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OJHAS Vol. 10, Issue 2:
(Apr-Jun 2011) |
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Comparative Study of Plasma Trace Elements (Copper, Iron and Zinc) Status
in Anaemic and Non-anaemic Pregnant Women in Abakaliki, Nigeria |
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Emmanuel I. Ugwuja, Senior Lecturer, Department of Chemical Pathology,
Faculty of Clinical Medicine, Ebonyi State University, P.M.B. 053 Abakaliki,
Nigeria,
Boniface N.
Ejikeme, Senior Lecturer, Department of Obstetrics
and Gynaecology, Faculty of Clinical Medicine, Ebonyi State University
Abakaliki, P.M.B. 053, Abakaliki, Nigeria,
Nicholas C.
Ugwu, Senior Lecturer, Department of Chemical Pathology,
Faculty of Clinical Medicine, Ebonyi State University, P.M.B. 053 Abakaliki,
Nigeria,
Onyechi Obidoa, Professor of Nutrition and Toxicological Biochemistry, University
of Nigeria, Nsukka, Enugu State, Nigeria. |
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Address for Correspondence |
Department of Chemical Pathology,
Faculty of Clinical Medicine,
Ebonyi State University,
P.M.B. 053 Abakaliki,
Nigeria.
E-mail:
ugwuja@yahoo.com |
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Ugwuja EI, Ejikeme BN, Ugwu NC, Obidoa O. A
Comparative Study of Plasma Trace Elements (Copper, Iron and Zinc) Status
in Anaemic and Non-anaemic Pregnant Women in Abakaliki, Nigeria. Online J Health Allied Scs.
2011;10(2):10 |
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Submitted: May 14,
2011; Accepted: Jul 16, 2011; Published: Jul 30, 2011 |
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| Abstract: |
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For a comparative
study of plasma copper, iron and zinc between anaemic and non-anaemic
pregnant women, data for anaemic (n = 223) and non-anaemic (n = 126)
pregnant women drawn from a cohort of 351 pregnant Nigerians recruited
at gestational age of ≤ 25 weeks for the study of impacts of trace
element status on pregnancy outcomes were analysed. With the exception
of plasma copper which was significantly (p < 0.05) higher in anaemic
women in comparison to the non-anaemic women (10.11 ± 10.15 vs. 8.68
± 7.92 µmol/l), plasma iron and zinc were lower (p > 0.05) in the
former. While plasma copper, iron and zinc concentration were not correlated
with maternal haemoglobin concentration, plasma zinc significantly correlated
negatively (r = -0.141, p < 0.05) with plasma copper. It is thus
concluded that anaemia in pregnant women in this population may partly
be due to a combination of trace element deficiencies and their interactions
with each other. While interventions should go beyond improving intakes,
more research is desired to clearly define these interactions.
Key Words:
Anaemia; Pregnancy; Copper; Iron; Zinc; Abakaliki; Nigeria
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Anaemia has been
recognised as one of the leading health challenges of the developing
countries with alarming prevalence in Asia and sub-Saharan Africa (1-3)
and a leading cause of pregnancy related complications, not only for
the mother, but also for their foetus.(4-6) In developing countries,
maternal anaemia during pregnancy is a product of many factors, such
as maternal malaria, intestinal parasitic infection, recurrent infection,
reduced dietary intakes, and micronutrient deficiencies just to name
but few.(7) Data relating haemoglobin concentrations and plasma
micronutrients levels, particularly trace elements have been conflicting
and inconclusive. For instance, zinc and copper deficiencies have been
associated with anaemia or iron deficiency with adverse effects on foetus
and pregnant women during pregnancy.(8) Also zinc status to some
extent has been found to account for haematological abnormalities in
middle-aged and pregnant Japanese women.(9,10) However, while Abdelrahim
et al.(11) reported that haemoglobin levels significantly correlated
positively with zinc and copper levels, Ma and colleagues (8) documented
an inverse correlation between copper and haemoglobin, especially among
anaemic pregnant women.(8) Additionally, Bushra et al (12) reported that maternal age, parity, gestational age, ferritin,
zinc and copper were not predictors for anaemia. Elemental interactions
among trace elements such as copper, zinc, iron and magnesium has also
been suggested to contribute to variations in the plasma levels of these
trace elements (13) and contribute to anaemia. Regrettably however,
most supplemental programmes in developing countries mainly focus on
iron supplementation.(14) In the present study the plasma levels
of copper, iron and zinc were evaluated in anaemic and non-anaemic pregnant
women in a bid to ascertain the impact of maternal anaemia on these
trace elements. The possible interactions between these trace elements
were also assessed.
The study was
carried out among pregnant women attending antenatal clinic of the Department
of Obstetrics and Gynaecology of the Federal Medical Centre, Abakaliki,
one of the referral tertiary health institutions in the South Eastern
part of Nigeria. The protocol for this study was approved by the Ethics
and Research Committee of the Federal Medical Centre, Abakaliki. Three
hundred and fifty-one (351) women, aged 15-40 years (Gestational age
≤ 25 weeks), who gave their consent to participate in the study, were
recruited between July 2007 and September 2008. Subjects’ selection
and detailed methodology has been previously described.(15) Plasma
copper and zinc were determined by Atomic Absorption Spectrophotometer
(Bulk Scientific, model AVG 210), haemoglobin concentration was determined
by Cyanmethaemoglobin method and total white blood cell counts (TWBC)
were determined as in a standard haematology textbook.(16) Data for anaemic (n = 223) and non-anaemic (n = 126) pregnant women were analysed
using Statistical Package for Social Sciences (SPSS version 7.5).
Data Analysis: Data were analysed
for proportions, mean and standard deviation while comparison between
subjects and controls were analysed using Student’s t-test with statistical
significance set at p < 0.05.
Table 1 shows
maternal characteristics. Both the anaemic and non-anaemic pregnant
women were of comparable age, body mass index and gestational age. However,
while anaemic subjects had significantly (p < 0.05) higher
parity and total white blood cell count than their non-anaemic counterparts,
the latter had statistically significant (p < 0.05) higher haemoglobin
concentration and attended more Antenatal Clinic.
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Table 1: Comparison
of Maternal Characteristics between Anaemic and Non-anaemic Pregnant
Women1 |
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Parameters |
Non-anaemic (n=126) |
Anaemic (n=223) |
p-values |
| Age (yrs) |
27.75 ± 4.56 |
26.67 ± 4.81 |
0.075 |
| BMI (Kg/m2) |
28.19 ± 4.54 |
26.79 ± 4.06 |
0.290 |
| Gestational
age (wks) |
21.83 ± 3.29 |
21.75 ± 3.00 |
0.160 |
| Parity (n) |
1.17 ± 1.36 |
1.55 ± 1.5 |
0.004* |
| Number of ANC
attendance |
7.51 ± 2.82 |
6.71 ± 2.29 |
0.002* |
| HBC (g/dl) |
11.54 ± 0.51 |
9.46 ± 0.87 |
0.000* |
| TWBC (x 109/l) |
5.15 ± 1.21 |
5.88 ± 1.50 |
0.001* |
BMI:
Body Mass Index; ANC: Antenatal Clinic; TWBC:
Total White Blood Cell.
1 Values
are expressed as mean ± standard deviation
*
p-values statistically significant (p < 0.05). |
From Table 2,
although there appeared to be higher prevalence of trace element deficiencies
in anaemic women when compared to non-anaemic women, the differences
were not statistically significant (p > 0.05).
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Table 2: Comparison
of Prevalence of Trace Element Deficiencies between Anaemic and Non-anaemic
Pregnant Women 1 |
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Parameters |
Non-anaemic (n = 126) |
Anaemic (n = 223) |
p-values |
| Copper |
69 (54.8) |
134 (60.10) |
0.332 |
| Iron |
79 (62.7) |
143 (64.1) |
0.790 |
| Zinc |
50 (39.7) |
110 (49.3) |
0.082 |
| Copper &
Iron |
46 (36.5) |
82 (36.8) |
0.961 |
| Copper &
Zinc |
23 (18.3) |
60 (26.9) |
0.068 |
| Iron and Zinc |
33 (26.2) |
65 (29.1) |
0.620 |
| Copper, Iron
and Zinc |
16 (12.7) |
33 (14.8) |
0.588 |
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1
Percentages in parenthesis |
Except for plasma
copper which was significantly (p < 0.05) higher in anaemic women
in comparison to the non-anaemic women (10.11 ± 10.15 vs. 8.68
± 7.92 µmol/l), plasma iron and zinc were lower (p > 0.05) in the
anaemic women, although the values were within the reference ranges
(Table 3). Pearson correlation analysis showed that plasma copper,
iron and zinc concentration were not correlated with maternal haemoglobin
concentration. However, plasma zinc significantly correlated negatively
(r = -0.141, p < 0.05) with plasma copper.
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Table 3: Comparison
of Plasma Trace Elements (Copper, Iron and Zinc) Levels between Anaemic
and Non-anaemic Pregnant Women 1 |
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Parameters |
Non-anaemic (n = 126) |
Anaemic (n = 223) |
p-values |
| Copper (µmol/l) |
8.68 ± 7.92 |
10.11 ± 10.15 |
0.004* |
| Iron (µmol/l) |
10.36 ± 7.65 |
10.18 ± 7.72 |
0.567 |
| Zinc (µmol/l) |
9.74 ± 8.59 |
8.81 ± 9.48 |
0.941 |
1 Values
are expressed as mean ± standard deviation
*
p-values statistically significant (p < 0.05). |
Data from the
present study show that deficiencies of copper, iron and zinc were prevalent
and appeared to be higher (p > 0.05) in anaemic than non-anaemic
women, with lower plasma levels of the elements in the former, except
for copper which was significantly (p < 0.05) higher. Also, although
a significant inverse relationship (r = -0.141, p = 0.008) was found
between plasma copper and zinc, plasma levels of copper, iron and zinc
were not related to maternal anaemia. The higher prevalence (although
not significant) of copper, iron and zinc deficiencies in anaemic pregnant
women when compared to their non-anaemic counterparts in the present
study highlight the importance of these elements in erythropoiesis.
Again, the lower plasma levels of iron and zinc in anaemic pregnant
women when compared to their non-anaemic counterparts in the present
study are in corroboration with earlier studies (8), thus reaffirming
the roles of these elements in haemoglobin synthesis. Widespread prevalence
of micronutrient deficiencies have been associated with several factor,
including low dietary intake, low bioavailabity as in the case of
copper, iron and zinc, poor utilisation due to environmental factors
such as poor hygiene that lead to increased infections and infestations,
adverse nutrient-nutrient interactions (17) and genetic causes.(18)
High prevalence of copper, iron and zinc deficiencies has been previously
reported in this population.(19) It could therefore be inferred that
deficiencies of these elements probably may have contributed in part
to anaemia of pregnancy in this population. Significantly higher plasma
copper in anaemic pregnant women in the present study however contrasts
lower serum copper reported by Bushra et al(12) among anaemic pregnant women in Central Sudan. Although the
reason for increased plasma copper concentration in the presence of
lower plasma iron and zinc in anaemic women is obscure, inter-element
interactions have been documented among divalent cations, leading to
changes in plasma concentrations of the elements.(13) Interactions
between trace elements are evidenced by the inverse correlation between
plasma copper and zinc in the present study. Interactions between trace
elements have long been recognised.(20,21) For instance, an intriguing
interactions appear to exist between copper, zinc and iron in absorption
and utilisation. On one hand, supplementation of iron has been reported
to affect bioavailability of zinc and copper in iron deficiency anaemia
by inter-element competition in the bowel, while on the other hand,
bioavailability of copper and iron are affected by zinc supplementation
which is reflected in their blood levels.(17) The secondary effects
of iron deficiency on copper metabolism have been confirmed in several
studies. For instance, it has been established that iron deficiency
results in increased copper levels in the liver(22,23), while severe
copper deficiency causes changes in iron metabolism, leading to anaemia
and accumulation of iron in the liver.(24) Also intraluminal and intracellular
interactions have been suggested to occur between iron and zinc.(25,26)
Three possible mechanisms have been proposed for iron-zinc interactions.(27)
These include: (1). Displacement of one another on the molecule
responsible for their uptake from the lumen into the enterocytes.(2)
Competition between the two elements for pathways through the mucosal
cell into the systemic circulation or (3) Interactions between the two
elements with a third substance to form an insoluble complex that may
impair the absorption of both. The lack of correlation between plasma
trace elements and maternal haemoglobin recorded in this study is in
corroboration with the findings of Bushra et al (12), but contrasts
the significant positive correlation between haemoglobin and zinc levels
reported among adolescent schoolgirls in Eastern Sudan.(11) The difference
in the two finding may be partly attributed to patients’ selection.
While the present study was done on pregnant women, theirs was on non-pregnant
adolescent schoolgirls. The present findings of significantly higher
parity in anaemic pregnant women also contrast earlier report of lack
of effect of parity on maternal anaemia among pregnant women in Central
Sudan.(12) However, it has been shown that multiparous women are more
prone to nutritional deficiencies and by extension to anaemia as a result
of maternal depletion syndrome.(28) Evidence suggests that anaemia
in pregnant women in this population may not only be due to trace elements
deficiencies, but also as a result elemental interactions. Thus, in
addition to improving dietary intakes, further studies are needed to
clarify these interactive forces.
- Mason JB, Lotfi
M, Dalmiya N, Sethuraman K, Deitchler M, Geibel S, Gillenwater
K, Gilman A, Mason K, Mock N. The micronutrient report:
current progress in the control of vitamin A, iodine and iron deficiencies.
Ottawa Micronutrient Initiative/International Development Research Center.
2001(Available at:
http://www.micronutrient.org/frame_HTML/resource_text/publications/mn_report.pdf. (Accessed on 20/10/2007).
- Janghorban R, Ziaei S, Faghihzade S. Evaluation of serum copper level in pregnant
women with high haemoglobin. Iran J Med Sci
2006;31(3):170-172.
- World Health Organisation. The prevalence of anaemia in women: a tabulation of available
information. WHO. Geneva. 1992
- Allen LH. Anaemia and iron deficiency: effects on pregnancy outcome. American
Journal of Clinical Nutrition
2000;71(Suppl.):1280S-1284S.
- Scanlon KS, Yip
R, Schieve LA, Cogswell ME. High and low cience
haemoglobin during pregnancy: differential risks for preterm birth
and small for gestational age. Obstetrics and Gynaecology
2000;96(5 pt1):741-748.
- World Health Organisation.
(2002). Turning the tide of malnutrition, responding to the challenge
of the 21st century, WHO, Geneva.
- Verhoeff FH, Brabin
BJ, Chimsuku L, Kazembe P, Broadhead R. An analysis
of the determinant s of anaemia in pregnant women in rural Malawi-a
basis for action. Annals of Tropical Medicine and Parasitology 1999;93:119-133.
- Ma AG, Chen XC, Xu RX, Zheng MC, Wang Y, Li JS. Comparison
of serum levels of iron, zinc and copper in anaemic and non-anaemic
pregnant women in China. Asia Pacific J Clin Nutr 2004;13(4):348-352.
- Nishiyama S, Irisa
K, Matsubasa T, Higashi A, Matsuda I. Zinc status relates
to haematological deficits in middle-aged women. Journal of the American
College of Nutrition 1998;7(3):291-295.
- Nishiyama S, Kiwaki
K, Miyazaki Y, Hasuda T. Journal of the American College
of Nutrition 1999;18(3):261-267.
- Abdelrahim II, Mahgoub HM, Mohamed AA, Ali NI, Elbashir MI, Adam
I. Anaemia, folate, zinc and copper deficiencies among adolescent
schoolgirls in Eastern Sudan. Biol Trace Elem Res 2009
Dec;132(1-3):60-66.
- Bushra M, Elhssan
EM, Ali NI, Osman E, Bakheit KH, Adam II. Anaemia, zinc and copper deficiencies among pregnant women in
Central Sudan. Biol Trace Elem Res 2010 Dec;137(3):255-61. Epub 2009
Dec 29.
- Kathleen M. Sylvia
ES. Food, nutrition and diet therapy, 11th
ed. Saunders, USA, 2004. pp101-109.
- Stephannsson O, Dickman PW, Johanson A, Cnattingiuss
S. Maternal haemoglobin
concentration during pregnancy and risk of stillbirth. Journal of
American Medical Association 2000;284(20):2611-2617.
- Ugwuja EI, Akubugwo
EI, Ibiam UA, Obidoa O. Impact of Maternal Copper
and Zinc Status on Pregnancy Outcomes in a Population of Pregnant Nigerians.
Pakistan Journal of Nutrition. 2010;9(7):678-682.
- Dacie JV, Lewis
SM. Practical Haematology, 8th Ed. Churchill livingstone,
Edinburg 1994. Pp 49-59.
- Sandstorm B. Micronutrient interactions: effects on absorption and bioavailability.
British Journal of Nutrition
2001;85 (2):S181-185.
- Seshadri S. Nutritional anaemia
in South Asia: In Malnutrition in South Asia-A regional Profile 1997;75:124.
- Ugwuja EI, Akubugwo EI, Ibiam
UA, Obidoa O, Ugwu NC. Plasma Copper
and Zinc among Pregnant Women in Abakaliki, Southeastern Nigeria.
The Internet Journal of Nutrition and Wellness
2010;10(1).
- Danzeisen R, McArdle
HJ. Identification & location of a placenta copper oxidase
in a human choriocarcinoma cell line. J
Physiol London 2000;523:172-175.
- Fox PL. The copper-iron chronicles: the story of an intimate relationship.
Biometals 2003;16:9-40.
- Evans JL, Abraham
PA. Anaemia, iron storage and ceruloplasmin in copper nutrition
in the growing rat. Journal of Nutrition 1973;103:196-201.
- Owen Jr., CA. Effects of iron on copper metabolism and copper on iron metabolism in
rat. American Journal of Physiology
1973;224:514-518.
- Auclair S, Feillet-Coudray
C, Coudray C, Schneider S, Muchenthaler MU, Mazur A.
Mild copper deficiency alters gene expression of proteins involved in
iron metabolism. Blood Cell and Molecular Disease
2006;36:15-20.
- Rossander-Hulten
L, Brune M, Sanstrom B, Lonnerdal B, Hallberg L. Competitive inhibition of iron absorption by manganese and zinc in humans.
American Journal of Clinical Nutrition
1991;54:152-156.
- Solomons NW, Pineda
O, Viteri F, Sandstead HH. Studies of the bioavailability
of zinc in humans: mechanism of the intestinal interaction of nonheme
iron and zinc. Journal of Nutrition 1983;113:337-349.
- King JC. Determinants of maternal zinc status during pregnancy. American Journal
of Clinical Nutrition 2000;71(Supp l):1334S-1343S.
- King JC. The
risk of maternal nutritional depletion and poor outcomes increases in
early or closely spaced pregnancies. Journal of Nutrition 2003;133:1732S-1736S.
Available at
http://jn.nutrition.org/content/133/5/1732S.full
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