Effects of Vivax Malaria Acquired Before 20 Weeks of Pregnancy on Subsequent Changes in Fetal Growth

Abstract

Abstract. The resistance index (RI), pulsatility index (PI), fetal biometry, fetal heart rate (FHR), placental thickness, and hemoglobin levels were compared in 30 Plasmodium vivax-infected women between 14 and 20 weeks of pregnancy and a control group. Evaluations were performed at the moment of the malaria diagnosis and 26 weeks of pregnancy. The malaria group had lower levels of hemoglobin and greater placental thickness in both assessments, higher FHR in the first evaluation, and lower values on fetal biometry in the second assessment. There were no differences when comparing RI and PI on umbilical arteries between the two groups. Birth weight and height were lower in newborns in the malaria group than the control group. The results suggest that P. vivax infections at an earlier gestational age do not affect umbilical arteries blood flow but do affect fetal biometry in the second trimester of pregnancy and at birth.

The Impact of Gravidity, Symptomatology and Timing of Infection on Placental Malaria

“…Previous studies exploring the impact of timing of malaria infection during pregnancy have been mixed, and few prior studies have examined the relationship between timing of infection in pregnancy and development of placental malaria despite the well-established association of placental malaria with increased adverse obstetric outcomes. 10,19,20 Several studies have found increased rates of SGA, 21 decreased birthweight, 22,23 and decreased fetal growth velocity 24 with early malaria infection while others have found more significant detrimental effects on fetal growth with infection in the second or third trimesters 25 and/or at delivery. 26,27 Additionally, several studies found a negative impact on fetal growth with both early and late infection.…”

Effects of Plasmodium falciparum infection on umbilical artery resistance and intrafetal blood flow distribution: a Doppler ultrasound study from Papua New Guinea

“…A small number of ultrasound-based studies in LMICs have examined factors associated with abnormal placental development and fetal growth, and have evaluated the potential effects of malaria parasitaemia on uteroplacental and fetoplacental blood flow [14–19]. Symptomatic falciparum malaria in early third trimester was associated with acutely increased UARI and reduced MCA resistance in French Guiana [14, 15].…”

“…Infection in early pregnancy (<20 gestational weeks) was associated with increased uterine artery resistance in undernourished Congolese women, and with reduced UARI in later pregnancy amongst primigravidae, the latter perhaps being due to adaptive villous angiogenesis following a treated infection [18]. In a case–control study of P. vivax in pregnancy in Brazil, parasitaemia early in pregnancy was associated with reduced fetal growth later in pregnancy, but UARI did not differ between infected/uninfected groups [19]. …”

The impact of gravidity, symptomatology and timing of infection on placental malaria

“…Previous studies exploring the impact of timing of malaria infection during pregnancy have been mixed, and few prior studies have examined the relationship between timing of infection in pregnancy and development of placental malaria despite the well-established association of placental malaria with increased adverse obstetric outcomes [10,19,20]. Several studies have found increased rates of SGA [21], decreased birthweight [22,23], and decreased fetal growth velocity [24] with early malaria infection while others have found more signi cant detrimental effects on fetal growth with infection in the second or third trimesters [25] and/or at delivery [26,27].…”