Public Health Nutrition

Special Groups

Predictors of anaemia and iron deficiency in HIV-infected pregnant women in Tanzania: a potential role for vitamin D and parasitic infections

Julia L Finkelsteina1a2a3 c1, Saurabh Mehtaa1, Christopher P Duggana2a4, Donna Spiegelmana3a5, Said Abouda6, Roland Kupkaa2a7, Gernard I Msamangaa8 and Wafaie W Fawzia2a3a9

a1 Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853, USA

a2 Department of Nutrition, Harvard School of Public Health, Boston, MA, USA

a3 Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA

a4 Division of GI/Nutrition, Children's Hospital Boston, MA, USA

a5 Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA

a6 Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania

a7 United Nations Children's Fund, Regional Office for West and Central Africa, Dakar, Senegal

a8 Department of Community Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania

a9 Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA


Objective Anaemia is common during pregnancy, and prenatal Fe supplementation is the standard of care. However, the persistence of anaemia despite Fe supplementation, particularly in HIV infection, suggests that its aetiology may be more complex and warrants further investigation. The present study was conducted to examine predictors of incident haematological outcomes in HIV-infected pregnant women in Tanzania.

Design Prospective cohort study. Cox proportional hazards and binomial regression models were used to identify predictors of incident haematological outcomes: anaemia (Hb < 110 g/l), severe anaemia (Hb < 85 g/l) and hypochromic microcytosis, during the follow-up period.

Setting Antenatal clinics in Dar es Salaam, Tanzania.

Subjects Participants were 904 HIV-infected pregnant women enrolled in a randomized trial of vitamins (1995–1997).

Results Malaria, pathogenic protozoan and hookworm infections at baseline were associated with a two-fold increase in the risk of anaemia and hypochromic microcytosis during follow-up. Higher baseline erythrocyte sedimentation rate and CD8 T-cell concentrations, and lower Hb concentrations and CD4 T-cell counts, were independent predictors of incident anaemia and Fe deficiency. Low baseline vitamin D (<32 ng/ml) concentrations predicted a 1·4 and 2·3 times greater risk of severe anaemia and hypochromic microcytosis, respectively, during the follow-up period.

Conclusions Parasitic infections, vitamin D insufficiency, low CD4 T-cell count and high erythrocyte sedimentation rate were the main predictors of anaemia and Fe deficiency in pregnancy and the postpartum period in this population. A comprehensive approach to prevent and manage anaemia, including micronutrient supplementation and infectious disease control, is warranted in HIV-infected women in resource-limited settings – particularly during the pre- and postpartum periods.

(Received December 05 2010)

(Accepted August 23 2011)

(Online publication October 04 2011)


c1 Corresponding author: Email