Impact of Malaria at the End of Pregnancy on Infant Mortality and Morbidity

Abstract

Background. There is some consensus that malaria in pregnancy may negatively affect infant's mortality and malaria morbidity, but there is less evidence concerning the factors involved.Methods. A total of 1030 Mozambican pregnant women were enrolled in a randomized, placebo-controlled trial of intermittent preventive treatment with sulfadoxine-pyrimethamine, and their infants were followed up throughout infancy. Overall mortality and malaria morbidity rates were recorded. The association of maternal and fetal risk factors with infant mortality and malaria morbidity was assessed.Results. There were 58 infant deaths among 997 live-born infants. The risk of dying during infancy was increased among infants born to women with acute placental infection (odds ratio [OR], 5.08 [95% confidence interval (CI), 1.77–14.53)], parasitemia in cord blood (OR, 19.31 [95% CI, 4.44–84.02]), low birth weight (OR, 2.82 [95% CI, 1.27–6.28]) or prematurity (OR, 3.19 [95% CI, 1.14–8.95]). Infants born to women who had clinical malaria during pregnancy (OR, 1.96 [95% CI, 1.13–3.41]) or acute placental infection (OR, 4.63 [95% CI, 2.10–10.24]) had an increased risk of clinical malaria during infancy.Conclusions. Malaria infection at the end of pregnancy and maternal clinical malaria negatively impact survival and malaria morbidity in infancy. Effective clinical management and prevention of malaria in pregnancy may improve infant's health and survival.

Pregnancy and Malaria Exposure Are Associated with Changes in the B Cell Pool and in Plasma Eotaxin Levels

“…However, pregnant women are at a higher risk of malaria infection compared with nonpregnant adults. Malaria infection in pregnancy is associated with maternal and infant morbidity and mortality through maternal anemia, clinical malaria, low birth weight, and prematurity (3)(4)(5)(6)(7)(8). Increased infection risk and disease morbidity during pregnancy or postpartum have been described in other infectious diseases such as influenza or tuberculosis (9,10).…”

Malaria Modifies Neonatal and Early-Life Toll-Like Receptor Cytokine Responses

“…With an annual estimate of 50 million or more mothers at risk, pregnancy-associated malaria (PAM) due to Plasmodium falciparum is a well-recognized and well-described example of such an infection, representing a major public health burden measurable by the adverse pregnancy outcomes it causes (reviewed in references [6][7][8][9][10]. Quite apart from the association between PAM and low birth weight and the poor prognosis of survival that goes with it, a number of studies have documented the increased susceptibility to malaria of infants born to mothers with P. falciparum infection detected at delivery (11)(12)(13)(14)(15). PAM has also recently been shown to be associated with an increased risk of fever episodes of nonmalarial causes in infancy (16).…”

Clinical Presentation and Management of Neonatal Malaria: A Review

“…Emphasis should be placed on developing the capacity for rapid and reliable laboratory services with adequate quality control. Neonatal mortality contributes about forty percent to all child death in malaria endemic areas [62] and most of these death and deliveries occur outside health facilities so the proportion of these deaths that are malaria related remains undetermined and unrecorded [23,63,64].…”

“…Hb F levels decline after a peak level at 6 weeks of age [17], and as both IgG and HbF disappear from circulation, making infants more susceptible to malaria infection [22]. In countries with high malarial burden, the presentation of congenital malaria is relatively early (Mozambique and Benin from South Africa) [23,24]. The reasons are unclear however it can be related to prenatal fetal priming [25].…”