Quantifying differences in iron deficiency-attributable anemia during pregnancy and postpartum

Eliza M Davidson; Michelle J L Scoullar; Elizabeth Peach; Christopher J Morgan; Pele Melepia; D Herbert Opi; Hadlee Supsup; Priscah Hezeri; Wilson Philip; Dukduk Kabiu; Kerryanne Tokmun; Rose Suruka; Ruth Fidelis; Arthur Elijah; Peter M Siba; William Pomat; Benishar Kombut; Leanne J Robinson; Brendan S Crabb; Elissa Kennedy; Philippe Boeuf; Julie A Simpson; James G Beeson; Freya J I Fowkes

doi:10.1016/j.xcrm.2023.101097

Quantifying differences in iron deficiency-attributable anemia during pregnancy and postpartum

Cell Rep Med. 2023 Jul 18;4(7):101097. doi: 10.1016/j.xcrm.2023.101097. Epub 2023 Jul 5.

Authors

Eliza M Davidson¹, Michelle J L Scoullar², Elizabeth Peach³, Christopher J Morgan⁴, Pele Melepia⁵, D Herbert Opi⁶, Hadlee Supsup⁷, Priscah Hezeri⁵, Wilson Philip⁵, Dukduk Kabiu⁵, Kerryanne Tokmun⁵, Rose Suruka⁵, Ruth Fidelis⁵, Arthur Elijah⁸, Peter M Siba⁹, William Pomat¹⁰, Benishar Kombut¹¹, Leanne J Robinson¹², Brendan S Crabb³, Elissa Kennedy¹³, Philippe Boeuf³, Julie A Simpson¹⁴, James G Beeson¹⁵, Freya J I Fowkes¹⁶

Affiliations

¹ Burnet Institute, Melbourne, VIC, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.
² Burnet Institute, Melbourne, VIC, Australia; Department of Medicine, University of Melbourne, Melbourne, VIC, Australia.
³ Burnet Institute, Melbourne, VIC, Australia.
⁴ Burnet Institute, Melbourne, VIC, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia; John Hopkins Program for International Education in Gynecology and Obstetrics, Baltimore, MD, USA.
⁵ Burnet Institute, Kokopo, East New Britain, Papua New Guinea.
⁶ Burnet Institute, Melbourne, VIC, Australia; Department of Medicine, University of Melbourne, Melbourne, VIC, Australia; Department of Immunology, Monash University, Wellington Road, Melbourne, VIC, Australia.
⁷ Burnet Institute, Kokopo, East New Britain, Papua New Guinea; East New Britain Provincial Health Authority, Rabaul, East New Britain, Papua New Guinea.
⁸ School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea.
⁹ Centre for Health Research and Diagnostics, Divine Word University, Madang, Papua New Guinea.
¹⁰ Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
¹¹ Burnet Institute, Kokopo, East New Britain, Papua New Guinea; Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
¹² Burnet Institute, Melbourne, VIC, Australia; Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
¹³ Burnet Institute, Melbourne, VIC, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
¹⁴ Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.
¹⁵ Burnet Institute, Melbourne, VIC, Australia; Department of Medicine, University of Melbourne, Melbourne, VIC, Australia; Department of Immunology, Monash University, Wellington Road, Melbourne, VIC, Australia; Department of Microbiology, Monash University, Melbourne, VIC, Australia.
¹⁶ Burnet Institute, Melbourne, VIC, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia. Electronic address: [email protected].

Abstract

Pregnant women in resource-limited settings are highly susceptible to anemia and iron deficiency, but the etiology of postpartum anemia remains poorly defined. To inform the optimal timing for anemia interventions, changes in iron deficiency-attributable anemia through pregnancy and postpartum need to be understood. In 699 pregnant Papua New Guinean women attending their first antenatal care appointment and following up at birth and 6 and 12 months postpartum, we undertake logistic mixed-effects modeling to determine the effect of iron deficiency on anemia and population attributable fractions, calculated from odds ratios, to quantify the contribution of iron deficiency to anemia. Anemia is highly prevalent during pregnancy and 12 months postpartum, with iron deficiency increasing the odds of anemia during pregnancy and, to a lesser extent, postpartum. Iron deficiency accounts for ≥72% of anemia during pregnancy and 20%-37% postpartum. Early iron supplementation during and between pregnancies could break the cycle of chronic anemia in women of reproductive age.

Keywords: Papua New Guinea; anemia; iron deficiency; malaria; postpartum; pregnancy.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Anemia* / epidemiology
Anemia* / etiology
Anemia, Iron-Deficiency* / complications
Anemia, Iron-Deficiency* / epidemiology
Female
Humans
Infant, Newborn
Iron / therapeutic use
Iron Deficiencies*
Postpartum Period
Pregnancy

Substances

Iron