors.forename: Mingli
authors.initials: M
authors.lastname: Liu
authors.affiliation: Department of Microbiology, Biochemistry and Immunology, Morehouse School of Medicine.
authors.forename: Carmen
authors.initials: C
authors.lastname: Dickinson-Copeland
authors.affiliation: University of Alabama, Birmingham Alabama, Department of Epidemiology.
authors.forename: Nelly
authors.initials: N
authors.lastname: Yatich
authors.affiliation: University of Alabama, Birmingham Alabama, Department of Epidemiology.
authors.forename: John
authors.initials: J
authors.lastname: Keenan
authors.affiliation: University of Alabama, Birmingham Alabama, Department of Epidemiology.
authors.forename: Cornelius
authors.initials: C
authors.lastname: Turpin
authors.affiliation: University of Alabama, Birmingham Alabama, Department of Epidemiology.
authors.forename: Pauline
authors.initials: P
authors.lastname: Jolly
authors.affiliation: University of Ghana Medical School, Department of Pathology, Korle-Bu Teaching Hospital, Accra, Ghana.
authors.forename: Richard
authors.initials: R
authors.lastname: Gyasi
authors.affiliation: University of Ghana Medical School, Department of Pathology, Korle-Bu Teaching Hospital, Accra, Ghana.
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Adjei
authors.affiliation: Department of Microbiology, Biochemistry and Immunology, Morehouse School of Medicine.
authors.forename: Jonathan K
authors.initials: JK
authors.lastname: Stiles
keywords: Heme; Heme oxygenase-1; Iron supplementation; Placental malaria; Preterm delivery