C-reactive protein is differentially modulated by co-existing infections,vitamin deficiencies and maternal factors in pregnant and lactating indigenous Panamanian women

Background:The usefulness of C-reactive protein(CRP)as a non-specific marker of inflammation during pregnancy and lactation is unclear in impoverished populations where co-existing infections and vitamin deficiencies are common.Methods:This cross-sectional study in Panama recruited 120 pregnant and 99 lactating Ngäbe-Buglewomen from 14 communities in rural Panama.Obstetric history,indoor wood smoke exposure,fieldwork,BMI,vitamins A,B_(12),D,and folic acid,and inflammation markers(CRP,neutrophil/lymphocyte ratio(NLR),plateletcrit and cytokines)were measured.Multiple regressions explored both associations of CRP with other inflammatory markers and associations of CRP and elevated CRP based on trimester-specific cut-offs with maternal factors,infections and vitamin deficiencies.Results:CRP was higher in pregnancy(51.4±4.7 nmol/L)than lactation(27.8±3.5 nmol/L)and was elevated above trimester specific cut-offs in 21%of pregnant and 30%of lactating women.Vitamin deficiencies were common(vitamin A 29.6%;vitamin D 68.5%;vitamin B1268%;folic acid 25.5%)and over 50%of women had two or more concurrent deficiencies as well as multiple infections.Multiple regression models highlighted differences in variables associated with CRP between pregnancy and lactation.In pregnancy,CRP was positively associated with greater indoor wood smoke exposure,caries and hookworm and negatively associated with Ascaris and vaginal Lactobacillus and Bacteroides/Gardnerella scores.Consistent with this,greater wood smoke exposure,caries as well as higher diplococcal infection score increased the odds of trimester-elevated CRP concentrations whereas longer gestational age lowered the likelihood of a trimester-elevated CRP.During lactation,folic acid deficiency was associated with higher CRP whereas parity,number of eosinophils and Mobiluncus score were associated with lower CRP.Also,a higher BMI and Trichomonas vaginalis score increased the likelihood of an elevated CRP whereas higher parity and number of eosinophils were associated with lower likelihood of an elevated CRP.Conclusions:Infections both raise and lower CRP concentrations in pregnant and lactating mothers.Only folic acid deficiency during lactation was associated with higher CRP concentrations.Caution is required when interpreting CRP concentrations in pregnant and lactating women who have co-existing nutrient deficiencies and multiple infections.