Mediation of the effect of malaria in pregnancy on stillbirth and neonatal death in an area of low transmission: observational data analysis

Moore, Kerryn A.; Fowkes, Freya J. I.; Wiladphaingern, Jacher; Wai, Nan San; Paw, Moo Kho; Pimanpanarak, Mupawjay; Carrara, Verena I.; Raksuansak, Jathee; Simpson, Julie A.; White, Nicholas J.; Nosten, François; McGready, Rose

doi:10.1186/s12916-017-0863-z

Cited by 48 publications

(47 citation statements)

References 36 publications

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“…In areas of high transmission, primigravidae develop antibodies to VAR2CSA protein produced by malaria parasites, and are partially protected during subsequent pregnancies; this tends not to happen in areas of low transmission. 19 Overall, pregnant women living in areas with low or unstable (episodic) transmission have little or no immunity to malaria and are at a two-to-three times higher risk of severe disease compared to non-pregnant controls. 20 P. falciparum has typically been associated with more severe MIP than P. vivax, although P. vivax is more likely to occur in a mother with little acquired immunity.…”

Section: Risk Factors For Malaria In Pregnancymentioning

confidence: 99%

An overview of malaria in pregnancy

Bauserman

Conroy

North

et al. 2019

Seminars in Perinatology

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One hundred twenty-five million pregnant women are at risk for contracting malaria, a preventable cause of maternal and infant morbidity and death. Malaria parasites contribute to adverse pregnancy and birth outcomes due to their preferential accumulation in placental intervillous spaces. Pregnant women are particularly vulnerable to malaria infections, and malaria infections during pregnancy put their fetuses at risk. Malaria in pregnancy is associated with anemia, stillbirth, low birth weight and maternal and fetal death. We review the challenges to diagnosing malaria in pregnancy, as well as strategies to prevent and treat malaria in pregnancy. Finally, we discuss the current gaps in knowledge and potential areas for continued research.

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Section: Risk Factors For Malaria In Pregnancymentioning

confidence: 99%

An overview of malaria in pregnancy

Bauserman

Conroy

North

et al. 2019

Seminars in Perinatology

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“…Malaria during pregnancy is a public health problem causing maternal anemia and placental insufficiency leading to preterm delivery, stillbirth and low birth weight (LBW) [1][2][3]. Each year, more than 30 million of all women who become pregnant in Sub-Saharan Africa are at risk of malaria [4].…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of Sulfadoxine–Pyrimethamine for Intermittent Preventive Treatment of Malaria and Adverse Birth Outcomes in Pregnant Women

et al. 2020

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Effectiveness of intermittent preventive treatment in pregnancy with sulfadoxine–pyrimethamine (IPTp-SP) for prevention of malaria and adverse birth outcomes can be compromised by parasites-resistance to sulfadoxine–pyrimethamine. This study prospectively evaluated the effectiveness of IPTp-SP in Southeast Tanzania. From January 2017 to May 2019, HIV-negative and malaria-negative (mRDT) pregnant women attending their first antenatal-care visit in the second or third trimester (n = 500) were enrolled to receive monthly IPTp-SP and followed the protocol till delivery. The primary outcome was the prevalence of histopathological placental malaria. Secondary outcomes were anemia, malaria parasites detected during pregnancy and at delivery, adverse birth outcomes (low-birth-weight [LBW], premature birth, fetal anemia, still birth, and spontaneous abortion). Rates of histopathological placental malaria, any parasitemia at delivery (placental, cord or maternal), and any adverse birth outcome were 9.4%, 20.9%, and 26.5%, respectively. Rates of symptomatic malaria and parasitemia during pregnancy were 2.8% and 16%, respectively. Histopathological placental malaria significantly increased the odds of any adverse birth outcomes, particularly LBW. IPTp-SP with more than or equal to three doses significantly improved birth weight and reduced the risk of LBW by 56% compared to <3 SP doses (p = 0.009). IPTp-SP with more than or equal to three doses is still effective in improving birth weight. However, the detection of histopathological placental-malaria in one-tenth and parasitemia in one-fifth of pregnant women reflects the need to optimize the prevention of malaria during pregnancy.

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“…In high transmission areas, pregnancy malaria due to Plasmodium falciparum impacts both maternal and fetal health. P. falciparum infection during pregnancy is associated with increased maternal anemia, low birthweight, preterm delivery and stillbirth [13][14][15] .…”

Section: Introductionmentioning

confidence: 99%

Adverse pregnancy outcomes among women presenting at antenatal clinics in Ouélessébougou, Mali

Andemel

Gaoussou²,

Issiaka³

et al. 2020

Reprod Health

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Background: In sub-Saharan Africa, malaria continues to scourge the population and is the primary cause of morbidity and mortality in young children and pregnant women. As current preventative measures such as intermittent preventive treatment and use of insecticide-treated nets provide incomplete protection, several malaria vaccines are currently under development, including one to specifically prevent pregnancy malaria. Prior to conducting vaccine trials, it is important to obtain background information on poor pregnancy outcomes in the target population to establish a baseline. Methods: Pregnant women presenting at community health care centers for antenatal care were recruited to the study. Gestational age was determined by ultrasound examination following recruitment. Antenatal care and pregnancy outcome information were collected during a visit 4-8 weeks post-delivery. Results: One thousand eight hundred fifty women completed the study, and analysis included 1814 women after excluding multiple gestations (n = 26) and missing/incomplete data (n = 10). The percentage (95% CI) of adverse pregnancy outcomes is as follows: miscarriage, 0.28% (0.04-0.52); stillbirth, 1.93% (1.30-2.56); early neonatal death, 1.65% (1.03-2.24); late neonatal death, 0.39%, (0.10-0.68); and preterm delivery (PTD), 4.74% (3.76-5.73). The percentages of early and late neonatal deaths and PTD were significantly higher (p < 0.01) in primigravid compared to multigravid women. In primigravidae, 3.1, 1.1 and 7.1% of pregnancies resulted in early neonatal death, late neonatal death and PTD, respectively, while these outcomes in multigravidae were 1.0, 0.1 and 2.7%, respectively. Major malformations were identified in 4 newborns. Conclusions: Low gravidity and young age predict perinatal death and PTD. The information collected here can be used as a baseline for adverse pregnancy outcomes in future vaccine trials in pregnant women.

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Mediation of the effect of malaria in pregnancy on stillbirth and neonatal death in an area of low transmission: observational data analysis

Cited by 48 publications

References 36 publications

An overview of malaria in pregnancy

An overview of malaria in pregnancy

Effectiveness of Sulfadoxine–Pyrimethamine for Intermittent Preventive Treatment of Malaria and Adverse Birth Outcomes in Pregnant Women

Adverse pregnancy outcomes among women presenting at antenatal clinics in Ouélessébougou, Mali

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