Abstract
BackgroundPlasmodium falciparum in pregnancy results in substantial poor health outcomes for both mother and child, particularly in young, primigravid mothers who are at greatest risk of placental malaria (PM) infection. Complications of PM include maternal anaemia, low birth weight and preterm delivery, which contribute to maternal and infant morbidity and mortality in coastal Papua New Guinea (PNG).MethodsPlacental biopsies were examined from 1451 pregnant women who were enrolled in a malaria prevention study at 14–26 weeks gestation. Clinical and demographic information were collected at first antenatal clinic visits and women were followed until delivery. Placental biopsies were collected and examined for PM using histology. The presence of infected erythrocytes and/or the malaria pigment in monocytes or fibrin was used to determine the type of placental infection.ResultsOf 1451 placentas examined, PM infection was detected in 269 (18.5%), of which 54 (3.7%) were acute, 55 (3.8%) chronic, and 160 (11.0%) were past infections. Risk factors for PM included residing in rural areas (adjusted odds ratio (AOR) 3.65, 95% CI 1.76–7.51; p ≤ 0.001), being primigravid (AOR 2.45, 95% CI 1.26–4.77; p = 0.008) and having symptomatic malaria during pregnancy (AOR 2.05, 95% CI 1.16–3.62; p = 0.013). After adjustment for covariates, compared to uninfected women, acute infections (AOR 1.97, 95% CI 0.98–3.95; p = 0.056) were associated with low birth weight babies, whereas chronic infections were associated with preterm delivery (AOR 3.92, 95% CI 1.64–9.38; p = 0.002) and anaemia (AOR 2.22, 95% CI 1.02–4.84; p = 0.045).ConclusionsAmong pregnant PNG women receiving at least one dose of intermittent preventive treatment in pregnancy and using insecticide-treated bed nets, active PM infections were associated with adverse outcomes. Improved malaria prevention is required to optimize pregnancy outcomes.
Highlights
Plasmodium falciparum in pregnancy results in substantial poor health outcomes for both mother and child, in young, primigravid mothers who are at greatest risk of placental malaria (PM) infection
Maternal anaemia and preterm delivery (PTD) were associated with chronic PM infections, whereas low birth weight (LBW) was more common in acute PM infections
The present study focused on P. falciparum-infected placentas, as this parasite was the only one detected in placentas with active infection by qPCR, and it is the major cause of adverse effects on the mother and baby world-wide in regions where malaria is endemic [1]
Summary
Plasmodium falciparum in pregnancy results in substantial poor health outcomes for both mother and child, in young, primigravid mothers who are at greatest risk of placental malaria (PM) infection. In African settings, pregnant women are more vulnerable to malaria infection than non-pregnant women [4] and susceptibility is highest in young, primigravid mothers who have two to seven times higher risk of delivering low birth weight (LBW, < 2500 g) babies than multigravidae [2], while other associated poor outcomes include maternal anaemia and preterm delivery (PTD, < 37 weeks) [2, 4]. There are relatively limited data from Papua New Guinea (PNG), previous studies have reported similar findings [5,6,7] Both LBW and PTD complicating malaria in pregnancy are associated with increased risk of infant mortality [4] and high rates of cognitive impairment, learning disability and behavioural problems in children [2]. Maternal anaemia due to malaria is an independent risk factor for LBW and intrauterine growth restriction (IUGR) [8,9,10] and may increase the risk of PTD and stillbirth [5, 11]
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