Intestinal Parasitic Infections among Pregnant Women in Venezuela

Introduction. Intestinal parasitic infections, especially due to helminths, increase anemia in pregnant women. The results of this are low pregnancy weight gain and IUGR, followed by LBW, with its associated greater risks of infection and higher perinatal mortality rates. For these reasons, in the setting of no large previous studies in Venezuela about this problem, a national multicentric study was conducted. Methods. Pregnant women from nine states were studied, a prenatal evaluation with a coproparasitological study. Univariated and multivariated analyses were made to determine risk factors for intestinal parasitosis and related anemia. Results. During 19 months, 1038 pregnant women were included and evaluated. Intestinal parasitosis was evidenced in 73.9%: A lumbricoides 57.0%, T trichiura 36.0%, G lamblia 14.1%, E hystolitica 12.0%, N americanus 8.1%, E vermicularis 6.3%, S stercoralis 3.3%. Relative risk for anemia in those women with intestinal parasitosis was 2.56 (P < .01). Discussion. Intestinal parasitoses could be associated with conditions for development of anemia at pregnancy. These features reflect the need of routine coproparasitological study among pregnant women in rural and endemic zones for intestinal parasites. Further therapeutic and prophylactic protocols are needed. Additional research on pregnant intestinal parasitic infection impact on newborn health is also considered

Clinical Study Intestinal Parasitic Infections Among Pregnant Women in Venezuela

Introduction. Intestinal parasitic infections, especially due to helminths, increase anemia in pregnant women. The results of this are low pregnancy weight gain and IUGR, followed by LBW, with its associated greater risks of infection and higher perinatal mortality rates. For these reasons, in the setting of no large previous studies in Venezuela about this problem, a national multicentric study was conducted. Methods. Pregnant women from nine states were studied, a prenatal evaluation with a coproparasitological study. Univariated and multivariated analyses were made to determine risk factors for intestinal parasitosis and related anemia. Results. During 19 months, 1038 pregnant women were included and evaluated. Intestinal parasitosis was evidenced in 73.9%: A lumbricoides 57.0%, T trichiura 36.0%, G lamblia 14.1%, E hystolitica 12.0%, N americanus 8.1%, E vermicularis 6.3%, S stercoralis 3.3%. Relative risk for anemia in those women with intestinal parasitosis was 2.56 (P &lt; .01). Discussion. Intestinal parasitoses could be associated with conditions for development of anemia at pregnancy. These features reflect the need of routine coproparasitological study among pregnant women in rural and endemic zones for intestinal parasites. Further therapeutic and prophylactic protocols are needed. Additional research on pregnant intestinal parasitic infection impact on newborn health is also considered. INTRODUCTION The soil-transmitted helminthiases are ancient diseases that continue to cause misery and disability in poor populations. The numbers affected are staggering. About 2 billion harbor these infections worldwide, of whom 300 million suffer associated severe morbidity. Of the total number infected, an estimated 400 millions are school-age children. In 1999, World Health Organization (WHO) estimated that schistosomiasis and soil-transmitted helminthiasis represented more than 40% of the disease burden due to all tropical diseases, excluding malaria Tropical diseases such as malaria, schistosomiasis, intestinal helminths, and filariasis have a dramatic impact on reproductive health. Many cases of unexplained pregnancy loss are due to undiagnosed tropical diseases. Malnutrition or anemia caused by intestinal worms may be worsened by pregnancy and make the pregnancy difficult In the developing world, young women, pregnant women, and their infants and children frequently experience a 2 Infectious Diseases in Obstetrics and Gynecology cycle, where undernutrition (macronutrient and micronutrient) and repeated infection, including parasitic infections, lead to adverse consequences that can continue from one generation to the next. Among parasitic infections, malaria and intestinal helminths coexist widely with micronutrient deficiencies and contribute importantly to anemia and this cycle of retarded growth and development. In somewhat more limited or focal geographic settings, other parasitic diseases (eg, schistosomiasis, filariasis) contribute similarly to this cycle. It is undoubtedly much better to enter a pregnancy free of infection and nutritionally replete than the various alternatives Intestinal parasitic infections, especially due to the helminths, increase anemia in pregnant women For these reasons, in the setting of no large previous studies in Venezuela about this problem, a national multicentric study was conducted with the objectives to describe preliminarily the epidemiological importance of intestinal parasitosis in pregnant women and its possible impacts. METHODS The study was a transversal analysis of pregnant women attending to prenatal control outpatient health care centers in Venezuela. Pregnant women from fifteen centers located in semi-urban and rural areas of nine states in the country were studied during the period January 2003-July 2004. All women accepted to be studied and included in this study. Women with previous diagnosis of infectious diseases as HIV/AIDS, HBV infection, syphilis, or toxoplasmosis were not enrolled. Evaluation of those women included, as a part of their routine prenatal control, an initial interrogation, physical examination, and laboratory studies: count of blood cells (CBC) (including thick and thin films, stained with Giemsa), serological screening studies for HIV-1 and -2 (ELISA), HBV (HbsAg and IgM anti-HBc), VDRL, and FTA-ABS, and toxoplasmosis (antibody titers by DAT). For this study, we considered as normal levels of Hb in women those between 12-16 g/dL, and between 37-48% for the hematocrit. An eosinophils proportion up to 4% was considered normal. All women were asked for a fresh stool sample each for coproparasitological study. The stool samples were masked, coded, and processed for parasitological examination. All stool samples were processed within 2 hours of collection. Isolation of enteric bacterial and viral pathogens was not studied in these samples. Different stool examinations were used for efficacy in detecting parasites. These were direct wet-mount, formaldehyde-ether sedimentation method and modified acid-fast staining techniques RESULTS One thousand thirty eight pregnant women were enrolled in this study. The mean age of this population was 25.5 ± 6.5 years old. The mean gestational age at enrollment moment was 28.5 ± 4.0 weeks (60% was on the 3rd trimester). At clinical evaluations, no apparent significant obstetrical alterations were observed. All women were asymptomatic. All serological studies were negative in all women (HIV, HBV, VDRL, Toxoplasmosis). Hematological evaluation showed that 65.1% of women presented anemia. The mean hemoglobin levels were 10.3 ± 0.4 g/dL, mean hematocrit was 30.6 ± 1.8%. Eosinophils relative mean proportion was 5.1 ± 4.2%. Eosinophilia was seen in 22.3% women. No other alterations were seen in these women. Intestinal parasitosis was seen in 767 women (73.9%). From this total, 360 (46.9 %) presented infections due to two simultaneous intestinal parasite species, 84 (10.9 %) with three intestinal parasite species, and only 2 women presented infections due to more than three intestinal parasite species (0.3 %). In this studied group of women, ten different species of intestinal parasites were found, 2 nonpathogenic protozoans, 3 pathogenic protozoans, and 5 helminths species Univariated and multivariated analyses made to assess risk factors for intestinal parasitosis and related anemia only found significance for the presence of intestinal parasitosis as a risk to have anemia during pregnancy, relative risk (RR) was 2.56 (95% CI 2.13-3.08)