Impact of Intestinal Helminth Infections on Iron Deficiency Anemia during Pregnancy

Iron deficiency anemia (IDA) remains a major public health challenge among pregnant women, particularly in low- and middle-income countries where intestinal parasitic infections (IPIs) are highly endemic. Evidence from cross-sectional, case-control, cohort studies, and systematic reviews consistently demonstrates a strong association between helminthic infections and maternal anemia. In rural Chad, anemia affected 53% of pregnant women, with high rates of intestinal parasitism. Similarly, in Southern Ethiopia, 38.7% of pregnant women were infected with intestinal parasites, and anemia prevalence was significantly higher among infected women (55.6%) compared to non-infected counterparts (16.4%), with a sixfold increased odds of anemia (AOR=6.14). Helminth-specific studies in East Wollega, Ethiopia, reported a 24.7% prevalence of intestinal helminths, predominantly hookworm (15.1%), and confirmed significant associations between helminth infection and anemia. A global meta-analysis further estimated pooled prevalences of hookworm (19%), Ascaris lumbricoides (17%), and Trichuris trichiura (11%) among pregnant women, demonstrating a 2.65-fold increased risk of anemia in infected individuals. Prospective cohort data showed significant reductions in hemoglobin and hematocrit levels among infected pregnant women, particularly with hookworm and Schistosoma mansoni infections. Mechanistically, helminths contribute to chronic intestinal blood loss, impaired iron absorption, reduced appetite, and inflammation-mediated nutrient malabsorption, exacerbating iron deficiency during pregnancy. Co-infections amplify severity, increasing risks of miscarriage, low birth weight, and small-for-gestational-age outcomes. Evidence from randomized trials indicates that second-trimester deworming may reduce maternal anemia prevalence. Collectively, these findings underscore the dual burden of IPIs and IDA in pregnancy and highlight the importance of routine screening, deworming strategies, iron supplementation, and improved water, sanitation, and hygiene interventions to mitigate adverse maternal and neonatal outcomes.