Abstract
ObjectiveMalaria in pregnancy is associated with adverse perinatal outcomes. The objective was to compare outcomes of simple and severe malaria and to determine whether they vary by trimester or severity of infection.MethodsProspective cohort study performed 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.ResultsThere were 446 pregnant women with confirmed malaria and outcome data; 361 (80.9%) had simple malaria. Severe malaria was more common as pregnancy progressed; out of 85 with severe malaria, 12.9%, 29.4% and 57.6% were in the 1st, 2nd and 3rd trimesters (p<0.0001). Overall, a normal term delivery occurred in 57.6%, with preterm delivery in 24.9% and abortion in 13.5%. Adverse perinatal outcomes increased with trimester of infection (p<0.0001). Eight of the 9 early neonatal deaths had 3rd trimester infection (p<0.0001). There were 27 stillbirths; 63.7% were associated with 3rd trimester infection. A significant difference in perinatal outcomes between simple and severe malaria was seen: 64% of women with simple malaria had a normal term delivery as compared to 30.6% with severe malaria (p<0.0001). All complications were significantly greater with severe malaria.ConclusionOverall poor 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, treatment education and monitoring pregnancies affected by malaria.
Highlights
Malaria remains a serious life threatening public health concern in sub-Saharan Africa with 25 million pregnant women affected by malaria, predominantly by Plasmodium falciparum [1]
Severe malaria was more common as pregnancy progressed; out of 85 with severe malaria, 12.9%, 29.4% and 57.6% were in the 1st, 2nd and 3rd trimesters (p
Our study demonstrates that in Rwanda, malaria in pregnancy is associated with poor outcomes in every trimester and that even simple malaria can cause adverse outcome such as abortion, low birth weight and stillbirth as well as maternal morbidity and mortality
Summary
Malaria remains a serious life threatening public health concern in sub-Saharan Africa with 25 million pregnant women affected by malaria, predominantly by Plasmodium falciparum [1]. Multigravidas have developed a degree of immunity to the parasite from previous infections [3]. Women from hyperendemic areas with lifelong exposure to the malaria parasite have heightened immunity. Women in mesoendemic regions, such as in highland areas of Rwanda, have less exposure, and less immunity, and are at risk for more severe manifestations. Between 2012 and 2016 there was an 8 fold increase with reported malaria cases reaching more than 2 million in 2015, leaving women of reproductive age vulnerable as they are less likely to have immunity [1, 4, 5]
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