Burden and impact of Plasmodium vivax in pregnancy: A multi-centre prospective observational study

Abstract

BackgroundDespite that over 90 million pregnancies are at risk of Plasmodium vivax infection annually, little is known about the epidemiology and impact of the infection in pregnancy.Methodology and principal findingsWe undertook a health facility-based prospective observational study in pregnant women from Guatemala (GT), Colombia (CO), Brazil (BR), India (IN) and Papua New Guinea PNG). Malaria and anemia were determined during pregnancy and fetal outcomes assessed at delivery. A total of 9388 women were enrolled at antennal care (ANC), of whom 53% (4957) were followed until delivery. Prevalence of P. vivax monoinfection in maternal blood at delivery was 0.4% (20/4461) by microscopy [GT 0.1%, CO 0.5%, BR 0.1%, IN 0.2%, PNG 1.2%] and 7% (104/1488) by PCR. P. falciparum monoinfection was found in 0.5% (22/4463) of women by microscopy [GT 0%, CO 0.5%, BR 0%, IN 0%, PNG 2%]. P. vivax infection was observed in 0.4% (14/3725) of placentas examined by microscopy and in 3.7% (19/508) by PCR. P. vivax in newborn blood was detected in 0.02% (1/4302) of samples examined by microscopy [in cord blood; 0.05% (2/4040) by microscopy, and 2.6% (13/497) by PCR]. Clinical P. vivax infection was associated with increased risk of maternal anemia (Odds Ratio-OR, 5.48, [95% CI 1.83–16.41]; p = 0.009), while submicroscopic vivax infection was not associated with increased risk of moderate-severe anemia (Hb<8g/dL) (OR, 1.16, [95% CI 0.52–2.59]; p = 0.717), or low birth weight (<2500g) (OR, 0.52, [95% CI, 0.23–1.16]; p = 0.110).ConclusionsIn this multicenter study, the prevalence of P. vivax infection in pregnancy by microscopy was overall low across all endemic study sites; however, molecular methods revealed a significant number of submicroscopic infections. Clinical vivax infection in pregnancy was associated with maternal anemia, which may be deleterious for infant’s health. These results may help to guide maternal health programs in settings where vivax malaria is endemic; they also highlight the need of addressing a vulnerable population such as pregnant women while embracing malaria elimination in endemic countries.

Malaria during pregnancy and newborns outcome in an unstable transmission area in Brazil: a population-based record linkage study

“…The number of studies estimating the real frequency of malaria in pregnant women is still limited, both in Brazil and in other regions of the Americas, which are considered low transmission areas 2 . The prevalence (8.9%) of malaria during pregnancy in our study was similar to the findings of a multi-centric study that enrolled data from the Americas (Guatemala, Colombia, and Brazil) between 2008-2011, and another study performed in Urubá (Colombia) between 2005-2009 24,25 . Though, the prevalence is higher in relation to reports from Iquitos (6.6%) (Peru), and from other Brazilian cities, such as Manaus (6.1%) and Coari (4.3%) in the Amazonas state, and Rio Branco (1.4%) in Acre state 26-29 .…”

Maternal and newborn health indicators in Papua New Guinea – 2008–2018

“…Overall, the rate of any anaemia (that is, haemoglobin levels <11 g/dL) ranged from 84% of women at their first antenatal visit (2008-2011) to 16% in women from a number of rural health facilities. 29,46 In Port Moresby General Hospital, the rate was 23% 25 which was the same as the district hospital in Madang with a rate of 23% from 2009 to 2012. 31 Goroka district hospital had a rate of 47% of anaemia (haemoglobin <10 g/ dL) and 33% severe anaemia (haemoglobin <8 g/ dL) from 2005-2008.…”

“…25,27 The only community-based study had an even higher MMR estimate, ranging between 600-900 per 100,000 live births in rural settings. 24 Three of the four studies were based on case notes [24][25][26][27] Neonatal health Neonatal mortality rate (NMR) 1 26 Stillbirth rate 8 [24][25][26][28][29][30][31][32] Reproduction Reproductive health Contraception prevalence rate (CPR) 3 [33][34][35] Obstetric and gynaecological admissions owing to abortions 2 36,37 Pregnancy Maternal health Adolescent birth rate 0 n/a STI prevalence in pregnancy 6 25,[38][39][40][41][42] HIV prevalence in pregnancy 7 25,28,32,35,39,41,43 Malaria prevalence in pregnancy 7 27,29,31,32,[44][45][46] Anaemia prevalence in pregnancy 6 25,29,31,32,35,…”

Malaria prevalence in pregnant women receiving antenatal care at the health centre of University of Uyo, Nigeria

“…During pregnancy, this immunity becomes suppressed. This makes both the pregnant woman and the foetus vulnerable to the adverse effects of malaria, particularly by Plasmodium falciparum [19,20].…”