Gestational intestinal parasitosis and anaemia: A double-hit for pregnancy outcomes

Gestational anaemia (GA) is a significant public health concern worldwide, affecting approximately 30 % of pregnant women. The causes of GA are multifactorial, and intestinal parasitic infections (IPIs) have been implicated as contributing factors. However, the prevalence of IPIs in pregnant women and its relationship with the incidence and severity of GA and pregnancy outcomes remain unclear. This study aimed to evaluate the prevalence of IPIs in pregnant women and its relation to the incidence and severity of GA and pregnancy outcomes. A total of 238 pregnant women were clinically evaluated, stool specimens were collected for parasitological examinations, and blood samples were collected for ELISA detection of anti-trichinlla and anti-schistosoma IgG. The haemoglobin concentration (HBC) was estimated during the 1st and 3rd trimesters, and the extent of change in HBC was calculated. The enrolled women were categorized according to the 1st trimester HBC into anaemic and non-anaemic groups, and the incidence of pregnancy outcomes was determined. The 3rd trimester HBC was significantly lower than the 1st trimester HBC, and the incidence of GA increased from 30.25 % to 50.84 %. The frequency of IPIs was 45 %, with a coinfection rate of 43 % among infected women. Infection by Ascaris (A.) lumbricoides and Ancylostoma (A.) duodenale was detected in 33.6 % and 19.6 % of specimens, respectively. The frequency of infections by A. duodenale and Schistosoma species was significantly greater among anaemic women. Fifty-one women (21.4 %) developed pregnancy-related complications, with a significantly greater incidence among anaemic women. The incidence of miscarriage and small for gestational age (SGA) was significantly greater among anaemic women. This study demonstrated that gestational IPIs induce and/or aggravate maternal anaemia and deleteriously affect pregnancy outcomes. Parasitic coinfection is a high-risk factor for the development of severe anaemia late in pregnancy, the occurrence of miscarriage, and SGA. The implementation of parasitological evaluation in routine pre-pregnancy counseling or at pregnancy diagnosis is mandatory to reduce the risk of adverse pregnancy outcomes.