Author:
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Lufele, Elvin; Umbers, Alexandra J.; Ordi i Majà, Jaume; Ome-Kaius, Maria; Wangnapi, Regina A.; Unger, Holger Werner; Tarongka, Nandao; Siba, Peter; Mueller, Ivo; Robinson, Leanne J.; Rogerson, Stephen John
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Abstract:
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BACKGROUND: Plasmodium 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). METHODS: Placental 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. RESULTS: Of 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). CONCLUSIONS: Among
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. |