Risk factors and pregnancy outcomes associated with placental malaria in a prospective cohort of Papua New Guinean women

Malaria Journal

Research

Jaume Ordi¹  Stephen Rogerson²  Peter Siba³  Regina Wangnapi³  Elvin Lufele³  Maria Ome-Kaius³  Nandao Tarongka³  Holger Unger⁴  Alexandra Umbers⁴  Leanne Robinson⁵  Ivo Mueller⁶ 

[1] Barcelona Centre for International Health Research (CRESIB), Barcelona, Spain;Department of Medicine and Radiology, Peter Doherty Institute, University of Melbourne, Melbourne, VIC, Australia;Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea;Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea;Department of Medicine and Radiology, Peter Doherty Institute, University of Melbourne, Melbourne, VIC, Australia;Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea;Population Health and Immunity Division, Walter and Eliza Hall Institute, Melbourne, VIC, Australia;Burnet Institute, Melbourne, VIC, Australia;Population Health and Immunity Division, Walter and Eliza Hall Institute, Melbourne, VIC, Australia;Institute Pasteur, Paris, France;

关键词: Placental malaria;    Pregnancy;    Birth outcomes;    Intermittent preventive treatment in pregnancy;    Insecticide-treated bed nets;    Papua New Guinea;   

DOI  :  10.1186/s12936-017-2077-4

 received in 2017-07-21, accepted in 2017-10-19,  发布年份 2017

来源: Springer

【 摘 要 】

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.

【 授权许可】

CC BY   
© The Author(s) 2017