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      High prevalence of kaolin consumption in migrant women living in a major urban area of France: A cross-sectional investigation

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          Abstract

          Geophagia is a feeding behavior involving the regular intake of soil, including clay-like kaolin. Frequent in Africa, kaolin consumption is associated with heavy metal intoxication, iron and other micronutrient deficiencies, geohelminth infection and inactivation of concomitantly taken drugs. It is expected that this practice would be imported into an asylum country during the immigration process. To confirm this hypothesis, a single center, cross-sectional study was conducted at the University Hospital of Nantes, France, whose main objective was to assess whether the prevalence of kaolin consumers was high in a migrant population living in a large French metropolitan area (the city of Nantes). Each woman consulting for the first time at the Medical and Psychosocial Gynecology Obstetric Unit during the inclusion period ranging from January 1, 2017, to July 1, 2017, was asked for consent to be included in the study. The main outcome was the proportion of positive answers regarding consumption of kaolin within the last twelve months, with its 95% confidence interval (CI). A logistic regression was performed to identify drivers of consumption, and a clustering approach was conducted to identify profiles of consumers. A total of 284 women were included in the study, of whom 110 (38.7%) were pregnant. Our main finding was a 14.1% (95% CI: 10.5–18.6) prevalence of clay consumers. Second, the characteristic most strongly associated with consumption was Central or West Africa origin (adjusted Odds Ratio (aOR) = 52.7; 95% CI: 13.7–202.2). Finally, 60% of consumers showed signs of addictive-like phenomena, and three profiles were identified, depicting a continuum of patients in regard to their control over their kaolin consumption. Our results suggest that kaolin consumption is frequent in particular subpopulations of migrants. This warrants further study of the clinical consequences of kaolin consumption and its associated addictive-like symptoms.

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          Most cited references 37

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          Anemia and iron deficiency: effects on pregnancy outcome.

           L H Allen (2000)
          This article reviews current knowledge of the effects of maternal anemia and iron deficiency on pregnancy outcome. A considerable amount of information remains to be learned about the benefits of maternal iron supplementation on the health and iron status of the mother and her child during pregnancy and postpartum. Current knowledge indicates that iron deficiency anemia in pregnancy is a risk factor for preterm delivery and subsequent low birth weight, and possibly for inferior neonatal health. Data are inadequate to determine the extent to which maternal anemia might contribute to maternal mortality. Even for women who enter pregnancy with reasonable iron stores, iron supplements improve iron status during pregnancy and for a considerable length of time postpartum, thus providing some protection against iron deficiency in the subsequent pregnancy. Mounting evidence indicates that maternal iron deficiency in pregnancy reduces fetal iron stores, perhaps well into the first year of life. This deserves further exploration because of the tendency of infants to develop iron deficiency anemia and because of the documented adverse consequences of this condition on infant development. The weight of evidence supports the advisability of routine iron supplementation during pregnancy.
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            A clustering technique for summarizing multivariate data.

             Chad G. Ball,  D. Hall (1967)
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              Maternal anemia during pregnancy is an independent risk factor for low birthweight and preterm delivery.

              The present study was designed to investigate the outcome of pregnancy and delivery in patients with anemia. A retrospective population-based study comparing all singleton pregnancies of patients with and without anemia was performed. Deliveries occurred during the years 1988-2002 in the Soroka University Medical Center. Maternal anemia was defined as hemoglobin concentration lower than 10 g/dl during pregnancy. Patients with hemoglobinopathies such as thalassemia were excluded from the analysis. Multiple logistic regression models were performed to control for confounders. During the study period there were 153,396 deliveries, of which 13,204 (8.6%) occurred in patients with anemia. In a multivariable analysis, the following conditions were significantly associated with maternal anemia: placental abruption, placenta previa, labor induction, previous cesarean section (CS), non-vertex presentation and Bedouin ethnicity. Higher rates of preterm deliveries (<37 weeks gestation) and low birthweight (<2500 g) were found among patients with anemia as compared to the non-anemic women (10.7% versus 9.0%, p < 0.001 and 10.5% versus 9.4%, p < 0.001; respectively). Higher rates of CS were found among anemic women (20.4% versus 10.3%; p < 0.001). The significant association between anemia and low birthweight persisted after adjusting for gender, ethnicity and gestational age, using a multivariable analysis (OR = 1.1; 95% CI 1.0-1.2, p = 0.02). Two multivariable logistic regression models, with preterm delivery (<37 weeks gestation) and low birthweight (<2500 g) as the outcome variables, were constructed in order to control for possible confounders such as ethnicity, maternal age, placental problems, mode of delivery and non-vertex presentation. Maternal anemia was an independent risk factor for both, preterm delivery (OR = 1.2; 95% CI 1.1-1.2, p < 0.001) and low birthweight (OR = 1.1; 95% CI 1.1-1.2, p = 0.001). Maternal anemia influences birthweight and preterm delivery, but in our population, is not associated with adverse perinatal outcome.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SoftwareRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: InvestigationRole: ResourcesRole: SupervisionRole: ValidationRole: Writing – review & editing
                Role: ConceptualizationRole: Methodology
                Role: Data curationRole: Investigation
                Role: ConceptualizationRole: Formal analysisRole: Methodology
                Role: ConceptualizationRole: InvestigationRole: Validation
                Role: ConceptualizationRole: InvestigationRole: Validation
                Role: Funding acquisition
                Role: Funding acquisitionRole: InvestigationRole: ValidationRole: Writing – review & editing
                Role: ConceptualizationRole: InvestigationRole: MethodologyRole: Project administrationRole: SupervisionRole: ValidationRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                31 July 2019
                2019
                : 14
                : 7
                Affiliations
                [1 ] Department of Clinical Pharmacology, University Hospital of Nantes, Nantes, France
                [2 ] Department of Gynecology and Obstetrics, University Hospital of Nantes, Nantes, France
                [3 ] Department of Addictology and Psychiatry, University Hospital of Nantes, Nantes, France
                [4 ] SPHERE U1246 Unit, University of Nantes, University of Tours, INSERM, Nantes, France
                [5 ] INRA, UMR 1280, Physiology of Nutritional Adaptations, University of Nantes, IMAD, Nantes, France
                Universidad de Valladolid, SPAIN
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Article
                PONE-D-18-36899
                10.1371/journal.pone.0220557
                6668907
                31365572
                © 2019 Caillet et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                Page count
                Figures: 0, Tables: 6, Pages: 14
                Product
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/501100009406, Centre Hospitalier Universitaire de Nantes;
                This work was supported by the University Hospital of Nantes. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Biology and Life Sciences
                Psychology
                Addiction
                Social Sciences
                Psychology
                Addiction
                Medicine and Health Sciences
                Women's Health
                Maternal Health
                Pregnancy
                Medicine and Health Sciences
                Women's Health
                Obstetrics and Gynecology
                Pregnancy
                People and Places
                Geographical Locations
                Africa
                Medicine and Health Sciences
                Hematology
                Anemia
                Iron Deficiency Anemia
                People and Places
                Population Groupings
                Age Groups
                Children
                People and Places
                Population Groupings
                Families
                Children
                Social Sciences
                Economics
                Finance
                Medicine and Health Sciences
                Mental Health and Psychiatry
                Substance-Related Disorders
                Intoxication
                Medicine and Health Sciences
                Public and Occupational Health
                Substance-Related Disorders
                Intoxication
                Physical Sciences
                Chemistry
                Chemical Elements
                Iron
                Custom metadata
                Given the confidentiality of this clinical research, our ethics committee (GNEDS) is preventing us from making our data set publicly available. However, we are willing to make our data available upon request as we consider that it is important for open and reproducible science, and thus we will ensure that all interested and qualified researchers will be able to be granted access.Furthermore, Anne Omnès ( anne.omnes@ 123456chu-nantes.fr ) is the contact for data requests and she will able to approve and distribute our data upon request.

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