Impact of asymptomatic maternal malaria parasitaemia at parturition on perinatal outcome

Abstract

A cross-sectional study involving 564 parturients who delivered singleton babies and 214 matched non-pregnant controls was carried out to determine the prevalence and impact of asymptomatic maternal malaria parasitaemia at parturition on the perinatal outcome. One hundred and forty (24.8%) parturients and 50 (23.4%) non-pregnant women were found to have asymptomatic malaria parasitaemia, respectively, while the congenital malaria rate in the neonates of the parasitaemic parturients was 0.7%. The incidence of malaria parasitaemia was higher in the para 2 and over (29.33%) as compare to the para 1 (21.43%) and primigravid (18.42%). There was no significant difference between the mean birth weight of infants delivered by parasitaemic parturients (2.93+/-0.61 kg) and aparasitaemic parturients (3.07+/-0.32 kg) (P=0.501). There was also no significant difference when comparing the mean placental weight of the parasitaemic mothers (0.60+/-0.15 kg) with that of the aparasitaemic mothers (0.62+/-0.20 kg) (P=0.329). Only in the para 2 and over was the mean placental weight of the parasitaemic mothers significantly lower than that of the aparasitaemia mothers (0.46+/-0.16 kg; 0.66+/-0.23 kg P=0.035). The mean packed cell volume of the parasitaemics parturients (30.89+/-1.87) was significantly lower than the aparasitaemic parturients (31.98+/-2.25) (P<0.001). Significant difference was not achieved between the parasitaemics and aparasitaemics inrespect of apgar score at 1 minute, or at 5 minutes, premature births (16.43%; 15.33%; P>0.05), stillbirth rate (3.57%; 2.59, P>0.05), mean placental index (0.204, 0.202, P>0.50) and mode of delivery. The findings in this study show that even though malaria parasitaemia is prevalent in our locality, the effects on maternal and fetal wellbeing are comparable with the aparasitaemics.

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.…”

“…[6][7][8][9] Various studies have linked placental malaria to maternal anaemia. 18,24 However, in this study, there was no significant association between placental malaria and maternal anaemia when controlled for the other confounding variables, using the multivariate logistic regression model.…”

“…13 The World Health Organization (WHO) has recommended a three prong approach to the prevention and control of malaria during pregnancy in areas of stable transmission through the use of intermittent preventive (IPT) of asymptomatic pregnant women, use of insecticide treated nets (ITNs) and prompt and effective case management of acute malaria in pregnancy. 14 Although there have been some studies demonstrating how placental parasitaemia adversely affect pregnancy outcome in some parts of the country, 6,8,9,15 none has been conducted in Akwa Ibom State, South -South Nigeria. Considering the endemic nature of the disease in the State and the impact it could have on both mother and the fetus, this study was necessary to determine the prevalence of placental malaria and its influence on pregnancy outcome especially during the peri-partum period when preventive measures would have already been instituted.…”

“…[4][5] Although often asymptomatic, especially in immune women, malaria has been implicated in several studies as a cause of some unfavourable pregnancy outcomes. [6][7][8][9] These outcomes include anemia in pregnancy, fetal anemia, miscarriage, intra-uterine fetal death, premature labour and congenital malaria. The adverse consequences are mainly as a result of sequestration of parasitized erythrocytes present in the placental intervillous spaces, to chondroitin sulphate A (CSA) in the placenta.…”

Congenital malaria: an overview

“…Some other reports in the 1980s however noted that the low reported incidence of congenital malaria particularly in Africa was surprising since malaria occurs more commonly in pregnancy (McGregor, 1983;Lehner & Andrews, 1988). More recently, findings from a number of studies from sub-Saharan Africa have described congenital malaria as a rare event largely because the prevalence of malaria parasite in cord blood or neonatal blood was very low and few newborns developed clinical disease during the first few weeks of life (Lamikanra 1993;Djibo & Cenac, 2000;Adachi et al, 2000;Sule-Odu et al, 2002). These studies had speculated that the effectiveness of the placenta to restrain the malaria parasite passage to the foetus and the remarkable capacity of the foetus to resist infection as demonstrated by Miller & Telford (1997) was responsible for the rarity of congenital malaria.…”