Abstract
Malaria in pregnancy very often includes gestational (parasites in maternal peripheral blood) and placental (parasites in placental blood) infection, but the later condition can only be detected after delivery. High frequency of placental plasmodial infection has been confirmed in many countries and is associated with negative birth outcomes. With the hypothesis that placental infection is accompanied by hemozoin circulation in maternal peripheral blood, an exploratory study was conducted to evaluate the association between peripheral leukocytes with hemozoin and placental infection by Plasmodium vivax or Plasmodium falciparum in parturient women. A descriptive, transversal and exploratory (pilot type) study was carried out with women from two malaria-endemic localities of northwest Colombia. A total of 25 parturient women with confirmed placental infection and 25 without placental infection were included. Two independent readers measured the number of leukocytes with hemozoin in thick smears of maternal peripheral blood. Plasmodial infection in maternal peripheral blood and placental blood was detected by thick smear and quantitative polymerase chain reaction (qPCR). Four parturient women had leukocytes with hemozoin in peripheral blood; three of them had placental plasmodial infection and one was negative for placental infection. No statistically significant association between leukocytes with hemozoin in peripheral blood and placental infection was observed. With this limited sample size, detection of leukocytes with hemozoin by thick smear of maternal peripheral blood did not indicate presence of placental infection.
Highlights
Malaria in pregnancy very often includes gestational and placental infection, but the later condition can only be detected after delivery
There are no official reports on the frequency of malaria during pregnancy in Colombia; some research studies carried out in the region Urabá-Altos Sinú/San Jorge-Bajo Cauca reported a frequency of gestational and placental infection detected by thick smear of 10% and 11%, respectively [8], while studies using a very sensitive molecular technique confirmed a frequency of gestational and placental infection of 49% and 57%, respectively [10]
This study evaluated whether the presence of leukocytes with hemozoin in thick smears of maternal peripheral blood is an indicator of placental infection by either P. falciparum or P. vivax
Summary
Malaria in pregnancy very often includes gestational (parasites in maternal peripheral blood) and placental (parasites in placental blood) infection, but the later condition can only be detected after delivery. A systematic review and meta-analysis of malaria prevalence confirmed the presence of peripheral and placental malaria parasites in one-third of more than 300,000 pregnant women in sub-Saharan Africa [3]; the prevalence of gestational and placental malaria is strongly influenced by the region, endemicity level, predominant plasmodial species, and the sensitivity of the diagnostic test [4,5,6]. There are no official reports on the frequency of malaria during pregnancy in Colombia; some research studies carried out in the region Urabá-Altos Sinú/San Jorge-Bajo Cauca reported a frequency of gestational and placental infection detected by thick smear of 10% and 11%, respectively [8], while studies using a very sensitive molecular technique (quantitative polymerase chain reaction [qPCR]) confirmed a frequency of gestational and placental infection of 49% and 57%, respectively [10]. Submicroscopic plasmodial infection during pregnancy is very common in this region, and even submicroscopic infections were
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