Ringshaw Jessica E, Zieff Michal R, Williams Sadeeka, Jacobs Chloë A, Goolam Nabi Zayaan, Mazubane Thandeka, Miles Marlie, Herr Donna, Alexander Daniel C, Gladstone Melissa, Klepac-Ceraj Vanja, Gabard-Durnam Laurel J, Amso Dima, Fifer William P, Jones Derek K, Stein Dan J, Williams Steven C R, Donald Kirsten A
Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.
Neuroscience Institute, University of Cape Town, Cape Town, South Africa.
PLOS Glob Public Health. 2025 Jul 9;5(7):e0004174. doi: 10.1371/journal.pgph.0004174. eCollection 2025.
The scarcity of epidemiological data on anaemia in low- and middle-income countries, coupled with contrasting approaches to the assessment of iron status with inflammation, represent critical research gaps. This study characterised the prevalence and profile of iron deficiency anaemia, including adjustment for inflammation, in mothers and infants from South Africa. Mother-child dyads (n = 394) were recruited (2021-2022) for the Khula birth cohort in Cape Town. Haematological metrics, iron metrics, and inflammatory biomarkers were obtained from mothers antenatally and 3-6 months postnatally, and infants 3-18 months postnatally. The extent to which inflammation impacted iron deficiency was assessed using two methods; Method A: higher serum ferritin thresholds for classifying iron status in participants with inflammation (World Health Organisation), Method B: Biomarkers Reflecting Inflammation and Nutritional Determinants of Anaemia (BRINDA) regression which corrects serum ferritin based on inflammatory biomarker concentrations. Prevalence of maternal anaemia was 34.74% (107/308) in pregnancy and 22.50% (54/240) in mothers at 3-6 months after childbirth. Of their infants, 46.82% (125/267) and 48.10% (136/283) were anaemic by 6-12 months and 12-18 months, respectively. Using Method A, the prevalence of maternal iron deficiency (regardless of anaemia), increased from 18.35% (20/109) to 55.04% (60/109) in pregnancy, and from 11.97% (28/234) to 46.58% (109/234) postnatally. Similarly, using Method B, maternal iron deficiency prevalence increased to 38.53% (42/109) in pregnancy, and 25.21% (59/234) postnatally. In infants at 12-18 months, the prevalence of iron deficiency increased from 19.79% (19/96) to 31.25% (30/96) and 32.29% (31/96) using Methods A and B, respectively. Approximately half of anaemia cases in mothers antenatally (50%; 20/40) and postnatally (45.10%; 23/51), and infants at 12-18 months (55.56%; 10/18), were attributable to iron deficiency. This is one of the first studies reporting the extent to which iron deficiency anaemia may be underestimated if inflammation is unaccounted for in South African mothers and infants.
低收入和中等收入国家贫血的流行病学数据匮乏，再加上评估伴有炎症的铁状态的方法存在差异，这些都是关键的研究空白。本研究对南非母亲和婴儿缺铁性贫血的患病率及特征进行了描述，包括对炎症因素的校正。母婴二元组（n = 394）于2021年至2022年被招募进入开普敦的库拉出生队列研究。从母亲产前以及产后3至6个月，以及婴儿产后3至18个月获取血液学指标、铁指标和炎症生物标志物。使用两种方法评估炎症对缺铁的影响程度；方法A：对伴有炎症的参与者（世界卫生组织）采用更高的血清铁蛋白阈值来分类铁状态，方法B：反映炎症和贫血营养决定因素的生物标志物（BRINDA）回归，该方法根据炎症生物标志物浓度校正血清铁蛋白。母亲贫血的患病率在孕期为34.74%（107/308），产后3至6个月时为22.50%（54/240）。她们的婴儿在6至12个月和12至18个月时贫血的患病率分别为46.82%（125/267）和48.10%（136/283）。采用方法A，母亲缺铁（无论是否贫血）的患病率在孕期从18.35%（20/109）增至55.04%（60/109），产后从11.97%（28/234）增至46.58%（109/234）。同样，采用方法B，母亲缺铁患病率在孕期增至38.53%（42/109），产后为25.21%（59/234）。在12至18个月的婴儿中，采用方法A和方法B时缺铁患病率分别从19.79%（19/96）增至31.25%（30/96）和32.29%（31/96）。母亲产前（50%；20/40）和产后（45.10%；23/51）以及12至18个月婴儿（55.56%；10/18）中，约一半的贫血病例可归因于缺铁。这是首批报告之一，指出在南非母亲和婴儿中，如果不考虑炎症因素，缺铁性贫血可能被低估的程度。
