Placental infections with histologically confirmed Plasmodium falciparum are associated with adverse birth outcomes in India: a cross-sectional study

Malaria Journal

Research

Rukhsana Ahmed¹  Feiko O ter Kuile¹  Dianne J Terlouw²  Meghna Desai³  Venkatachalam Udhayakumar³  Pushpendra P Singh⁴  Neeru Singh⁴  Praveen K Bharti⁴ 

[1] Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK;Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK;Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi;Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA;National Institute of Malaria Research Field Station, Regional Medical Research Centre, Jabalpur, India;

关键词: Malaria;    Pregnancy;    Placenta;    Histopathology;    Birth weight;    Haemoglobin;    Gestational age;    India;   

DOI  :  10.1186/1475-2875-13-232

 received in 2014-03-25, accepted in 2014-06-08,  发布年份 2014

来源: Springer

【 摘 要 】

BackgroundFew studies have assessed placental malaria infections from low transmission areas by histopathology to define their impact and underlying mechanisms.MethodsPeripheral smears and rapid diagnostic tests (RDTs), placental smears and histological samples, birth weight and gestational age were collected from 2,282 deliveries in three hospitals during a one-year (2006–2007) continuous cross-sectional survey in Madhya Pradesh. Placental histopathology included all 50 cases positive by microscopy or RDT plus 456 randomly selected samples of women negative for malaria by microscopy or RDT. Histological examination included parasites, inflammatory cells, pigment in fibrin, and morphological changes.ResultsThere were 52 histology-positive cases; 38 (73.1%) active (acute and chronic) and 14 past infections. Intervillous parasitaemia was low (60% had < 1% parasitaemia) and monocytosis mostly mild (63%). Compared with uninfected placentas, acute Plasmodium falciparum infections were associated with stillbirth (RR 3.8, 95% CI 1.2-12.1), lower maternal haemoglobin (mean difference: 1.5 g/dL, 95% CI 0.5-2.5), lower birth weight (mean difference 451 g, 95% CI 169–609) and shorter gestation (mean difference 0.8 weeks, 95% CI 0.2-1.4). Chronic or past infections were not associated with these outcomes. Among the 11 peripheral Plasmodium vivax cases, placental parasites were absent, but they were associated with increased placental polymorphonuclear cells.ConclusionsMalaria associated stillbirth and low birth weight in women with low protective immunity may result, at least in part, from a shortened gestation triggered by acute infection, stressing the importance of early malaria detection.

【 授权许可】

Unknown   
© Ahmed et al.; licensee BioMed Central Ltd. 2014. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.