Impact of malaria during pregnancy on pregnancy outcomes in a Ugandan prospectivecohort with intensive malaria screening and prompt treatment

Abstract

BackgroundMalaria in pregnancy (MiP) is a major public health problem in endemic areas of sub-Saharan Africa and has important consequences on birth outcome. Because MiP is a complex phenomenon and malaria epidemiology is rapidly changing, additional evidence is still required to understand how best to control malaria. This study followed a prospective cohort of pregnant women who had access to intensive malaria screening and prompt treatment to identify factors associated with increased risk of MiP and to analyse how various characteristics of MiP affect delivery outcomes.MethodsBetween October 2006 and May 2009, 1,218 pregnant women were enrolled in a prospective cohort. After an initial assessment, they were screened weekly for malaria. At delivery, blood smears were obtained from the mother, placenta, cord and newborn. Multivariate analyses were performed to analyse the association between mothers’ characteristics and malaria risk, as well as between MiP and birth outcome, length and weight at birth. This study is a secondary analysis of a trial registered with ClinicalTrials.gov, number NCT00495508.ResultsOverall, 288/1,069 (27%) mothers had 345 peripheral malaria infections. The risk of peripheral malaria was higher in mothers who were younger, infected with HIV, had less education, lived in rural areas or reported no bed net use, whereas the risk of placental infection was associated with more frequent malaria infections and with infection during late pregnancy. The risk of pre-term delivery and of miscarriage was increased in mothers infected with HIV, living in rural areas and with MiP occurring within two weeks of delivery.In adjusted analysis, birth weight but not length was reduced in babies of mothers exposed to MiP (−60g, 95%CI: -120 to 0 for at least one infection and -150 g, 95%CI: -280 to −20 for >1 infections).ConclusionsIn this study, the timing, parasitaemia level and number of peripherally-detected malaria infections, but not the presence of fever, were associated with adverse birth outcomes. Hence, prompt malaria detection and treatment should be offered to pregnant women regardless of symptoms or other preventive measures used during pregnancy, and with increased focus on mothers living in remote areas.

Effects of Malaria in Pregnancy (MiP) on Pregnancy Development and its Outcome: a Critical Review

“…Different species of malaria parasite release different antigen to facilitate binding. For instance, P. falciparum releases Erythrocyte Binding Antigen-175 (EBA-175) [51], a microneme protein which binds to the sialic acid residue on glycophorins of the RBCs [55]. A merozoite serine protease cleaves band 3, causing a disruption in the cytoskeleton of RBC.…”

“…This results in mechanical destruction of the RBC through haemolysis [51]. The AMA-1 also releases coats the surface of non-parasitized RBCs and are cleared by the immune system [55,51]. Again, the antigens act to down regulate erythropoiesis, and the cumulative effect of these activities seeks to reduce the quantity of RBCs leading to anaemia [48].…”

“…Mechanism of clearance of IRBCs is known to be mediated by phagocytosis and complement activation [56]. Notwithstanding, reports show that examination of bone marrow from children with severe anaemia showed hypercellularity, mild to normal erythroid hyperplasia and abnormal features of late erythroid progenitor cells [7,52,55]. Haemozoin produced through phagocytosis by bone marrow macrophages has been proposed to cause dyserythropoiesis either through direct accumulation in the bone marrow and generation of reactive toxic species or activation of the innate immune response [7,56,57].…”

Haematological Profile of Pregnant Women Infected With Malaria Parasites at Federal Teaching Hospital Abakaliki, Ebonyi State

“…Many studies from areas with different malaria transmission patterns have investigated the consequences of malaria in pregnancy on both maternal health and birth outcomes (DeBeaudrap et al, 2013). Malaria in pregnancy has been associated with significant degree of intrauterine growth restriction, 36% of preterm deliveries, 30% of preventable low birth weight deliveries, 14% of low birth weight deliveries and 15% of maternal anaemia (Steketee et al, 2001).…”

Effect of a Nurse-Led Health Talk on Malaria Prevention Behaviors among Primigravida Women Attending University of Jos Health Centre, Plateau State

“…Malaria infection during pregnancy has been a major public health problem in endemic areas such as tropical and subtropical regions throughout the world. 4 The burden of malaria infection during pregnancy is caused chiefly by Plasmodium falciparum; the most common malaria species in Africa. 5 Primigravida accounted for a greater part of the 60% prevalence of malaria that affected mainly women in their first trimester of pregnancy, and the age range of the infected women is 30-39 years.…”