Cargando…
Relationships between infection with Plasmodium falciparum during pregnancy, measures of placental malaria, and adverse birth outcomes
BACKGROUND: Malaria in pregnancy has been associated with maternal morbidity, placental malaria, and adverse birth outcomes. However, data are limited on the relationships between longitudinal measures of malaria during pregnancy, measures of placental malaria, and birth outcomes. METHODS: This is a...
Autores principales: | , , , , , , , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2017
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5629777/ https://www.ncbi.nlm.nih.gov/pubmed/28982374 http://dx.doi.org/10.1186/s12936-017-2040-4 |
_version_ | 1783269115287306240 |
---|---|
author | Kapisi, James Kakuru, Abel Jagannathan, Prasanna Muhindo, Mary K. Natureeba, Paul Awori, Patricia Nakalembe, Miriam Ssekitoleko, Richard Olwoch, Peter Ategeka, John Nayebare, Patience Clark, Tamara D. Rizzuto, Gabrielle Muehlenbachs, Atis Havlir, Diane V. Kamya, Moses R. Dorsey, Grant Gaw, Stephanie L. |
author_facet | Kapisi, James Kakuru, Abel Jagannathan, Prasanna Muhindo, Mary K. Natureeba, Paul Awori, Patricia Nakalembe, Miriam Ssekitoleko, Richard Olwoch, Peter Ategeka, John Nayebare, Patience Clark, Tamara D. Rizzuto, Gabrielle Muehlenbachs, Atis Havlir, Diane V. Kamya, Moses R. Dorsey, Grant Gaw, Stephanie L. |
author_sort | Kapisi, James |
collection | PubMed |
description | BACKGROUND: Malaria in pregnancy has been associated with maternal morbidity, placental malaria, and adverse birth outcomes. However, data are limited on the relationships between longitudinal measures of malaria during pregnancy, measures of placental malaria, and birth outcomes. METHODS: This is a nested observational study of data from a randomized controlled trial of intermittent preventive therapy during pregnancy among 282 participants with assessment of placental malaria and delivery outcomes. HIV-uninfected pregnant women were enrolled at 12–20 weeks of gestation. Symptomatic malaria during pregnancy was measured using passive surveillance and monthly detection of asymptomatic parasitaemia using loop-mediated isothermal amplification (LAMP). Placental malaria was defined as either the presence of parasites in placental blood by microscopy, detection of parasites in placental blood by LAMP, or histopathologic evidence of parasites or pigment. Adverse birth outcomes assessed included low birth weight (LBW), preterm birth (PTB), and small for gestational age (SGA) infants. RESULTS: The 282 women were divided into three groups representing increasing malaria burden during pregnancy. Fifty-two (18.4%) had no episodes of symptomatic malaria or asymptomatic parasitaemia during the pregnancy, 157 (55.7%) had low malaria burden (0–1 episodes of symptomatic malaria and < 50% of samples LAMP+), and 73 (25.9%) had high malaria burden during pregnancy (≥ 2 episodes of symptomatic malaria or ≥ 50% of samples LAMP+). Women with high malaria burden had increased risks of placental malaria by blood microscopy and LAMP [aRR 14.2 (1.80–111.6) and 4.06 (1.73–9.51), respectively], compared to the other two groups combined. Compared with women with no malaria exposure during pregnancy, the risk of placental malaria by histopathology was higher among low and high burden groups [aRR = 3.27 (1.32–8.12) and aRR = 7.07 (2.84–17.6), respectively]. Detection of placental parasites by any method was significantly associated with PTB [aRR 5.64 (1.46–21.8)], and with a trend towards increased risk for LBW and SGA irrespective of the level of malaria burden during pregnancy. CONCLUSION: Higher malaria burden during pregnancy was associated with placental malaria and together with the detection of parasites in the placenta were associated with increased risk for adverse birth outcomes. Trial Registration Current Controlled Trials Identifier NCT02163447 ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12936-017-2040-4) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-5629777 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-56297772017-10-13 Relationships between infection with Plasmodium falciparum during pregnancy, measures of placental malaria, and adverse birth outcomes Kapisi, James Kakuru, Abel Jagannathan, Prasanna Muhindo, Mary K. Natureeba, Paul Awori, Patricia Nakalembe, Miriam Ssekitoleko, Richard Olwoch, Peter Ategeka, John Nayebare, Patience Clark, Tamara D. Rizzuto, Gabrielle Muehlenbachs, Atis Havlir, Diane V. Kamya, Moses R. Dorsey, Grant Gaw, Stephanie L. Malar J Research BACKGROUND: Malaria in pregnancy has been associated with maternal morbidity, placental malaria, and adverse birth outcomes. However, data are limited on the relationships between longitudinal measures of malaria during pregnancy, measures of placental malaria, and birth outcomes. METHODS: This is a nested observational study of data from a randomized controlled trial of intermittent preventive therapy during pregnancy among 282 participants with assessment of placental malaria and delivery outcomes. HIV-uninfected pregnant women were enrolled at 12–20 weeks of gestation. Symptomatic malaria during pregnancy was measured using passive surveillance and monthly detection of asymptomatic parasitaemia using loop-mediated isothermal amplification (LAMP). Placental malaria was defined as either the presence of parasites in placental blood by microscopy, detection of parasites in placental blood by LAMP, or histopathologic evidence of parasites or pigment. Adverse birth outcomes assessed included low birth weight (LBW), preterm birth (PTB), and small for gestational age (SGA) infants. RESULTS: The 282 women were divided into three groups representing increasing malaria burden during pregnancy. Fifty-two (18.4%) had no episodes of symptomatic malaria or asymptomatic parasitaemia during the pregnancy, 157 (55.7%) had low malaria burden (0–1 episodes of symptomatic malaria and < 50% of samples LAMP+), and 73 (25.9%) had high malaria burden during pregnancy (≥ 2 episodes of symptomatic malaria or ≥ 50% of samples LAMP+). Women with high malaria burden had increased risks of placental malaria by blood microscopy and LAMP [aRR 14.2 (1.80–111.6) and 4.06 (1.73–9.51), respectively], compared to the other two groups combined. Compared with women with no malaria exposure during pregnancy, the risk of placental malaria by histopathology was higher among low and high burden groups [aRR = 3.27 (1.32–8.12) and aRR = 7.07 (2.84–17.6), respectively]. Detection of placental parasites by any method was significantly associated with PTB [aRR 5.64 (1.46–21.8)], and with a trend towards increased risk for LBW and SGA irrespective of the level of malaria burden during pregnancy. CONCLUSION: Higher malaria burden during pregnancy was associated with placental malaria and together with the detection of parasites in the placenta were associated with increased risk for adverse birth outcomes. Trial Registration Current Controlled Trials Identifier NCT02163447 ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12936-017-2040-4) contains supplementary material, which is available to authorized users. BioMed Central 2017-10-05 /pmc/articles/PMC5629777/ /pubmed/28982374 http://dx.doi.org/10.1186/s12936-017-2040-4 Text en © The Author(s) 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. 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. |
spellingShingle | Research Kapisi, James Kakuru, Abel Jagannathan, Prasanna Muhindo, Mary K. Natureeba, Paul Awori, Patricia Nakalembe, Miriam Ssekitoleko, Richard Olwoch, Peter Ategeka, John Nayebare, Patience Clark, Tamara D. Rizzuto, Gabrielle Muehlenbachs, Atis Havlir, Diane V. Kamya, Moses R. Dorsey, Grant Gaw, Stephanie L. Relationships between infection with Plasmodium falciparum during pregnancy, measures of placental malaria, and adverse birth outcomes |
title | Relationships between infection with Plasmodium falciparum during pregnancy, measures of placental malaria, and adverse birth outcomes |
title_full | Relationships between infection with Plasmodium falciparum during pregnancy, measures of placental malaria, and adverse birth outcomes |
title_fullStr | Relationships between infection with Plasmodium falciparum during pregnancy, measures of placental malaria, and adverse birth outcomes |
title_full_unstemmed | Relationships between infection with Plasmodium falciparum during pregnancy, measures of placental malaria, and adverse birth outcomes |
title_short | Relationships between infection with Plasmodium falciparum during pregnancy, measures of placental malaria, and adverse birth outcomes |
title_sort | relationships between infection with plasmodium falciparum during pregnancy, measures of placental malaria, and adverse birth outcomes |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5629777/ https://www.ncbi.nlm.nih.gov/pubmed/28982374 http://dx.doi.org/10.1186/s12936-017-2040-4 |
work_keys_str_mv | AT kapisijames relationshipsbetweeninfectionwithplasmodiumfalciparumduringpregnancymeasuresofplacentalmalariaandadversebirthoutcomes AT kakuruabel relationshipsbetweeninfectionwithplasmodiumfalciparumduringpregnancymeasuresofplacentalmalariaandadversebirthoutcomes AT jagannathanprasanna relationshipsbetweeninfectionwithplasmodiumfalciparumduringpregnancymeasuresofplacentalmalariaandadversebirthoutcomes AT muhindomaryk relationshipsbetweeninfectionwithplasmodiumfalciparumduringpregnancymeasuresofplacentalmalariaandadversebirthoutcomes AT natureebapaul relationshipsbetweeninfectionwithplasmodiumfalciparumduringpregnancymeasuresofplacentalmalariaandadversebirthoutcomes AT aworipatricia relationshipsbetweeninfectionwithplasmodiumfalciparumduringpregnancymeasuresofplacentalmalariaandadversebirthoutcomes AT nakalembemiriam relationshipsbetweeninfectionwithplasmodiumfalciparumduringpregnancymeasuresofplacentalmalariaandadversebirthoutcomes AT ssekitolekorichard relationshipsbetweeninfectionwithplasmodiumfalciparumduringpregnancymeasuresofplacentalmalariaandadversebirthoutcomes AT olwochpeter relationshipsbetweeninfectionwithplasmodiumfalciparumduringpregnancymeasuresofplacentalmalariaandadversebirthoutcomes AT ategekajohn relationshipsbetweeninfectionwithplasmodiumfalciparumduringpregnancymeasuresofplacentalmalariaandadversebirthoutcomes AT nayebarepatience relationshipsbetweeninfectionwithplasmodiumfalciparumduringpregnancymeasuresofplacentalmalariaandadversebirthoutcomes AT clarktamarad relationshipsbetweeninfectionwithplasmodiumfalciparumduringpregnancymeasuresofplacentalmalariaandadversebirthoutcomes AT rizzutogabrielle relationshipsbetweeninfectionwithplasmodiumfalciparumduringpregnancymeasuresofplacentalmalariaandadversebirthoutcomes AT muehlenbachsatis relationshipsbetweeninfectionwithplasmodiumfalciparumduringpregnancymeasuresofplacentalmalariaandadversebirthoutcomes AT havlirdianev relationshipsbetweeninfectionwithplasmodiumfalciparumduringpregnancymeasuresofplacentalmalariaandadversebirthoutcomes AT kamyamosesr relationshipsbetweeninfectionwithplasmodiumfalciparumduringpregnancymeasuresofplacentalmalariaandadversebirthoutcomes AT dorseygrant relationshipsbetweeninfectionwithplasmodiumfalciparumduringpregnancymeasuresofplacentalmalariaandadversebirthoutcomes AT gawstephaniel relationshipsbetweeninfectionwithplasmodiumfalciparumduringpregnancymeasuresofplacentalmalariaandadversebirthoutcomes |