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The Association between Malaria and Iron Status or Supplementation in Pregnancy: A Systematic Review and Meta-Analysis

INTRODUCTION: Malaria prevention and iron supplementation are associated with improved maternal and infant outcomes. However, evidence from studies in children suggests iron may adversely modify the risk of malaria. We reviewed the evidence in pregnancy of the association between malaria and markers...

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Autores principales: Sangaré, Laura, van Eijk, Anna Maria, ter Kuile, Feiko O., Walson, Judd, Stergachis, Andy
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3925104/
https://www.ncbi.nlm.nih.gov/pubmed/24551064
http://dx.doi.org/10.1371/journal.pone.0087743
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author Sangaré, Laura
van Eijk, Anna Maria
ter Kuile, Feiko O.
Walson, Judd
Stergachis, Andy
author_facet Sangaré, Laura
van Eijk, Anna Maria
ter Kuile, Feiko O.
Walson, Judd
Stergachis, Andy
author_sort Sangaré, Laura
collection PubMed
description INTRODUCTION: Malaria prevention and iron supplementation are associated with improved maternal and infant outcomes. However, evidence from studies in children suggests iron may adversely modify the risk of malaria. We reviewed the evidence in pregnancy of the association between malaria and markers of iron status, iron supplementation or parenteral treatment. METHODS AND FINDINGS: We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, the Global Health Library, and the Malaria in Pregnancy library to identify studies that investigated the association between iron status, iron treatment or supplementation during pregnancy and malaria. Thirty one studies contributed to the analysis; 3 experimental and 28 observational studies. Iron supplementation was not associated with an increased risk of P. falciparum malaria during pregnancy or delivery in Africa (summary Relative Risk = 0.89, 95% Confidence Interval (CI) 0.66–1.20, I(2) = 78.8%, 5 studies). One study in Asia reported an increased risk of P. vivax within 30 days of iron supplementation (e.g. adjusted Hazard Ratio = 1.75, 95% CI 1.14–2.70 for 1–15 days), but not after 60 days. Iron deficiency (based on ferritin and C-reactive protein) was associated with lower odds for malaria infection (summary Odds Ratio = 0.35, 0.24–0.51, I(2) = 59.2%, 5 studies). With the exception of the acute phase protein ferritin, biomarkers of iron deficiency were generally not associated with malaria infection. CONCLUSIONS: Iron supplementation was associated with a temporal increase in P vivax, but not with an increased risk of P. falciparum; however, data are insufficient to rule out the potential for an increased risk of P. falciparum. Iron deficiency was associated with a decreased malaria risk in pregnancy only when measured with ferritin. Until there is more evidence, it is prudent to provide iron in combination with malaria prevention during pregnancy.
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spelling pubmed-39251042014-02-18 The Association between Malaria and Iron Status or Supplementation in Pregnancy: A Systematic Review and Meta-Analysis Sangaré, Laura van Eijk, Anna Maria ter Kuile, Feiko O. Walson, Judd Stergachis, Andy PLoS One Research Article INTRODUCTION: Malaria prevention and iron supplementation are associated with improved maternal and infant outcomes. However, evidence from studies in children suggests iron may adversely modify the risk of malaria. We reviewed the evidence in pregnancy of the association between malaria and markers of iron status, iron supplementation or parenteral treatment. METHODS AND FINDINGS: We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, the Global Health Library, and the Malaria in Pregnancy library to identify studies that investigated the association between iron status, iron treatment or supplementation during pregnancy and malaria. Thirty one studies contributed to the analysis; 3 experimental and 28 observational studies. Iron supplementation was not associated with an increased risk of P. falciparum malaria during pregnancy or delivery in Africa (summary Relative Risk = 0.89, 95% Confidence Interval (CI) 0.66–1.20, I(2) = 78.8%, 5 studies). One study in Asia reported an increased risk of P. vivax within 30 days of iron supplementation (e.g. adjusted Hazard Ratio = 1.75, 95% CI 1.14–2.70 for 1–15 days), but not after 60 days. Iron deficiency (based on ferritin and C-reactive protein) was associated with lower odds for malaria infection (summary Odds Ratio = 0.35, 0.24–0.51, I(2) = 59.2%, 5 studies). With the exception of the acute phase protein ferritin, biomarkers of iron deficiency were generally not associated with malaria infection. CONCLUSIONS: Iron supplementation was associated with a temporal increase in P vivax, but not with an increased risk of P. falciparum; however, data are insufficient to rule out the potential for an increased risk of P. falciparum. Iron deficiency was associated with a decreased malaria risk in pregnancy only when measured with ferritin. Until there is more evidence, it is prudent to provide iron in combination with malaria prevention during pregnancy. Public Library of Science 2014-02-14 /pmc/articles/PMC3925104/ /pubmed/24551064 http://dx.doi.org/10.1371/journal.pone.0087743 Text en © 2014 Sangaré et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
Sangaré, Laura
van Eijk, Anna Maria
ter Kuile, Feiko O.
Walson, Judd
Stergachis, Andy
The Association between Malaria and Iron Status or Supplementation in Pregnancy: A Systematic Review and Meta-Analysis
title The Association between Malaria and Iron Status or Supplementation in Pregnancy: A Systematic Review and Meta-Analysis
title_full The Association between Malaria and Iron Status or Supplementation in Pregnancy: A Systematic Review and Meta-Analysis
title_fullStr The Association between Malaria and Iron Status or Supplementation in Pregnancy: A Systematic Review and Meta-Analysis
title_full_unstemmed The Association between Malaria and Iron Status or Supplementation in Pregnancy: A Systematic Review and Meta-Analysis
title_short The Association between Malaria and Iron Status or Supplementation in Pregnancy: A Systematic Review and Meta-Analysis
title_sort association between malaria and iron status or supplementation in pregnancy: a systematic review and meta-analysis
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3925104/
https://www.ncbi.nlm.nih.gov/pubmed/24551064
http://dx.doi.org/10.1371/journal.pone.0087743
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