The Sick Placenta—The Role of Malaria

Brabin, Bernard; Romagosa, Cleofé; Abdelgalil, S.; Menéndez, Clara; Verhoeff, Francine H.; McGready, Rose; Fletcher, K. A.; Owens, Stephen; D’Alessandro, Umberto; Nosten, François; Fischer, Philip R.; Ordi, Jaume

doi:10.1016/j.placenta.2003.10.019

Cited by 323 publications

(291 citation statements)

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“…A further explanation is that transplacental transport of iron is disturbed by pathological changes of the syncytiotrophoblast with placental malaria. Although there is general agreement that iron is bound to transferrin at the maternal side of the placenta, very little is known about how iron is subsequently transported across the syncytiotrophoblast (Srai et al, 2002;Fuchs and Ellinger, 2004;Brabin et al, 2004a). Seasonal factors could also alter anaemia risk, but in view of the short study duration it was not possible to assess these.…”

Section: Discussionmentioning

confidence: 99%

A cohort study of haemoglobin and zinc protoporphyrin levels in term Zambian infants: effects of iron stores at birth, complementary food and placental malaria

et al. 2007

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Objective: To examine zinc-protoporphyrin (ZPP) and haemoglobin levels, and to determine predictors of iron deficiency anaemia (IDA) in Zambian infants. Subjects and methods: Ninety-one women and their normal birth weight (NBW) infants were followed bi-monthly during the first 6 months of life, and iron status, food intake, malaria parasitaemia and growth were monitored. At 4 months, the infants were divided into two groups, and the data were analysed according to whether or not they were exclusively breastfed. Results: Almost two-third of infants were born with low iron stores as defined by ZPP levels, and this proportion increased with age. Over 50% had developed IDA by 6 months. Exclusive breastfeeding at 4 months could be a protective factor for IDA (odds ratio (OR): 0.2; 95% confidence interval (CI): 0.0-1.1). Exclusively breastfed infants had higher haemoglobin values at 4 and 6 months (mean difference 0.6; 95% CI: 0.1-1.2 g/dl and mean difference 0.9; 95% CI: 0.2-1.7 g/dl, respectively), compared with infants with early complementary feeding. In univariate analysis, past or chronic placental malaria appeared to be a predictor of IDA at 4 and 6 months, but the significance was lost in multivariate analysis. Conclusions: Zambian NBW infants are born with low iron stores and have a high risk to develop IDA in the first 6 months of life. Continuation of exclusive breastfeeding after 4 months is associated with a reduction of anaemia. The effect of placental malaria infection on increased risk of infant IDA could not be proven.

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Section: Discussionmentioning

confidence: 99%

A cohort study of haemoglobin and zinc protoporphyrin levels in term Zambian infants: effects of iron stores at birth, complementary food and placental malaria

et al. 2007

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“…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. This may relate to a number of mechanisms, for example, mechanical blockage from the thickening of the trophoblast basement membrane, increased nutrient requirements by replicating parasites, or poor oxygen and glucose transfer [33,34]. Placental abnormalities resulting from nutritional deficiency or maternal vascular changes affecting the placenta may be involved [35].…”

Section: Discussionmentioning

confidence: 99%

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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“…Coxiella burnettii, the agent of Q fever, is an intracellular bacterium which may infect trophoblast (Baumgartner and Bachmann 1992;Ben Amara et al 2010) and, in rare cases, the fetus (Carcopino et al 2009) leading to abortion and premature delivery. Plasmodium falciparum, the etiological agent of the malaria, has long been known to affect pregnancy (Brabin et al 2004). Parasitized erythrocytes bind to chondroitin sulfate A expressed at the syncytiotrophoblast apical surface, where they accumulate, impeding the physiological functions of the placenta (Scherf et al 2001).…”

Section: Microbes and The Placental Barriermentioning

confidence: 99%