Abstract
IntroductionLaos has the highest maternal mortality ratio in mainland Southeast Asia and a high incidence of infectious diseases. Globally, malaria has been the pathogen most intensively investigated in relation to impact on pregnancy, but there has been relatively little research on the aetiology and impact of other diseases. We therefore aimed to determine the causes and impact of fever in pregnant women admitted to two central hospitals in Vientiane City, Lao PDR (Laos).Materials and MethodsThis hospital-based prospective study was conducted in Mahosot Hospital and the Mother and Child Hospital, Vientiane, between 2006 and 2010, with the aim to recruit 250 consenting pregnant women admitted with tympanic temperature ≥37.5°C. Primary outcome was the cause of fever and secondary outcomes were pregnancy outcomes. Specific investigations (culture, antigen, molecular and serological tests) were performed to investigate causes of fever. After discharge, all pregnant women were asked to return for review and convalescence serum on day 10–14 and were monitored until delivery.Principle findings250 pregnant women were recruited to this study between February 2006 and November 2010. Fifty percent were pregnant for the first time. Their median (range) gestational age on admission was 24 (4–43) weeks. The median (range) tympanic admission temperature was 38.5°C (37.5–40.5°C). Fifteen percent of patients stated that they had taken antibiotics before admission. Headache, myalgia, back pain and arthralgia were described by >60% of patients and 149 (60%) were given a laboratory diagnosis. Of those with confirmed diagnoses, 132 (53%) had a single disease and 17 (7%) had apparent mixed diseases. Among those who had a single disease, dengue fever was the most common diagnosis, followed by pyelonephritis, scrub typhus, murine typhus and typhoid. Patients were also diagnosed with tuberculosis, appendicitis, Staphylococcus aureus septicemia, leptospirosis, Japanese encephalitis virus infection and Plasmodium falciparum malaria. Severe consequences, including maternal death, miscarriage, stillbirth, low birth weight and preterm birth, were found among 28 (78%) mothers with dengue fever, rickettsioses and typhoid.ConclusionFevers other than malaria, such as dengue, pyelonephritis, rickettsioses and typhoid are common causes of fever during pregnancy in the Asian tropics. Further investigations of their impact in the community on maternal death, fetal loss, vertical transmission, low birth weight and preterm birth are needed.
Highlights
Maternal death and poor birth outcomes remain significant public health problems in much of the world [1,2]
Malaria has not been reported in Vientiane City for decades, but others diseases such as dengue fever, rickettsioses, typhoid fever, leptospirosis and Japanese encephalitis, have
For most common causes of fever in the tropics there is little evidence as to whether pregnant women are at higher risk of disease, of severe disease and what the impacts are on mothers and their offspring, by pathogens and gestational age [10–14]
Summary
Maternal death and poor birth outcomes remain significant public health problems in much of the world [1,2]. There is relatively little information on the importance of the great diversity of infectious diseases on pregnancy outcome, especially in the tropics. Some infectious diseases are more common or more severe in pregnancy (e.g. Plasmodium falciparum, Listeria monocytogenes, hepatitis E virus (HEV), herpes simplex virus and influenza) [3–9]. For most common causes of fever in the tropics there is little evidence as to whether pregnant women are at higher risk of disease, of severe disease and what the impacts are on mothers and their offspring, by pathogens and gestational age [10–14]. Understanding of the relationship is impaired as deaths from infectious diseases and deaths in pregnancy are often not connected in public health surveillance
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