Odhiambo Collins, Zeh Clement, Angira Frank, Opollo Valarie, Akinyi Brenda, Masaba Rose, Williamson John M, Otieno Juliana, Mills Lisa A, Lecher Shirley Lee, Thomas Timothy K
Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.
Centers for Disease Control and Prevention, Kisumu, Kenya.
Trop Med Int Health. 2016 Mar;21(3):373-84. doi: 10.1111/tmi.12662. Epub 2016 Jan 22.
The prevalence of anaemia during pregnancy is estimated to be 35-75% in sub-Saharan Africa and is associated with an increased risk of maternal mortality. We evaluated the frequency and factors associated with anaemia in HIV-infected women undergoing antiretroviral (ARV) therapy for prevention of mother-to-child transmission (PMTCT) enrolled in The Kisumu Breastfeeding Study 2003-2009.
Maternal haematological parameters were monitored from 32 to 34 weeks of gestation to 2 years post-delivery among 522 enrolled women. Clinical and laboratory assessments for causes of anaemia were performed, and appropriate management was initiated. Anaemia was graded using the National Institutes of Health Division of AIDS 1994 Adult Toxicity Tables. Data were analysed using SAS software, v 9.2. The Wilcoxon two-sample rank test was used to compare groups. A logistic regression model was fitted to describe the trend in anaemia over time.
At enrolment, the prevalence of any grade anaemia (Hb < 9.4 g/dl) was 61.8%, but fell during ARV therapy, reaching a nadir (7.4%) by 6 months post-partum. A total of 41 women (8%) developed severe anaemia (Hb < 7 g/dl) during follow-up; 2 (4.9%) were hospitalised for blood transfusion, whereas 3 (7.3%) were transfused while hospitalised (for delivery). The greatest proportion of severe anaemia events occurred around delivery (48.8%; n = 20). Anaemia (Hb ≥ 7 and < 9.4 g/dl) at enrolment was associated with severe anaemia at delivery (OR 5.87; 95% CI: 4.48, 7.68, P < 0.01). Few cases of severe anaemia coincided with clinical malaria (24.4%; n = 10) and helminth (7.3%; n = 3) infections.
Resolution of anaemia among most participants during study follow-up was likely related to receipt of ARV therapy. Efforts should be geared towards addressing common causes of anaemia in HIV-infected pregnant women, prioritising initiation of ARV therapy and management of peripartum blood loss.
据估计，撒哈拉以南非洲地区孕期贫血患病率为35%-75%，且与孕产妇死亡风险增加相关。我们评估了参加2003-2009年基苏木母乳喂养研究的接受抗逆转录病毒（ARV）治疗以预防母婴传播（PMTCT）的HIV感染女性中贫血的发生频率及相关因素。
对522名入组女性从妊娠32至34周直至产后2年进行孕产妇血液学参数监测。针对贫血原因进行临床和实验室评估，并启动适当治疗。使用美国国立卫生研究院艾滋病司1994年成人毒性表对贫血进行分级。数据采用SAS软件v 9.2进行分析。采用Wilcoxon两样本秩和检验比较组间差异。拟合逻辑回归模型以描述贫血随时间的变化趋势。
入组时，任何级别贫血（血红蛋白<9.4 g/dl）的患病率为61.8%，但在ARV治疗期间有所下降，产后6个月降至最低点（7.4%）。共有41名女性（8%）在随访期间出现严重贫血（血红蛋白<7 g/dl）；2名（4.9%）因输血住院，3名（7.3%）在住院（分娩）期间接受输血。严重贫血事件的最大比例发生在分娩前后（48.8%；n = 20）。入组时贫血（血红蛋白≥7且<9.4 g/dl）与分娩时严重贫血相关（比值比5.87；95%置信区间：4.48, 7.68，P<0.01）。少数严重贫血病例与临床疟疾（24.4%；n = 10）和蠕虫感染（7.3%；n = 3）同时发生。
在研究随访期间，大多数参与者贫血症状的缓解可能与接受ARV治疗有关。应努力解决HIV感染孕妇贫血的常见原因，优先启动ARV治疗并处理围产期失血情况。
