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HELICOBACTER PYLORI INFECTION IS ASSOCIATED WITH SEVERE ANEMIA OF PREGNANCY ON PEMBA ISLAND, ZANZIBAR

Helicobacter pylori infection has recently been associated with iron deficiency and anemia in developed countries. To determine the association of H. pylori and anemia in a tropical region, we measured hemoglobin concentration (Hb) and H. pylori infection by the ¹³C urea breath test among 857 pregnant women attending antenatal care clinics. Parasitology, anthropometry, obstetric history, sociodemographic and dietary variables were also assessed. Logistic regression showed an odds ratio of 7.63 (95% confidence interval = 1.73–33.55) for H. pylori infection comparing women with and without severe anemia (Hb < 7 g/dL), controlling for hookworm infection, body mass index and parity, but only among women with a diet low in foods containing heme iron. Infection with H. pylori with low bacterial load was associated with lower Hb concentration while high bacterial load was associated with higher Hb concentration. Further research is needed to establish causality because high worldwide prevalence means that even a small associated risk would be of public health significance.

Received August 1, 2006. Accepted for publication November 24, 2006.

Acknowledgments: We thank the women who participated in the study. Tamer H. Farag designed and implemented the study, interpreted the results, and wrote the manuscript. Tamer H. Farag and James M. Tielsch performed the analysis. Rebecca J. Stoltzfus and James M. Tielsch participated in study design, project planning, interpretation of results, and manuscript review. Sabra S. Khalfan participated in the design and implementation of the data collection and field management systems and manuscript review. As the senior investigator, James M. Tielsch oversaw all aspects of the study.

Financial support: This study was supported by a grant from the Bill and Melinda Gates Foundation. Meretek Diagnostics, Inc. (Nashville, TN) loaned us the UBiT-IR300 portable infrared spectrophotometer and provided the ¹³C-labeled urea test kits at cost.

Disclosure: None of the authors had a conflict of interest.

^* Address correspondence to Tamer H. Farag, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Room W5009, Baltimore, MD, 21205. E-mail: tfarag{at}jhsph.edu

Authors’ addresses: Tamer H. Farag and James M. Tielsch, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Room W5009, Baltimore, MD, 21205, Telephone: 410-236-4280, Fax: 410-955-2029, E-mails: tfarag{at}jhsph.edu and jtielsch{at}jhsph.edu. Rebecca J. Stoltzfus, Division of Nutritional Sciences, Cornell University, 120 Savage Hall, Ithaca, NY 14853, Telephone: 607-255-7671, Fax: 607-255-1033, E-mail: rjs62{at}ycornell.edu. Sabra S. Khalfan, Public Health Laboratory–Ivo de Carneri, Chake-Chake, Pemba Island, Zanzibar, Tanzania, Telephone: 255-777-424690, E-mail: sskhalfan2003{at}yahoo.com.