The present study assessed the maternal cortisol, Adrenocorticotropic hormone (ACTH), Pregnancy associated plasma protein-A (PAPP-A) and alpha-fetoprotein (AFP) concentrations in malaria infected pregnant women. A total of 76 (40 apparently healthy pregnant and 36 malaria-infected pregnant) women aged 18-40 years were prospectively recruited. Early morning blood samples (5 ml) were collected from each subject at 1 st and 2 nd trimesters. 1 ml of whole blood was used for the diagnosis of P. falciparum malaria using malaria Plasmodium falciparum Rapid Test Device (RTD) and Giemsa stained thick blood smears for microscopic detection of P. falciparum parasites while the remaining 4 ml was centrifuged, separated and serum used for estimation of cortisol, ACTH, AFP and PAPP-A using ELISA-based method. The mean cortisol (125.80 ±30.80 ng/ml) and AFP (1.9 ±0.7 MoM) concentrations in malaria-infected pregnant women were significantly (p<0.05) higher than those of normal pregnant women (86.70 ±3.30 and 1.5 ±0.7 respectively). Malaria-infected pregnant women had higher percentage of low birth weight babies (27.8%), preeclampsia (11.1%), premature rupture of membrane (11.1%), preterm delivery (30.6%), miscarriages (27.8%) and low APGAR score at one minute (2.8%). This shows the possible impact of malaria infection on pregnancy and birth outcomes. The increased cortisol concentration in malaria infected pregnant women shows that malaria infection in pregnancy increases the stress pregnant women are exposed to but the placental defect associated with increased placental permeability to AFP is not related to the effect of the stress (cortisol) and thus does not influence birth outcomes.

Background: There is limited information on if HIV infection induces stress in pregnancy. HIV can possibly contribute to the alterations in some fetal viability hormones thereby lead to adverse pregnancy outcome. The present study aimed to assess the possible changes in maternal cortisol, Adrenocorticotropic (ACTH), Pregnancy associated plasma protein-A (PAPP-A) and alpha-fetoprotein (AFP) hormone concentrations in HIV-infected pregnant women and their pregnancy outcomes. Methods:A cross sectional study of 80 (Eighty) volunteer pregnant women aged (18-49) years recruited during routine antenatal clinics in Nnamdi Azikiwe Teaching Hospital, Nnewi, Anambra State, Nigeria was conducted. The participants were divided into groups: 40 (forty) apparently healthy pregnant and 40 (forty) HIV-infected pregnant women. 5 ml of morning blood samples were collected from each subject in their 1 st and 2 nd trimesters for estimation of Cortisol, ACTH, AFP and PAPP-A using ELISA method. Results:The result showed that the mean systolic and diastolic blood pressures (mmHg) of HIV pregnant women were significantly higher than control (p<0.05 respectively). The mean value of cortisol (ng/ml) in HIV pregnant women was significantly higher when compared with control subjects (p<0.05). Cortisol showed inverse significant correlation with AFP in HIV-infected pregnant women. Maternal outcomes showed thatt HIV-infected pregnant women had significantly higher incidence of miscarriages and preeclampsia with higher incidence of perinatal outcomes such as low birth weight babies (LBW), preterm delivery, spontaneous abortion, still birth and low Apgar scores when compared with apparently normal pregnant women (P<0.05 respectively).Conclusion: the significantly higher cortisol level and BP in HIV pregnant women is indicative of oxidative stress due to perceived stress by HIV infection which might predispose the affected women to hypertension and preeclampsia. The highest adverse reactions observed in HIV pregnant women might be related to the damaged immune system by HIV infection however, the placental defect associated with increased placental permeability to AFP and the activity of the insulin-like growth factor (IGF) system is not related to the activity of stress thereby do not influence their birth outcomes.