HIV and other predictors of serum folate, serum ferritin, and hemoglobin in pregnancy: a cross-sectional study in Zimbabwe

Background: Folate and iron status and hemoglobin concentrations are import ant to maternal and infant health. Objective: Our goal was to identify predictors of serum folate, serum ferri tin, and hemoglobin. Design: This was a cross-sectional study of 1669 pregnant women (22-35 wk o f gestation) in Harare, Zimbabwe, who were receiving prenatal care. The sta tistical effects of age, season, gestational age, gravidity, HIV-1 infectio n, malaria parasitemia, and serum alpha (1)-antichymotrypsin (ACT) on serum folate, serum ferritin (log,, transformed), and hemoglobin were estimated by using multiple linear regression analyses. Results: Serum folate ((x) over bar: 11.4 mu mol/L) was 0.52-nmol/L (95% CI : 0.04, 1.0) lower in HIV-infected women than in uninfected women and 0.65- nmol/L (0.014, 1.28) lower in weeks 25-35 than in weeks 22-25. Serum ferrit in (geometric x: 11.6 mug/L) was 0.93 times (0.86, 0.99) lower in HIV-infec ted women and 2.25 times (1.41, 3.61) higher in women with malaria parasite mia than in uninfected women. Similarly, serum ferritin was 0.71 times (0.6 3, 0.79) higher in weeks 32-35 than in weeks 22-25 and 1.21 times (1.12, 1. 29) higher in gravida greater than or equal to3 than in gravida 1. Elevated serum ACT was a strong predictor of serum folate, serum ferritin, and hemo globin. HIV infection was associated with a 12.9-g/L (8.9, 16.8) lower hemo globin concentration in women with nondepleted iron stores but low serum re tinol and a 7-8-g/L lower hemoglobin concentration in women with other comb inations of serum ferritin and retinol (P for interaction = 0.038). Season, age, gestational age, and gravidity were not significant predictors of hem oglobin. Low serum folate, ferritin, and retinol were associated with low h emoglobin. Conclusions: HIV was associated with lower serum folate, serum ferritin, an d hemoglobin. HIV infection was also associated with lower hemoglobin, part icularly in women with stored iron and low serum retinol. Low serum folate, ferritin, and retinol were associated with low hemoglobin.