Raymond 3-045 Friday 11:30 am
Macdonald Campus, McGill University

March 29th, 2019

Doris Gonzalez-Fernandez (Final Seminar) Institute of Parasitology

Interpretation of maternal and fetal biomarkers in a population of pregnant indigenous women with coexisting nutrient deficiencies and infections

Detection of adverse pregnancy outcomes is challenging in remote settings, where modern biomarkers are usually non-accessible and where multiple infections, nutrient deficiencies and inflammation (MINDI) usually co-occur. Moreover, current research has questioned the usefulness of some biomarkers in the presence of MINDI. To evaluate risk of adverse outcomes in rural Panama: anemia/iron deficiency poorly responsive to iron supplements, hypertensive disorders of pregnancy and poor fetal growth, we recruited 213 pregnant women attending routine follow-up in a cross-sectional study. Data on maternal and environmental risk factors, anthropometry, symphysis-fundal height (SFH) and clinically and laboratory detected infections were collected; hematological indicators, biomarkers of inflammation (C-reactive protein CRP, hepcidin and cytokines), iron and protein status, and micronutrients (folic acid, vitamins B12, A and D) were measured. We first evaluated the utility of CRP, finding that it was positively and negatively associated with infections, but did not associate with ferritin. Therefore, other biomarkers of inflammation for iron status were explored. Hepcidin was useful detecting iron restriction due to inflammation whereas anemia was associated, not only with low iron, but with low folic acid and vitamin A, underscoring the lack of response to iron supplementation. Infections, inflammation, protein and folic acid deficiencies were also associated with higher risk of maternal hypertension, whereas low pulse pressure, protein deficiency, iron restriction due to inflammation and wood smoke were associated with lower SFH for gestational age. Our findings indicate the need for changing current public health policies in order to adapt to complex interactions between biomarkers and MINDI.