Malaria Infection during Pregnancy: Intrauterine Growth Retardation and Preterm Delivery in Malawi

Sullivan, Amy D.; Nyirenda, Thomas; Cullinan, Tim; Taylor, Terrie E.; Harlow, Sioḃán D.; James, Sherman A.; Meshnick, Steven R.

doi:10.1086/314752

Cited by 109 publications

(93 citation statements)

References 11 publications

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“…0 % in Zambia [20] and 19 . 7 % in a different region of Malawi [21]. This high incidence clearly indicates a major public health problem with maternal malaria and undernutrition [22].…”

Section: Discussionmentioning

confidence: 99%

“…In The Gambia, placental malaria was also significantly associated with IUGR [31], and in Mangochi, southern Malawi, two studies have shown a significant association between placental malaria and IUGR [21,32]. The exact mechanism leading to IUGR with placental malaria is unclear although placental insufficiency and reduction of oxygen and/or glucose transport to the fetus are likely to play a role.…”

Section: Discussionmentioning

confidence: 99%

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Adverse birth outcomes in a malarious area

et al. 2005

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SUMMARYTo determine factors associated with fetal growth, preterm delivery and stillbirth in an area of high malaria transmission in Southern Malawi, a cross-sectional study of pregnant women attending and delivering at two study hospitals was undertaken. A total of 243 (17 . 3 %) babies were preterm and 54 (3 . 7%) stillborn. Intra-uterine growth retardation (IUGR) occurred in 285 (20 . 3 %), of whom 109 (38 . 2%) were low birthweight and 26 (9 . 1%) preterm. Factors associated with IUGR were maternal short stature [adjusted odds ratio (AOR) 1 . 6, 95 % confidence interval (CI) 1 . 0-2 . 5] ; primigravidae (AOR 1 . 9, 95 % CI 1 . 4-2 . 7) ; placental or peripheral malaria at delivery (AOR 1 . 4, 95 % CI 1 . 0-1 . 9) and maternal anaemia at recruitment (Hb <8 g/dl) (AOR 1 . 9, 95% CI 1 . 3-2 . 7). Increasing parasite density in the placenta was associated with both IUGR (P=0 . 008) and prematurity (P=0 . 02). Factors associated with disproportionate fetal growth were maternal malnutrition [mid-upper arm circumference (MUAC) <23 cm, AOR 1 . 9, 95% CI 1 . 0-3 . 7] and primigravidae (AOR 1 . 8, 95% CI 1 . 0-3 . 1). Preterm delivery and stillbirth were associated with <5 antenatal care visits (AOR 2 . 2, 95% CI 1 . 3-3 . 7 and AOR 3 . 1, 95 % CI 1 . 4-7 . 0 respectively) and stillbirth with a positive Venereal Disease Research Laboratory (VDRL) test (AOR 4 . 7, 95 % CI 1 . 5-14 . 8). Interventions to reduce poor pregnancy outcomes must reduce the burden of malaria in pregnancy, improve antenatal care and maternal malnutrition.

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“…0 % in Zambia [20] and 19 . 7 % in a different region of Malawi [21]. This high incidence clearly indicates a major public health problem with maternal malaria and undernutrition [22].…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Adverse birth outcomes in a malarious area

et al. 2005

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“…The odds ratio (95% confidence interval [CI]) for a multiple infection was 3.0 (1.8-5.1) in the category 11-1,000 parasites/l, and 8.0 (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21) in the category Ͼ 1,000 parasites/l compared with the baseline category of submicroscopic infections. The odds ratio for multiple infection decreased with an increasing number of pregnancies, and was lowest among women with Ն 5 pregnancies.…”

Section: Multiplicity Of P Falciparum Infectionmentioning

confidence: 99%

“…13 In highly endemic areas, apart from children, pregnant women, and primigravidae in particular, are at increased risk of P. falciparum infection and clinical malaria. 14,15 Malaria in pregnancy causes intrauterine growth retardation, low birth weight, and preterm delivery, [16][17][18] significantly contributing to neonatal mortality. 19 This increased susceptibility has been attributed to specific strains of P. falciparum that are able to adhere to placental tissue.…”

Section: Introductionmentioning

confidence: 99%

Multiplicity of Plasmodium falciparum infection in pregnancy.

Beck¹,

Mockenhaupt²,

Bienzle³

et al. 2001

The American Journal of Tropical Medicine and Hygiene

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Abstract. Little is known about the distribution and disease association of multiple Plasmodium falciparum infections in pregnant women. Genotyping of the merozoite surface protein-1 region was performed in 332 P. falciparum infected pregnant women in Ghana, and clinical and epidemiologic data were obtained. Overall, 68% of the women were infected with more than one strain (mean number of strains per carrier ϭ 2.9). The multiplicity of infection decreased significantly with an increasing number of pregnancies, and infection with multiple P. falciparum strains was significantly associated with anemia. In logistic regression, women infected with four or more strains were 2.3 times more likely to be anemic than women harboring fewer strains. This association, however, was only observed in women with up to three pregnancies. The results suggest that with increasing gravidity and subsequent infections with multiple strains effective immune mechanisms against more and more strains develop. In pregnant women, the multiplicity of infection may be an important factor for the acquisition and maintenance of immunity against malaria.

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“…[8][9][10][11][12] A few studies have documented other maternal factors associated with adverse pregnancy outcomes in subs Saharan Africa. [13][14][15][16][17][18][19][20] However, there are few data on the examination of multiple determinants of birth outcome and the proportion of adverse birth events ats s tributable to these factors from the study region, partly because of a lack of simple, inexpensive diagnostic methods.…”

Section: Introductionmentioning

confidence: 99%

Adverse birth outcomes in United Republic of Tanzania - impact and prevention of maternal risk factors

Watson-Jones

Weiss

Changalucha

et al. 2007

Bull World Health Organ

129

121

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Objective To determine risk factors for poor birth outcome and their population attributable fractions. Methods 1688 women who attended for antenatal care were recruited into a prospective study of the effectiveness of syphilis screening and treatment. All women were screened and treated for syphilis and other reproductive tract infections (RTIs) during pregnancy and followed to delivery to measure the incidence of stillbirth, intrauterine growth retardation (IUGR), low birth weight (LBW) and preterm live birth. Findings At delivery, 2.7% of 1536 women experienced a stillbirth, 12% of live births were preterm and 8% were LBW. Stillbirth was independently associated with a past history of stillbirth, short maternal stature and anaemia. LBW was associated with short maternal stature, ethnicity, occupation, gravidity and maternal malaria whereas preterm birth was associated with occupation, age of sexual debut, untreated bacterial vaginosis and maternal malaria. IUGR was associated with gravidity, maternal malaria, short stature, and delivering a female infant. In the women who had been screened and treated for syphilis, in between 20 and 34% of women with each outcome was estimated to be attributable to malaria, and 63% of stillbirths were estimated as being attributable to maternal anaemia. Screening and treatment of RTIs was effective and no association was seen between treated RTIs and adverse pregnancy outcomes. Conclusion Maternal malaria and anaemia continue to be significant causes of adverse pregnancy outcome in sub-Saharan Africa. Providing reproductive health services that include treatment of RTIs and prevention of malaria and maternal anaemia to reduce adverse birth outcomes remains a priority. Voir page 16 le résumé en français. En la página 16 figura un resumen en español.

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Malaria Infection during Pregnancy: Intrauterine Growth Retardation and Preterm Delivery in Malawi

Cited by 109 publications

References 11 publications

Adverse birth outcomes in a malarious area

Adverse birth outcomes in a malarious area

Multiplicity of Plasmodium falciparum infection in pregnancy.

Adverse birth outcomes in United Republic of Tanzania - impact and prevention of maternal risk factors

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