Etiology of anemia in pregnancy in south Malawi

Background: Anemia in pregnancy is a major public health problem in develop ing countries. In sub-Saharan Africa, such anemia is generally accepted as resulting from nutritional deficiencies, particularly iron deficiency. Objective: We comprehensively assessed the full spectrum of nutritional and nonnutritional factors associated with pregnancy anemia. Design: Iron, folate, vitamin B-12, and vitamin A were measured in serum in a cross-sectional study of 150 pregnant women in Blantyre, Malawi. Bone ma rrow aspirates were evaluated, peripheral blood films were examined for mal aria parasites, stool and urine samples were examined for helminthic infect ion, and tests were done for genetic disorders and for HIV infection. C-rea ctive protein (CRP) concentrations and erythrocyte sedimentation rates were measured as markers of inflammation. Results: Of the 150 anemic women, 23% were iron deficient with no evidence of folate, vitamin B-12, or vitamin A deficiencies; 32% were deficient in i ron and one or more of the other micronutrients; 26% were not iron deficien t but had evidence of one of the other micronutrient deficiencies, most oft en vitamin A; and 19% were not deficient in any of the micronutrients studi ed. CRP concentrations were notably high in 54% of the anemic women with no nutritional deficiencies and in 73.5% of the anemic women who were iron re plete by bone marrow assessment. Conclusion: The role of chronic inflammation as a possible contributing fac tor to anemia in pregnancy has important implications for the clinical eval uation and treatment of women.