Associations Between Placental and Cord Blood Malaria Infection and Fetal Malnutrition in an Area of Malaria Holoendemicity

Abstract

The objective of this study was to determine the role of malaria in the etiology of fetal malnutrition in Nigeria. This study took place at the Neonatal and Maternity Units of the Wesley Guild Hospital, Ilesa, Nigeria. This is a prospective study of 304 consecutive, singleton, term live births delivered between January and August 2002. Anthropometric and clinical data were recorded. Fetal malnutrition (FM; failure to acquire adequate quantum of fat and muscle mass during intrauterine growth) was diagnosed using clinical assessment of fetal nutritional status (CANS) and the score (CANSCORE) adapted by Metcoff. The placenta tissues were examined for malaria pigments and parasites, and placental and cord blood smears were examined for parasites. Babies were followed up in the neonatal period for clinical malaria. Babies were grouped into those with malaria-infected placental and cord blood specimens and those without. The two groups were compared with regard to the proportions with FM and complications of FM. Three hundred four placental and cord blood specimens were examined for malaria. Of the 304, 101 (33.2%) of the placental and 67 (22.0%) of the cord blood specimens were positive for malaria. Sixty-six (21.7%) of the 304 babies had FM. Forty-four (66.7%) of the 66 placental blood specimens of babies with FM were positive for malaria, whereas 57 (24.0%) of the 238 placentae of babies without FM had placental malaria (chi(2) =42.5, P < 0.0001). Similarly, 27 (40.9%) of 66 babies with FM compared with 40 (16.8%) among 238 babies without FM had malaria parasites in the cord blood (chi(2) =17.5, P < 0.001). The means of birth weight, ponderal index, and placenta weight were significantly lower among the babies of mothers with malaria-infected placentae than those without (P < 0.05 in all cases). Lack of antenatal care, primiparity, and failure to have chemoprophylaxis against malaria were the maternal factors found to be associated with placental malaria infection. Placental malaria is a major factor in the etiology of FM in Nigeria.

Placental malarial parasitaemia and pregnancy outcome among parturients in a tertiary hospital in South- South Nigeria

“…The lower prevalence reported in this study may be due to the effective malaria control measures employed in the population, which include sulphadoxine -pyrimethamine 20 Several studies have shown that parity influences susceptibility to placental malaria with primigravidae being more susceptible compared to multigravidae. 19,24,25 In this study, higher parity did not confer any protection and this was consistent with the observations of Bako et al, 6 SuleOdu et al, 8 and Ofori et al 24 This finding was not surprising as same proportion of women across the various parities (nulliparous, primiparous and multiparous) used ITNs and also had at least 2 doses of IPT.…”

“…18 Higher rates of 33.2% and 53.6% were previously reported by Adebami et al 19 and BouyouAkotet et al 20 in Ile -Ife, Nigeria and Gabon respectively. The lower prevalence reported in this study may be due to the effective malaria control measures employed in the population, which include sulphadoxine -pyrimethamine 20 Several studies have shown that parity influences susceptibility to placental malaria with primigravidae being more susceptible compared to multigravidae.…”

Excess Fibrin Deposits Decrease Fetal Weight of Pregnant Mice Infected by Plasmodium berghei

“…Weight of fetuses was significantly different between the control group and treatment group, this was supported by many previous studies [6,9,10]. The means of birth weight, chest circumference, ponder index, and placental weight were significantly lower among the babies of mothers with malaria-infected placenta than those without.…”

“…Fibrin deposit in the treatment group was significantly increasing than the control group in this study. This finding was supported by [9] that histological sections for placental fibrin revealed that women with placental malaria had more deposition than normal pregnant women, although the difference was subtle. Placental malaria induces dysregulated hemostasis both active coagulation and suppressed fibrinolysis and thus provided an expanded functional explanation for the excessive fibrin accumulation found in the infected placenta [9].…”

Sulfadoxine-Pyrimethamine–Based Intermittent Preventive Treatment, Bed Net Use, and Antenatal Care during Pregnancy: Demographic Trends and Impact on the Health of Newborns in the Kassena Nankana District, Northeastern Ghana

“…16 It seems remarkable that a single dose of S/P during pregnancy could significantly improve the health of the newborn, and that these effects should only be seen in first-born children. It is no less surprising that this drug, even at multiple doses, should demonstrate a virtual absence of benefit in children born of multigravid mothers.…”