Burden of Placental Malaria among Pregnant Women Who Use or Do Not Use Intermittent Preventive Treatment at Mulago Hospital, Kampala

Abstract

Intermittent preventive treatment of malaria in pregnancy with sulphadoxine-pyrimethamine (SP-IPTp) is widely used to reduce the incidence of adverse pregnancy outcomes. As a monitor for continued effectiveness of this intervention amidst SP resistance, we aimed to assess malaria burden among pregnant women who use or do not use SP-IPTp. In a descriptive cohort study at Mulago Hospital, Kampala, 87 women who received two supervised doses of SP-IPTp were followed up until delivery. Controls were pregnant women presenting in early labour without history of SP-IPTp. Histopathological investigation for placental malaria (PM) was performed using the Bulmer classification criterion. Thirty-eight of the 87 women returned for delivery and 33 placentas were successfully collected and processed along with 33 placentas from SP nonusers. Overall, 12% (4/33) of the users had evidence of PM compared to 48% (16/33) of nonusers. Among nonusers, 17/33, 8/33, 2/33, and 6/33 had no placental infection, active infection, active-chronic infection, and past-chronic infection, respectively. Among users, respective proportions were 29/33, 2/33, 0/33, and 2/33. No difference in birth weights was apparent between the two groups, probably due to a higher proportion of infections occurring later in pregnancy. Histological evidence here suggests that SP continues to offer substantial benefit as IPTp.

Relative impact of pre-eclampsia on birth weight in a low resource setting: A prospective cohort study

“…Women were asked whether they had experienced a severe febrile illness during the pregnancy. Given knowledge of local infectious disease prevalence and population susceptibility [16] , this was likely to represent malaria during pregnancy ( Appendix S1 ). We also obtained data on whether the mother was known to be HIV positive or not.…”

Placental Malaria

“…A significant mediator of reduced risk in later pregnancies is through the development of antibodies against VAR2CSA [43,44]. However, in regions with low transmission rates, all pregnancies are at increased risk of for placental malaria given the lower immunity within the population [7].…”

“…Additionally, these infants are at increased risk for poor developmental outcomes through childhood and beyond [55]. This is of major concern as low birth weight is a placental malaria outcome that remains persistent in areas with low malaria transmission rates and is predicted to increase as malaria endemicity decreases globally [7,55].…”

Prevalence of placental malaria among asymptomatic pregnant women in Wolkite health center, Gurage zone, Southern Ethiopia

“…Placental malaria infection is characterized by the accumulation of parasitized red blood cells (pRBCs) in placental intervillous spaces that express unique membrane-bound proteins from the P. falciparum erythrocyte membrane protein-1 (PfEMP-1) to bind to host receptors like chondroitin sulfate A (CSA) in the placental intervillous space leading to placental malaria (PM) [5]. It is associated with increased risk of maternal anemia, LBW, preterm delivery, intrauterine growth restriction, reduced fetal anthropometric parameters, fetal anemia, and congenital malaria [6].…”