Volume 88, Issue 2
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



We investigated the effectiveness of routine preventive measures for anemia in Beninese pregnant women during pregnancy. Anemia (hemoglobin < 110 g/L) was common: 68.3% at first antenatal visit (ANV1), 64.7% at second antenatal visit (ANV2), and 40.6% at delivery. Parasitic infections and nutritional deficiencies were the most preventable causes. After intermittent preventive treatment (IPTp) and antihelminthic treatments, malaria prevalence decreased from 15.1% (ANV1) to 4.0% (ANV2) and increased again to 9.6% at delivery. Helminth infections dropped from 11.1% (ANV1) to 7.2% (ANV2) and 2.4% at delivery. Malaria was associated with lower mean hemoglobin on ANV1 and delivery, and iron deficiency was associated with lower mean hemoglobin on ANV1 and ANV2. IPTp and antihelminthic treatments were efficacious to clear parasitic infections and improve hematologic status, whereas the effectiveness of daily iron and folic acid supplements to correct iron and folate deficiencies and decrease anemia was less marked, possibly because of lack of compliance.


Article metrics loading...

Loading full text...

Full text loading...



  1. WHO, 2001. Iron Deficiency Anaemia Assessment, Prevention, and Control. A Guide for Programme Managers. Geneva, Switzerland: WHO.
  2. McLean E, Cogswell M, Egli I, Wojdyla D, de Benoist B, , 2009. Worldwide prevalence of anaemia, WHO Vitamin and Mineral Nutrition Information System, 1993–2005. Public Health Nutr 12: 444454.[Crossref]
  3. Stoltzfus RJ, , 2003. Iron deficiency: global prevalence and consequences. Food Nutr Bull 24: S99S103.[Crossref]
  4. Bodeau-Livinec F, Briand V, Berger J, Xiong X, Massougbodji A, Day KP, Cot M, , 2011. Maternal anemia in Benin: prevalence, risk factors, and association with low birth weight. Am J Trop Med Hyg 85: 414420.[Crossref]
  5. van den Broek N, , 1998. Anaemia in pregnancy in developing countries. Br J Obstet Gynaecol 105: 385390.[Crossref]
  6. Tolentino K, Friedman JF, , 2007. An update on anemia in less developed countries. Am J Trop Med Hyg 77: 4451.
  7. Balarajan Y, Ramakrishnan U, Ozaltin E, Shankar AH, Subramanian SV, , 2011. Anaemia in low-income and middle-income countries. Lancet 378: 21232135.[Crossref]
  8. Ouédraogo S, Koura GK, Accrombessi MMK, Bodeau-Livinec F, Massougbodji A, Cot M, , 2012. Maternal anaemia at first antenatal visit: prevalence and risk factors in a malaria endemic area in Benin. Am J Trop Med Hyg, 87: 418424.[Crossref]
  9. Stephansson O, Dickman PW, Johansson A, Cnattingius S, , 2000. Maternal hemoglobin concentration during pregnancy and risk of stillbirth. JAMA 284: 26112617.[Crossref]
  10. Xiong X, Buekens P, Fraser WD, Guo Z, , 2003. Anemia during pregnancy in a Chinese population. Int J Gynaecol Obstet 83: 159164.[Crossref]
  11. De Maeyer EM, , 1989. Preventing and Controlling Iron Deficiency Through Primary Care. Geneva, Switzerland: WHO.
  12. WHO, 2000. WHO Expert Committee on Malaria. Twentieth Report. Geneva, Switzerland: WHO.
  13. WHO, 2009. Weekly Iron-Folic Acid Supplementations (WIFS) in Women of Reproductive Age: Its Role in Promoting Optimal Maternal and Child Health Position Statement. Geneva, Switzerland: WHO.
  14. Ndibazza J, Muhangi L, Akishule D, Kiggundu M, Ameke C, Oweka J, Kizindo R, Duong T, Kleinschmidt I, Muwanga M, Elliott AM, , 2010. Effects of deworming during pregnancy on maternal and perinatal outcomes in Entebbe, Uganda: a randomized controlled trial. Clin Infect Dis 50: 531540.[Crossref]
  15. Kabyemela ER, Fried M, Kurtis JD, Mutabingwa TK, Duffy PE, , 2008. Decreased susceptibility to Plasmodium falciparum infection in pregnant women with iron deficiency. J Infect Dis 198: 163166.[Crossref]
  16. Beaton GH, , 2000. Iron needs during pregnancy: do we need to rethink our targets? Am J Clin Nutr 72: 265S271S.
  17. Milman N, , 2008. Prepartum anaemia: prevention and treatment. Ann Hematol 949: 959.
  18. Chesley LC, , 1972. Plasma and red cell volumes during pregnancy. Am J Obstet Gynecol 112: 440450.[Crossref]
  19. Hytten F, , 1985. Blood volume changes in normal pregnancy. Clin Haematol 14: 601612.
  20. Menendez C, Fleming AF, Alonso PL, , 2000. Malaria-related anaemia. Parasitol Today 16: 469476.[Crossref]
  21. Jennifer LS, Simon B, , 2010. Impact of hookworm infection and deworming on anaemia in non-pregnant populations: a systematic review. Trop Med Int Health 15: 776795.[Crossref]
  22. Stoltzfus RJ, Dreyfuss ML, , 1998. Guidelines for the Use of Iron Supplements to Prevent and Treat Iron Deficiency Anemia. Washington, DC: International Life Sciences Institute Press.
  23. Menendez C, Bardaji A, Sigauque B, Romagosa C, Sanz S, Serra-Casas E, Macete E, Berenguera A, David C, Dobano C, Naniche D, Mayor A, Ordi J, Mandomando I, Aponte JJ, Mabunda S, Alonso PL, , 2008. A randomized placebo-controlled trial of intermittent preventive treatment in pregnant women in the context of insecticide treated nets delivered through the antenatal clinic. PLoS One 3: e1934.[Crossref]
  24. Kayentao K, Kodio M, Newman RD, Maiga H, Doumtabe D, Ongoiba A, Coulibaly D, Keita AS, Maiga B, Mungai M, Parise ME, Doumbo O, , 2005. Comparison of intermittent preventive treatment with chemoprophylaxis for the prevention of malaria during pregnancy in Mali. J Infect Dis 191: 109116.[Crossref]
  25. Tukur IU, Thacher TD, Sagay AS, Madaki JK, , 2007. A comparison of sulfadoxine-pyrimethamine with chloroquine and pyrimethamine for prevention of malaria in pregnant Nigerian women. Am J Trop Med Hyg 76: 10191023.
  26. ter Kuile FO, van Eijk AM, Filler SJ, , 2007. Effect of sulfadoxine-pyrimethamine resistance on the efficacy of intermittent preventive therapy for malaria control during pregnancy: a systematic review. JAMA 297: 26032616.[Crossref]
  27. Huynh BT, Fievet N, Gbaguidi G, Dechavanne S, Borgella S, Guezo-Mevo B, Massougbodji A, Ndam NT, Deloron P, Cot M, , 2011. Influence of the timing of malaria infection during pregnancy on birth weight and on maternal anemia in Benin. Am J Trop Med Hyg 85: 214220.[Crossref]
  28. Faucher JF, Aubouy A, Adeothy A, Cottrell G, Doritchamou J, Gourmel B, Houze P, Kossou H, Amedome H, Massougbodji A, Cot M, Deloron P, , 2009. Comparison of sulfadoxine-pyrimethamine, unsupervised artemether-lumefantrine, and unsupervised artesunate-amodiaquine fixed-dose formulation for uncomplicated Plasmodium falciparum malaria in Benin: a randomized effectiveness noninferiority trial. J Infect Dis 200: 5765.[Crossref]
  29. Bertin G, Briand V, Bonaventure D, Carrieu A, Massougbodji A, Cot M, Deloron P, , 2011. Molecular markers of resistance to sulphadoxine-pyrimethamine during intermittent preventive treatment of pregnant women in Benin. Malar J 10: 196.[Crossref]
  30. WHO, 1989. Preventing and Controlling Iron Deficiency Anaemia Through Primary Health Care. A Guide for Health Administrators and Programme Managers. Geneva, Switzerland: WHO.
  31. Widdowson EM, Spray CM, , 1951. Chemical development in utero . Arch Dis Child 26: 205214.[Crossref]
  32. Kuizon MD, Desnacido JA, Placon CP, Ancheta LD, Macapinlac MP, , 1983. Iron supplementation using different dose levels in prenant Phillipinois. Nutr Res 3: 257264.[Crossref]
  33. Makrides M, Crowther CA, Gibson RA, Gibson RS, Skeaff CM, , 2003. Efficacy and tolerability of low-dose iron supplements during pregnancy: a randomized controlled trial. Am J Clin Nutr 78: 145153.
  34. Milman N, Bergholt T, Eriksen L, Byg K-E, Graudal N, Pedersen P, Hertz J, , 2005. Iron prophylaxis during pregnancy—how much iron is needed? A randomised, controlled study of 20 to 80 mg ferrous iron daily to pregnant women. Acta Obstet Gynecol Scand 84: 238247.[Crossref]
  35. Menendez C, Todd J, Alonso P, Francis N, Lulat S, Ceesay S, M'boge B, Greenwood B, , 1994. The effects of iron supplementation during pregnancy, given by traditional birth attendants, on the prevalence of anaemia and malaria. Trans R Soc Trop Med Hyg 88: 590593.[Crossref]
  36. Zavaleta N, Caulfield LE, Garcia T, , 2000. Changes in iron status during pregnancy in Peruvian women receiving prenatal iron and folic acid supplements with or without zinc. Am J Clin Nutr 71: 956961.
  37. Bonnar J, Goldberg A, Smith JA, , 1969. Do pregnant women take their iron? Lancet 1: 457458.[Crossref]
  38. Habib F, Alabdin EH, Alenazy M, Nooh R, , 2009. Compliance to iron supplementation during pregnancy. J Obstet Gynaecol 29: 487492.[Crossref]
  39. Seck BC, Jackson RT, , 2008. Determinants of compliance with iron supplementation among pregnant women in Senegal. Public Health Nutr 11: 596605.[Crossref]
  40. Pena-Rosas JP, Viteri FE, , 2009. Effects and safety of preventive oral iron or iron+folic acid supplementation for women during pregnancy. Cochrane Database Syst Rev 4: CD004736.

Data & Media loading...

  • Received : 27 Mar 2012
  • Accepted : 29 Jul 2012

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error