Abstract
BackgroundIn 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.MethodsPregnant 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.ResultsOne 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.ConclusionsLow 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.
Highlights
In 2015, an estimated 2.6 million stillbirths occurred worldwide, with 98% of them occurring in developing countries [1]
Plain English summary Malaria is a global scourge causing over 200 million cases and 400,000 deaths in 2017, with the majority occurring in sub-Saharan Africa
Pregnant women and their offspring are susceptible to malaria infection which causes poor pregnancy outcomes such as preterm delivery, low birth weight, and severe maternal anemia
Summary
In 2015, an estimated 2.6 million stillbirths occurred worldwide, with 98% of them occurring in developing countries [1]. Multiple factors have been associated with stillbirths including maternal age, non-communicable diseases, and infectious diseases like malaria, Group B Streptococcus, and syphilis in sub-Saharan Africa [1,2,3]. Increased systemic inflammatory immune response to malaria infection has been associated with increased risk of both pregnancy loss (miscarriage and perinatal death) and preterm birth [5]. Preterm birth is one of the leading causes for neonatal and under-5 child mortality [6]. Maternal immunization may be expanded to include new vaccines that are being developed against group B Streptococcus and Respiratory Syncytial Virus [9,10,11]. 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. Prior to conducting vaccine trials, it is important to obtain background information on poor pregnancy outcomes in the target population to establish a baseline
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