Maternal Anemia in Pregnancy: Assessing the Effect of Routine Preventive Measures in a Malaria-Endemic Area

Smaïla Ouédraogo Unité Mixte de Recherche 216, Mère et Enfant Face aux Infections Tropicales, Paris, France; Faculté des Sciences de la Santé, Cotonou, Benin; Faculté de Pharmacie, Université Paris Descartes, Paris, France; Ecole des Hautes Etudes en Santé Publique, Rennes, France

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Ghislain K. Koura Unité Mixte de Recherche 216, Mère et Enfant Face aux Infections Tropicales, Paris, France; Faculté des Sciences de la Santé, Cotonou, Benin; Faculté de Pharmacie, Université Paris Descartes, Paris, France; Ecole des Hautes Etudes en Santé Publique, Rennes, France

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Florence Bodeau-Livinec Unité Mixte de Recherche 216, Mère et Enfant Face aux Infections Tropicales, Paris, France; Faculté des Sciences de la Santé, Cotonou, Benin; Faculté de Pharmacie, Université Paris Descartes, Paris, France; Ecole des Hautes Etudes en Santé Publique, Rennes, France

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Manfred M. K. Accrombessi Unité Mixte de Recherche 216, Mère et Enfant Face aux Infections Tropicales, Paris, France; Faculté des Sciences de la Santé, Cotonou, Benin; Faculté de Pharmacie, Université Paris Descartes, Paris, France; Ecole des Hautes Etudes en Santé Publique, Rennes, France

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Achille Massougbodji Unité Mixte de Recherche 216, Mère et Enfant Face aux Infections Tropicales, Paris, France; Faculté des Sciences de la Santé, Cotonou, Benin; Faculté de Pharmacie, Université Paris Descartes, Paris, France; Ecole des Hautes Etudes en Santé Publique, Rennes, France

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Michel Cot Unité Mixte de Recherche 216, Mère et Enfant Face aux Infections Tropicales, Paris, France; Faculté des Sciences de la Santé, Cotonou, Benin; Faculté de Pharmacie, Université Paris Descartes, Paris, France; Ecole des Hautes Etudes en Santé Publique, Rennes, France

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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.

Author Notes

* Address correspondence to Smaïla Ouédraogo, Unité Mixte de Recherche 216, Mère et Enfant Face aux Infections Tropicales/Faculté des Sciences de la Santé, 4, avenue de l'Observatoire, 75270 Paris, France. E-mail: smaila11@yahoo.fr

Financial support: The study was supported by the Malaria in Pregnancy (MiP) Consortium, which is funded through a grant from the Bill and Melinda Gates Foundation to the Liverpool School of Tropical Medicine. The Malaria in Pregnancy Preventive Alternative Drugs (MiPPAD) trial is cofunded by the European and Developing Countries Clinical Trials Partnership (EDCTP-IP.07.31080.002). We also thank the MiPPAD executive committee and MiPc reviewers for valuable input in this work. S.O. was supported by an Institut de Recherche pour le Développement (IRD) grant while writing this paper.

Authors' addresses: Smaïla Ouédraogo, Unité Mixte de Recherche, Mère et Enfant Face aux Infections Tropicales/Faculté des Sciences de la Santé, Paris, France, E-mail: smaila11@yahoo.fr. Ghislain K. Koura and Michel Cot, Unité Mixte de Recherche, Mère et Enfant Face aux Infections Tropicales, Paris, France, and Faculté de Pharmacie, Université Paris Descartes, Paris, France, E-mails: kourakobtoghislain@yahoo.fr and michel.cot@ird.fr. Florence Bodeau-Livinec, Ecole des Hautes Etudes en Santé Publique, Rennes, France, E-mail: Florence.Bodeau-Livinec@ehesp.fr. Manfred M. K. Accrombessi and Achille Massougbodji, Faculté des Sciences de la Santé, Cotonou, Benin, E-mails: accrombessimanfred@yahoo.fr and massougbodjiachille@yahoo.fr.

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