Severe placental malaria and maternal shortness, thinness, and small skeletal size in rural Congo: cohort study

Abstract

lactic surgery, but that two companies also gave credit for enrolment on a mammographic surveillance programme. Another company reported that this will be part of a review of policy, and in future it may also credit mammographic surveillance. The variation in the industry's responses show that women with a family history who are offered a high rating by one company may receive a lower rating if they approach a second company.No respondent said that they would request further family history to see if second degree relatives were affected. Disclosure of more cases of cancer in second degree relatives could considerably increase the assessed risk. The artificial nature of the survey might have implied, however, that no further family history existed to be disclosed, so we cannot comment on whether second degree relative information would be requested in reality. How access to adverse test results for BRCA1 or BRCA2 would influence the response to a similar survey in the future remains to be seen.We thank the life insurance companies for participating in the study, and Adam Butterworth, Cambridge Genetics Knowledge Park, and Alan Tyler, independent insurance and health consultant, for advice and review of the manuscript.Contributors: AH designed the study with advice from SEH, and did the survey. AH wrote the paper. Both authors critically revised the paper. SEH is guarantor. (Accepted 8 November 2005)Severe placental malaria and maternal shortness, thinness, and small skeletal size in rural Congo: cohort study Hermione J Lovel, Rachel M Newby, Valerie F Hillier Despite global partnerships that aim to eradicate malaria, few studies have investigated susceptibility to severe placental malaria infection (apart from in primigravida 1 ). Reduced fetal growth 1 and maternal anaemia sequelae 2 are known, however, to have serious consequences. We measured mothers at antenatal booking and later explored severe placental malaria as part of a study on factors affecting fetal growth. Participants, methods, and resultsWe investigated a cohort of 436 consecutive rural Bantu women with a singleton pregnancy, with a gestation of less than 24 weeks at booking (determined by ultrasonography), and planning to deliver in Kasaji Hospital in this remote but settled rural area of Katanga province in the Democratic Republic of Congo. A third (31%, 135) were primigravida.3 RMN followed them all through pregnancy to delivery, between 1996 and 1998 (unaware of their placental malaria status at this stage). RMN took placental impression smears using a rigorous protocol. HC later examined them and counted parasites per field (without antenatal measurements) at the Tropical Diagnostic Laboratory (Dublin). RMN graded parasite density (0 = no parasites in 150 fields; 1 = 1-49 parasites per 50 fields; 2 = more than 50 parasites per 50 fields). Because supplies were limited, women were not given chemoprophylaxis for malaria, but prompt treatment with chloroquine was available for symptoms. We found placental infection in 322 women (74%; 125 (93%)...

Poor Birth Outcomes in Malaria in Pregnancy: Recent Insights Into Mechanisms and Prevention Approaches

“…Another major contributor to LBW is maternal undernutrition, a condition that is also highly prevalent in many areas with high malaria transmission. There is a growing number of studies suggesting that malaria and maternal undernutrition may worsen pregnancy outcomes ( 86 , 87 ). Malnourishment during pregnancy, indicated by low body mass index and smaller mid-upper arm circumference, was associated with lower levels of antibodies to placental-binding IE and increased parasite load in the placenta ( 88 ).…”

Undernutrition and malaria in pregnancy – a dangerous dyad?

“…Such interactions are likely to exist in pregnancy [ 18 ]. Whether undernutrition alters pregnant women’s risk of contracting malaria infection is unknown, but in the Democratic Republic of Congo women with low mid-upper arm circumference (MUAC) and low BMI were most likely to have high placental parasite loads [ 19 ].…”