Retardo no crescimento intrauterino, baixo peso ao nascer e prematuridade em recém-nascidos de grávidas com malária, na Colômbia

Abstract

RESUMOIntrodução: É frequente a associação da malária com complicações como prematuridade, retardo no crescimento intrauterino, baixo peso ao nascer e mortalidade infantil, efeitos pouco estudados em áreas hipoendêmicas para malaria. O objetivo deste estudo foi analisar a relação da malária gestacional com estes efeitos em recém-nascidos numa região endêmica para malária na Colômbia, entre 1993 e 2007. Métodos: Foram estudadas as características em 1.716 recém-nascidos num estudo de coorte. Fez-se seguimento em 394 gestantes com malária (27% por Plasmodium falciparum e 73% por P. vivax) e 1.322 sem malária. Resultados: Foi encontrada uma relação entre a exposição à malária na gestação e o risco maior de baixo peso ao nascer (RR = 1,37; 1,03-1,83), assim como estatura baixa (RR = 1,52; 1,25-1,85), retardo no crescimento intrauterino (RR = 1,29; 1,0-1,66) e prematuridade (RR = 1,68; 1,3-2,17). A frequência de nascimentos prematuros foi maior nas mães com malária por P. falciparum (77%) que aquelas com P. vivax (RR = 1,77; IC 95%: 1,2-2,6). Conclusões: O baixo peso ao nascer e o retardo no crescimento foi associado com malária na gestação na Colômbia. A infecção por P. vivax foi relacionada com efeitos adversos sobre o recém-nascido, de modo semelhante em relação ao P. falciparum. Palavras-chaves: Malária na gestação. Recém-nascidos. Peso ao nascer. Retardo no crescimento intrauterino. Prematuridade. ABSTRACT Introduction:Association between malaria and pregnancy complications, such as prematurity, intrauterine growth restriction, low birthweight and infant mortality has been reported. These effects have been studied widely in areas hyperendemic for malaria, but studies in low-endemic areas are scarce. The study investigated the relation between gestational malaria and low birthweight and intrauterine growth retardation in neonates of a malarial endemic region in Colombia, between 1993 and 2007. Methods: The pattern of development in 1,716 neonates of women with and without malaria infection during pregnancy was evaluated in a cohort study. A total of 394 infected (27% by P. falciparum and 73% by P. vivax) and 1,322 noninfected pregnant women were followed. Results: Exposure to gestational malaria was associated with increased risk of low birth weight (RR = 1.37; 1.03-1.83), short height (RR = 1.52; 1.25-1.85), intrauterine growth retardation (RR = 1.29; 1.0-1.66) and prematurity (RR = 1.68; 1.3-2.17). Prematurity was 77% higher in infants of mothers with malaria by P. falciparum than infants of mothers with malaria by P. vivax (RR = 1.77; 1.2-2.6). Conclusions: Low birth weight and intrauterine growth retardation were associated with malaria during pregnancy. Infection with P. vivax was related with adverse effects on the newborn, similar to that reported for P. falciparum.

Prevalence of hearing loss in newborns of mothers who had malaria and were treated with antimalaric drugs in pregnancy

“…In the present study, Plasmodium vivax was the most frequent species found in women during pregnancy, as also reported in other studies 10,13,[19][20][21] . The highest frequency of malaria was observed in the first trimester of gestation.…”

Prevalence of gestational, placental and congenital malaria in north-west Colombia

“…Recent evidence gathered in the country, confirmed the deleterious effect of the infection, in both P. vivax and P. falciparum malaria, in pregnant subjects, with presence of organ specific complications [10], congenital malaria [11], and low birth weight and prematurity [12]. All the above data confirmed gestational and placental malaria as a serious public health problem in north-west Colombia, where most of the country´s cases of malaria are reported.…”

“…Studies on gestational placental or congenital malaria are scarce in America in comparison to Africa [4-6,26,27] and most recent reports come from Colombia [7,9-12] and Brazil [4,26]. In the Brazilian Amazon, among 1,699 women with malaria, the prevalence of gestational malaria was 11.7% and P. vivax was confirmed in 83% of cases [25].…”

Reduction of incidence and relapse or recrudescence cases of malaria in the western region of the Brazilian Amazon

“…In addition, 0.8% of the patients were pregnant women. Despite this low percentage, pregnant women with malaria should be considered a high-risk group because the disease makes these women more susceptible to the severe forms of the disease [35], which can cause premature birth, low birth weight, anemia, and even abortion [36][37][38][39].…”