Anaemia at mid-pregnancy is associated with prehypertension in late pregnancy among urban women.

Background: Antenatal iron deficiency and anaemia are associated with gestational hypertension and diabetes mellitus, but so are elevated iron stores and haemoglobin. In South Africa, pregnant women receive routine iron supplementation regardless of iron status. Aim: This study aimed to assess associations of antenatal iron status and anaemia with blood pressure in pregnant women in urban South Africa. Secondary to this, associations with heart rate, fasting glucose and glucose tolerance were also investigated. Setting: Johannesburg, South Africa. Methods: A total of 250 pregnant women, aged 27 (24-32) years, were recruited using consecutive sampling. The authors measured biomarkers of iron status and anaemia at < 18 and ± 22 weeks', blood pressure and heart rate at ± 36 weeks', and fasting glucose and glucose tolerance between 24 and 28 weeks' gestation. Associations were determined using multivariable regression models adjusted for confounders. Results: The odds of prehypertension in late pregnancy among women with anaemia at ± 22 weeks' gestation were three times higher than among women without anaemia (odds ratio [OR]: 3.01, 95% confidence interval [CI]: 1.22, 7.42). Participants with anaemia at ± 22 weeks' gestation had 2.15 times higher odds of having elevated mean arterial pressure than women without anaemia (OR: 2.15, 95% CI: 1.01, 4.60). Conclusion: Anaemia at mid-pregnancy could be a predictor of hypertensive disorders in pregnancy. The cause of antenatal anaemia may need further investigation apart from iron deficiency. The effective management of anaemia in pregnant women living in urban South Africa remains a challenge. Contribution: This study provides evidence about the health impact of pregnant women regarding antenatal supplementation practices in South Africa.

Urinary bacterial profile and antibiotic susceptibility pattern among pregnant women in Rahima Moosa Mother and Child Hospital, Johannesburg.

BACKGROUND: Urinary tract infection (UTI) in pregnancy is associated with significant morbidity for both the mother and the foetus. The aim of this study was to determine the prevalence of UTI, urinary bacterial susceptibility, and resistance patterns among pregnant women with a possible UTI at Rahima Moosa Mother and Child Hospital (RMMCH) in Johannesburg. METHODS: In this retrospective study, we analysed mid-stream urine culture and antibiotic susceptibility data from both inpatients and outpatients of pregnant women who attended RMMCH from January 2017 to December 2017. Data were collected from patients' files and then matched with urine microscopy, sensitivity and culture (MC&S) results from the National Health Laboratory Services (NHLS) data. RESULTS: Urine microscopy, cultures and sensitivities were performed on 1984 specimens belonging to pregnant women who presented with symptoms and/or signs of a UTI. A total of 333 patients (16.8%) had positive bacterial cultures. Escherichia coli (E. coli) was the commonest bacterial isolate (49.9%). Other microorganisms isolated included Klebsiella species (14.4%), Enterococcus faecalis (12.9%) and coagulase-negative staphylococci (CoNS); (8.9%). Approximately 98% of organisms were sensitive to cephalexin. Cefuroxime (95.2%), ceftriaxone/cefotaxime (94.4%) and nitrofurantoin (81.9%) demonstrated antimicrobial effectiveness as indicated. Most isolates were resistant to ampicillin/amoxicillin (84.4%), Trimethoprim/Sulfamethoxazole (55.6%) and amoxicillin-clavulanic acid (50.2%). CONCLUSION: E. coli was the commonest pathogen causing UTIs in pregnancy with Enterococcus faecalis increasing in prevalence. The choice of antimicrobial therapy in pregnancy should be determined according to sensitivity and resistance and foeto-maternal safety.

Maternal iron-deficiency is associated with premature birth and higher birth weight despite routine antenatal iron supplementation in an urban South African setting: The NuPED prospective study.

BACKGROUND: Recent studies are suggesting a U-shaped relationship between antenatal iron exposure and birth outcomes. Little is known about the iron status and associated birth outcomes of pregnant women in South Africa. Our aim was to assess iron status at early, mid- and late pregnancy, and to determine associations with gestational age and birth weight in women in Johannesburg, South Africa. METHODS: In this prospective study of 250 pregnant women, we measured haemoglobin, biomarkers of iron status and inflammation at <18, 22 and 36 weeks of gestation, plus birth weight and gestational age at delivery. Associations of anaemia and iron status with birth outcomes were determined using regression models adjusted for confounders. RESULTS: At enrolment, the prevalence of anaemia, iron depletion (ID) and iron deficiency erythropoiesis (IDE) was 29%, 15% and 15%, respectively, and increased significantly with pregnancy progression. Anaemia and ID at 22 weeks, as well as IDE at 36 weeks were associated with higher birth weight (ß = 135.4; 95% CI: 4.8, 266.1 and ß = 205.4; 95% CI: 45.6, 365.1 and ß = 178.0; 95% CI: 47.3, 308.7, respectively). Women in the lowest ferritin quartile at 22 weeks gave birth to babies weighing 312 g (95% CI: 94.8, 528.8) more than those in the highest quartile. In contrast, IDE at 22 weeks was associated with a higher risk for premature birth (OR: 3.57, 95% CI: 1.24, 10.34) and women in lower haemoglobin quartiles at <18 weeks had a shorter gestation by 7 days (ß = -6.9, 95% CI: -13.3, -0.6) compared to those in the highest quartile. CONCLUSION: Anaemia, ID and IDE prevalence increased during pregnancy despite routine iron supplementation. ID and anaemia at mid-pregnancy were associated with higher birth weight, while IDE was associated with premature birth. These results suggest that current antenatal screening and supplementation practices in South Africa need to be revisited.