613: Assessment of Perinatal Outcomes of pregnant women with simple vs severe malaria

Abstract

Malaria in pregnancy is associated with adverse perinatal outcomes. The aim was to compare outcomes of simple and severe malaria and whether they vary by trimester of infection. A prospective cohort study performed over a 10 month period in 3 hospitals in Rwanda. Both hospitalized and non-hospitalized pregnant patients with confirmed malaria were enrolled and followed until 7 days postpartum. Demographic, clinical manifestations and perinatal outcomes were recorded. There were 484 pregnant women with confirmed malaria: 446 had perinatal outcomes and 38 women were lost to follow up. In total, 361 (80.9%) had simple malaria. Patients were predominantly from rural areas (85.4%). Among the patients with severe malaria, 84.7% were rural and 34.5% were primigravidas. Severe anemia (hemoglobin < 7g/dl) and thrombocytopenia (<50K) were present in 11.7% and11.4%. Severe CNS complications were noted in 18 patients (4.04%). Severe malaria was more common as pregnancy progressed; out of 85 with severe malaria, 12.9% were in the 1st, 29.4% in the 2nd and 57.6% in the 3rd trimester (p<0.0001). Overall, a normal term delivery occurred in 59%, with preterm delivery (PTD) in 17.4% and abortion in 13.9%. Adverse perinatal outcomes increased with trimester of infection (p<0.0001) (Table 1). Two-thirds of the 9 early neonatal deaths had 3rdtrimester infection (p<0.0001). A significant difference in perinatal outcomes between simple and severe malaria was seen: 65.1% of women with simple malaria had a normal term delivery as compared to 32.9% with severe malaria (p=0.003). All complications were significantly greater with severe malaria. Overall poor perinatal outcomes are seen in malaria with significant differences in perinatal outcomes between simple and severe malaria and by trimester of infection. In addition to vector control and exposure prevention, efforts need to be made in screening, education and monitoring pregnancies affected by malaria.