Mlewa Stella C, Pei Lulu X, Sauer Cassandra, Farrell Colleen C, Kroeun Hou, Borath Mam, Green Tim J, Whitfield Kyly C, Karakochuk Crystal D
Food, Nutrition, and Health, The University of British Columbia, Vancouver, British Columbia, Canada.
BC Children's Hospital and Women's Health Research Institutes, Vancouver, British Columbia, Canada.
PLOS Glob Public Health. 2025 Jun 4;5(6):e0004650. doi: 10.1371/journal.pgph.0004650. eCollection 2025.
Iron deficiency (ID) prevalence has been consistently reported as low among non-pregnant women in Cambodia, but less is known about iron status during pregnancy. Assessing iron status during pregnancy is critical, as deficiency can increase the risk of adverse pregnancy outcomes. We assessed anemia, ID, and inflammation prevalence in a cohort of pregnant women in Cambodia. Venous blood from 90 pregnant women (12-32 weeks' gestation) was collected before the start of a 2016 trial conducted in Prey Veng province. Gestational age was recorded on the same day as blood collection. Hemoglobin was measured on a hematology autoanalyzer, and ferritin, α-1 acid glycoprotein (AGP), and C-reactive protein (CRP) concentrations were measured with a sandwich-ELISA. Ferritin concentrations are presented as unadjusted and inflammation-adjusted (based on AGP and CRP concentrations). ANOVA and post-hoc pairwise t-tests were used to compare variables across trimesters of pregnancy. Mean±SD age of women was 26 ± 5 years. Most women (94%) reported consumption of iron and folic acid (IFA) tablets during pregnancy (mean±SD: 85 ± 19 tablets), and 72% received deworming treatment. Overall, 49% of women had anemia (hemoglobin <110 g/L for first and third trimesters; < 105 g/L for second trimester); with 43%, 34%, and 64% in the first, second and third trimester, respectively. ID prevalence (unadjusted ferritin <30 µg/L) ranged widely by trimester: 0%, 17% and 76% in the first, second and third trimester, as well as with use of a lower ferritin threshold (0-52%; < 15 µg/L), and whether ferritin was inflammation-adjusted (61% with and 43% without adjustment; < 30 µg/L). ID prevalence was high among women in third trimester, despite high IFA compliance. These findings underscore the need to consider the trimester of pregnancy in anemia and ID assessment. More research is needed to determine if trimester-specific thresholds for ferritin in pregnant populations are warranted and whether ferritin should be adjusted for inflammation in pregnancy.
柬埔寨非孕期女性的缺铁（ID）患病率一直被报告为较低，但孕期铁状态的情况却鲜为人知。评估孕期铁状态至关重要，因为铁缺乏会增加不良妊娠结局的风险。我们评估了柬埔寨一组孕妇的贫血、ID和炎症患病率。在2016年干丹省开展的一项试验开始前，收集了90名孕妇（妊娠12 - 32周）的静脉血。妊娠周数在采血当天记录。血红蛋白在血液学自动分析仪上测量，铁蛋白、α-1酸性糖蛋白（AGP）和C反应蛋白（CRP）浓度用夹心酶联免疫吸附测定法测量。铁蛋白浓度以未调整和炎症调整后（基于AGP和CRP浓度）呈现。采用方差分析和事后两两t检验比较孕期各阶段的变量。女性的平均年龄±标准差为26±5岁。大多数女性（94%）报告在孕期服用了铁和叶酸（IFA）片（平均±标准差：85±19片），72%接受了驱虫治疗。总体而言，49%的女性患有贫血（妊娠第一和第三阶段血红蛋白<110 g/L；妊娠第二阶段<105 g/L）；第一、第二和第三阶段分别为43%、34%和64%。ID患病率（未调整的铁蛋白<30 μg/L）在孕期各阶段差异很大：第一、第二和第三阶段分别为0%、17%和76%，以及采用较低的铁蛋白阈值时（0 - 52%；<15 μg/L），无论铁蛋白是否进行炎症调整（调整后为61%，未调整为43%；<30 μg/L）。尽管IFA依从性较高，但妊娠第三阶段女性的ID患病率仍很高。这些发现强调了在贫血和ID评估中需要考虑妊娠阶段。需要更多研究来确定是否有必要为孕妇群体制定特定阶段的铁蛋白阈值，以及孕期铁蛋白是否应进行炎症调整。
