Improved Pregnancy Outcomes in Women Exposed to Malaria With High Antibody Levels Against Plasmodium falciparum

Mayor, Alfredo; Kumar, Urwashi; Bardají, Azucena; Gupta, Pankaj; Jiménez, Alfons; Hamad, Amel Ben; Sigaùque, Betuel; Singh, Bijender; Quintó, Llorenç; Kumar, Sanjeev; Gupta, Puneet Kumar; Chauhan, Virander S.; Dobaño, Carlota; Alonso, Pedro L.; Menéndez, Clara; Chitnis, Chetan E.

doi:10.1093/infdis/jit083

Cited by 40 publications

(44 citation statements)

References 48 publications

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“…Again, previous malaria episodes have been demonstrated to be associated with increased antibody levels [59] but this was not explored in the present study. Another interesting factor associated with failure to acquire protective PAM immunity is exposure-reducing interventions [41].…”

Section: Discussionmentioning

confidence: 94%

Effect of IPTp on Plasmodium falciparum antibody levels among pregnant women and their babies in a sub-urban coastal area in Ghana

Stephens

Kyei-Baafour

Dickson

et al. 2017

Malar J

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BackgroundWomen exposed to Plasmodium infection develop antibodies and become semi-immune. This immunity is suppressed during pregnancy making both the pregnant woman and the foetus vulnerable to the adverse effects of malaria, particularly by Plasmodium falciparum. Intermittent preventive treatment of malaria in pregnancy (IPTp) with Sulfadoxine–pyrimethamine (SP) tablets is one of the current interventions to mitigate the effects of malaria on both the pregnant woman and the unborn child. The extent to which IPTp may interfere with the acquisition of protective immunity against pregnancy-associated malaria (PAM) is undefined in Ghana.MethodsThree-hundred-and-twenty pregnant women were randomly enrolled at the antenatal clinic (ANC) in Madina, Accra. Venous blood samples were obtained at first ANC registration and at 4-week intervals (post-IPTp administration). Placental and cord blood samples were obtained at delivery and the infants were followed monthly for 6 months after birth. Anti-IgG and IgM antibodies against a crude antigen preparation and the glutamate-rich protein (GLURP) of P. falciparum were quantified by the enzyme-linked immunosorbent assay (ELISA).ResultsThere was a general decline in the trend of mean concentrations of all the antibodies from enrolment to delivery. The levels of antibodies in cord blood and placenta were well correlated. Children did not show clinical signs of malaria at 6 months after birth.ConclusionsIgG against both crude antigen and GLURP were present in placenta and cord blood and it is therefore concluded that there is a trend of declining antibody from enrolment to delivery and IPTp-SP may have reduced malaria exposure, however, this does not impact on the transfer of antibodies to the foetus in utero. The levels of maternal and cord blood antibodies at delivery showed no adverse implications on malaria among the children at 6 months. However, the quantum and quality of the antibody transferred needs further investigation to ensure that the infants are protected from severe episodes of malaria.

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Section: Discussionmentioning

confidence: 94%

Effect of IPTp on Plasmodium falciparum antibody levels among pregnant women and their babies in a sub-urban coastal area in Ghana

Stephens

Kyei-Baafour

Dickson

et al. 2017

Malar J

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“…The interaction between malaria and HIV is particularly deleterious in pregnant women, leading to increased risk and severity of both malaria infection and disease [1],[2]. In addition, HIV infection attenuates the relative protection against malaria acquired with subsequent pregnancies, placing more women at risk for malaria-related complications [4],[5]. Moreover, HIV infection reduces the efficacy of malaria interventions and complicates the use of antimalarials because of potential drug interactions [6],[7].…”

Section: Introductionmentioning

confidence: 99%

Intermittent Preventive Treatment of Malaria in Pregnancy with Mefloquine in HIV-Infected Women Receiving Cotrimoxazole Prophylaxis: A Multicenter Randomized Placebo-Controlled Trial

et al. 2014

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“…In previous reports the mothers were secundigravidae [9], secundigravidae with placental malaria and HIV [41] or women with chronic placental infection [35] and antibody levels were measured at delivery rather than in early pregnancy. Rather than demonstrating population-wide associations between malaria antibodies and birthweight (as studied here), most published studies have been restricted to women of a specific gravidity or HIV and/or malaria infection status [12, 30, 33]. Further prospective studies of these high-risk groups for associations between immunity and outcome may be indicated.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, malaria infection, HIV and gravidity have been shown to modify the effects of the association between malaria immunity and pregnancy outcomes [12, 23]. Malaria prevention strategies such as indoor residual spraying, insecticide-treated bed nets (ITNs) and intermittent preventive treatment in pregnancy (IPTp) are designed to reduce the exposure to malaria and improve pregnancy outcomes, but may impair acquisition of immunity [24].…”

Section: Introductionmentioning

confidence: 99%

Association between malaria immunity and pregnancy outcomes among Malawian pregnant women receiving nutrient supplementation

Chandrasiri

Fowkes

Beeson

et al. 2016

Malar J

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BackgroundMalaria antibody responses measured at delivery have been associated with protection from maternal anaemia and low birth weight deliveries. Whether malarial antibodies present in the first half of pregnancy may protect from these or other poor birth outcomes is unclear. To determine whether malaria antibodies in the first half of pregnancy predict pregnancy outcomes, antibodies were measured to a range of merozoite antigens and to antigens expressed on the surface of parasitized red blood cells (pRBCs) in plasma samples collected at 14–20 weeks of gestation from Malawian women. The latter antibodies were measured as total IgG to pRBCs, and antibodies promoting opsonic phagocytosis of pRBCs. Associations between antibodies and maternal haemoglobin in late pregnancy or newborn size were investigated, after adjusting for potential covariates.ResultsAntibodies to pRBC surface antigens were associated with higher haemoglobin concentration at 36 weeks. Total IgG to pRBCs was associated with 0.4 g/l [(95% confidence interval (0.04, 0.8)] increase in haemoglobin, and opsonizing antibody with 0.5 (0.05, 0.9) increase in haemoglobin for each 10% increase in antibody. These antibodies were not associated with birthweight, placental malaria, or newborn anthropometrics. Antibodies to merozoite antigens and non-placental-binding IEs were not associated with decreased risk of any of these outcomes. In some instances, they were negatively associated with outcomes of interest.ConclusionAntibodies to placental-binding infected erythrocytes may be associated with higher haemoglobin levels in pregnancy, whereas antibodies to other malaria antigens may instead be markers of malaria exposure. Trial registration clinicaltrials.gov NCT01239693. Registered Nov 10, 2010.

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Improved Pregnancy Outcomes in Women Exposed to Malaria With High Antibody Levels Against Plasmodium falciparum

Cited by 40 publications

References 48 publications

Effect of IPTp on Plasmodium falciparum antibody levels among pregnant women and their babies in a sub-urban coastal area in Ghana

Effect of IPTp on Plasmodium falciparum antibody levels among pregnant women and their babies in a sub-urban coastal area in Ghana

Intermittent Preventive Treatment of Malaria in Pregnancy with Mefloquine in HIV-Infected Women Receiving Cotrimoxazole Prophylaxis: A Multicenter Randomized Placebo-Controlled Trial

Association between malaria immunity and pregnancy outcomes among Malawian pregnant women receiving nutrient supplementation

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