HIV and other predictors of serum folate, serum ferritin, and hemoglobin in pregnancy: a cross-sectional study in Zimbabwe

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Abstract
Background: Folate and iron status and hemoglobin concentrations are important to maternal and infant health. Objective: Our goal was to identify predictors of serum folate, serum ferritin, and hemoglobin. Design: This was a cross-sectional study of 1669 pregnant women (22–35 wk of gestation) in Harare, Zimbabwe, who were receiving prenatal care. The statistical effects of age, season, gestational age, gravidity, HIV-1 infection, malaria parasitemia, and serum α1-antichymotrypsin (ACT) on serum folate, serum ferritin (log10 transformed), and hemoglobin were estimated by using multiple linear regression analyses. Results: Serum folate (x̄: 11.4 μmol/L) was 0.52-nmol/L (95% CI: 0.04, 1.0) lower in HIV-infected women than in uninfected women and 0.65-nmol/L (0.014, 1.28) lower in weeks 25–35 than in weeks 22–25. Serum ferritin (geometric x̄: 11.6 μg/L) was 0.93 times (0.86, 0.99) lower in HIV-infected women and 2.25 times (1.41, 3.61) higher in women with malaria parasitemia than in uninfected women. Similarly, serum ferritin was 0.71 times (0.63, 0.79) higher in weeks 32–35 than in weeks 22–25 and 1.21 times (1.12, 1.29) higher in gravida ≥3 than in gravida 1. Elevated serum ACT was a strong predictor of serum folate, serum ferritin, and hemoglobin. HIV infection was associated with a 12.9-g/L (8.9, 16.8) lower hemoglobin concentration in women with nondepleted iron stores but low serum retinol and a 7–8-g/L lower hemoglobin concentration in women with other combinations of serum ferritin and retinol (P for interaction = 0.038). Season, age, gestational age, and gravidity were not significant predictors of hemoglobin. Low serum folate, ferritin, and retinol were associated with low hemoglobin. Conclusions: HIV was associated with lower serum folate, serum ferritin, and hemoglobin. HIV infection was also associated with lower hemoglobin, particularly in women with stored iron and low serum retinol. Low serum folate, ferritin, and retinol were associated with low hemoglobin.