Fetal and maternal hemodynamics in acute malaria during pregnancy

Abstract

ObjectiveTo measure maternal and fetal hemodynamics during acute malaria in pregnancy. MethodsTime courses of maternal heart rate (MHR), maternal blood pressure (BP), and fetal heart rate (FHR) were performed until 56days after initiation of anti-malarial treatment with artemether–lumefantrine. Women with malaria were hospitalized for at least 3days until recovery. ResultsMean baseline characteristics of pregnant women with malaria (n=38) versus pregnant women without malaria (n=39) were as follows: gestational age (28.8 vs 24.6weeks; P=0.006); maximum FHR (165.3 vs 158.3 beats per minute [bpm]; P=0.054); minimum FHR (137.6 vs 128.7bpm; P=0.016); mean BP (74.7 vs 80.9mm Hg; P=0.001); pulse pressure (40.3 vs 42.1mm Hg; P=0.300); and MHR (107.4 vs 81.3bpm; P<0.001). The geometric mean parasite count was 13 795 per μL. Complete time courses were collected from a subgroup of participants. For women with malaria, maternal body temperature and BP normalized within 24hours and after 72hours, respectively. The MHR among pregnant women without malaria showed a physiologic increase during pregnancy of approximately 7bpm between days 0 and 56. The mean FHR among women with malaria normalized after 72hours. ConclusionAcute malaria induces maternal and fetal hemodynamic changes.