Abstract
Background/ObjectivesThe iron-binding affinity of vaginal lactoferrin (Lf) reduces iron available to genital pathogens. We describe host reproductive, nutritional, infection and iron biomarker profiles affecting vaginal Lf concentration in young nulliparous and primigravid women in Burkina Faso.Subjects/MethodsVaginal eluates from women who had participated in a randomized, controlled periconceptional iron supplementation trial were used to measure Lf using a competitive double-sandwich ELISA. For this analysis samples from both trial arms were combined and pregnant and non-pregnant cohorts compared. Following randomization Lf was measured after 18 months (end assessment) for women remaining non-pregnant, and at two antenatal visits for those becoming pregnant. Associations between log Lf levels and demographic, anthropometric, infection and iron biomarker variables were assessed using linear mixed models.ResultsLf samples were available for 712 non-pregnant women at end assessment and for 303 women seen at an antenatal visit. Lf concentrations of pregnant women were comparable to those of non-pregnant, sexually active women. Lf concentration increased with mid-upper-arm circumference, (P = 0.047), body mass index (P = 0.018), Trichomonas vaginalis (P < 0.001) infection, bacterial vaginosis (P < 0.001), serum C-reactive protein (P = 0.048) and microbiota community state types III/IV. Adjusted Lf concentration was positively associated with serum hepcidin (P = 0.047), serum ferritin (P = 0.018) and total body iron stores (P = 0.042). There was evidence that some women maintained persistently high or low Lf concentrations from before, and through, pregnancy.ConclusionLf concentrations increased with genital infection, higher BMI, MUAC, body iron stores and hepcidin, suggesting nutritional and iron status influence homeostatic mechanisms controlling vaginal Lf responses.
Highlights
Materials and methodsAn essential role of human lactoferrin (Lf) is to prevent accumulation of free iron at mucosal sites
Lf is expressed in the genital tract as part of the innate immune system, active against common genital tract infections such as Trichomonas (T) vaginalis, bacterial vaginosis (BV)related species, and Candida spp
Vaginal Lf concentrations vary over the menstrual cycle with estrogen surges [13], and plasma Lf was reported to be higher in pregnancy [14]
Summary
Lf samples were available for 712 non-pregnant women at end assessment (after up to 18 months of weekly iron supplementation) and for 303 women seen at ANC1 or ANC2 who had become pregnant after randomization. The within-patient ICC was 0.57, indicating that Lf values were strongly correlated over time, with individuals having levels that persisted This is illustrated, which shows the longitudinal trends in Lf concentration for the 51 women assessed at end assessment and who were identified by urine screening at that time as in very early pregnancy and who later provided additional samples as part of the pregnant cohort at ANC1 and/or ANC2. ZPP and sTfR adjusted for MUAC were not significantly associated with Lf concentration
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