Redefining Anaemia: A Multicenter, International, Population-Based Study to Establish and Validate Global Reference Values for Anaemia in Pregnancy (ReMAPP).

January 10, 2025 | Ongoing Project | Reading time: 8 min

Introduction

The ReMAPP study is part of a larger study called PRISMA and is designed to better understand anaemia (low blood levels) in pregnant women to improve the health of mothers and their babies. The study, funded by the Bill and Melinda Gates Foundation, is being conducted in several countries, including Ghana, Kenya, Zambia, India, and Pakistan. The study will collect important information to help create better global guidelines for identifying and diagnosing anaemia in pregnant women. This will ensure that mothers get the care they need to stay healthy during pregnancy and after childbirth.

Investigators

Kintampo Health Research Centre (KHRC), Ghana: Dr. Kwaku Poku Asante, Mrs. Charlotte Tawiah, Ms. Veronica Agyemang

Kwame Nkrumah University of Science and Technology (KNUST), Ghana: Prof. Sam Newton

Korle Bu Teaching Hospital (KBTH), Ghana: Dr. Amma Benneh Kwasi-Kuma

George Washington University, United States: Prof. Emily Smith, Ms. Sasha Bauman.

Background

Anaemia is a deficiency in oxygen-rich blood and is characterized by low blood haemoglobin concentration and/or low red blood cell (RBC) count insufficient to meet physiological needs. Women of reproductive age (WRA), especially pregnant and lactating are disproportionately affected by anaemia affecting about 613 million and this is associated with increased risk of adverse outcomes for both mother and newborn. The burden of anaemia is more pronounced in low and middle-income countries (LMICs). The World Health Assembly aims to reduce anaemia in WRA by 50% by the year 2025. The causes of anaemia are multifaceted, however iron deficiency accounts for over 50% in WRA.

Objectives

The overarching objective of this study is to advance clinical knowledge of anaemia during pregnancy and contribute high quality, globally representative data toward establishing haemoglobin thresholds linked to functional outcomes. Nested within already established surveillance sites (Ghana, Kenya, Zambia, India and Pakistan) implementing a Pregnancy Risk, Infant Surveillance and Measurement Alliance (PRISMA) Maternal and Newborn Health (MNH) study, three primary aims of this study will be:

Aim 1: To define normal haemoglobin values in healthy women during pregnancy and within 42 days postpartum and estimate related statistical thresholds for anaemia diagnosis in these populations.

Aim 2: To establish haemoglobin thresholds for anaemia diagnosis in pregnancy based on the link with adverse maternal, fetal, and newborn health outcomes.

Methodology

Each participating site will recruit 1600 to 2000 pregnant women from the MNH study into the aim 2 cohort at gestational age of less than 20 weeks, with an effort to recruit in the first trimester (<14 weeks). Serial haemoglobin measurements will be done during the antenatal period (13 weeks, 20 weeks, 28 weeks, 36 weeks) and 42 days postpartum. Both mother and infant(s) will continue to be followed up until 1 year after delivery.

A sub cohort of 1200 to 2000 women from the aim 2 cohort will be further screened to identify a healthy pregnant population of 600 participants for the aim 1 (establishing reference values). Aim 3 will include a cross-section of 300 women (100 per trimester), randomly sampled from those screened for the Aim 1 sub-cohort, to participate in a biomarker intensive sub-study to determine the underlying contributing factors to anaemia.

Expected Outcomes

The study will contribute to a growing body of evidence that could inform new global guidelines for diagnosing maternal anaemia and identifying high-risk pregnancies based on haemoglobin levels.

Funders

Bill & Melinda Gates Foundation.

Study Duration : Two (2) years

Start Date : 01 Jul 2023

End Date : 31 Dec 2025