Does Iron Increase the Risk of Malaria in Pregnancy?

Background. Pregnancy-associated malaria (PAM) remains a significant health concern in sub-Saharan Africa. Cross-sectional studies report that iron might be associated with increased malaria morbidity, raising fears that cur-rent iron supplementation policies will cause harm in the present context of increasing resistance against intermit-tent preventive treatment in pregnancy (IPTp). Therefore, it is necessary to assess the relation of iron levels with malaria risk during the entire pregnancy. Methods. To investigate the association of maternal iron levels on malaria risk in the context of an IPTp clinical trial, 1005 human immunodeficiency virus-negative, pregnant Beninese women were monitored throughout their pregnancy between January 2010 and May 2011. Multilevel models with random intercept at the individual levels and random slope for gestational age were used to analyze the factors associated with increased risk of a positive blood smear and increased Plasmodium falciparum density. Results. During the follow-up, 29 % of the women had at least 1 episode of malaria. On average, women had 0.52 positive smears (95 % confidence interval [CI], 0.44–0.60). High iron levels (measured by the log10 of ferritin cor-rected on inflammation) were significantly associated with increased risk of a positive blood smear (adjusted odds ratio = 1.75; 95 % CI, 1.46–2.11; P <.001) and high P falciparum density (beta estimate = 0.22; 95 % CI, 0.18–0.27