Malaria in the third trimester and maternal‐perinatal outcome

Abstract

Objective To evaluate maternal and perinatal outcomes in cases of third‐trimester malaria (TTM). Methods A parity‐matched comparative cohort study was carried out between December 1, 2018, and April 30, 2019, in three university teaching hospitals in Yaoundé (Cameroon). Women with and without TTM were followed up till delivery. The variables analyzed included maternal and gestational ages at delivery, the regimen of intermittent preventive treatment, usage of insecticide‐treated net, history of malaria recorded during pregnancy, birth and placenta weights, Apgar score, and early neonatal outcomes. Fisher exact test, t‐test, and logistic regression were used for comparison. P<0.05 was considered statistically significant. Results Of 3063 pregnant women, 130 (4.2%) had TTM. Adverse outcomes associated with TTM were maternal anemia (relative risk [RR] 10, 95% confidence interval [CI] 4.91–20.34), intrauterine fetal demise (RR 7.50, 95% CI 1.47–38.06), preterm delivery (RR 4.50, 95% CI 2.37–8.51), low birth weight (adjusted RR 2.88, 95% CI 1.34–6.19), neonatal asphyxia especially if delivery occurred during parenteral treatment (RR 5.18, 95% CI 2.56–10.48), transfer of the newborn to the neonatal intensive care unit (RR 4.38, 95% CI 2.59–7.42), and intrapartum or early neonatal death (RR 4.18, 95% CI 1.48–11.74). Conclusion TTM was associated with adverse perinatal outcome especially if labor started during parenteral treatment.

Ramadan Fasting during Pregnancy and Health Outcomes in Offspring: A Systematic Review

“…These prospective studies should be carefully designed, as the sociological and religious dimension of Ramadan may also alter maternal behavior to protect the belief that Ramadan has no effect on their offspring. Another promising approach to studying these effects would be enhanced retrospective study designs based on routine data collection comparing Islamic pregnant women during and outside the Ramadan period to reduce the effect of confounding but only under the condition that (Ramadan) fasting is registered in routine care, as other seasonal effects on birth outcomes may still apply such as malaria [ 73 , 74 ] and vitamin D status [ 75 , 76 ]. These types of studies are also needed in order to confirm the results of high quality studies in birth and fetal health outcomes.…”

Poor Birth Outcomes in Malaria in Pregnancy: Recent Insights Into Mechanisms and Prevention Approaches

“…A study from Malawi showed that earlier infection (before 24 weeks gestation) was associated with a higher risk of preterm delivery (26). In a Cameroon study, pregnant women who experienced MiP during the third trimester were four times more likely to have preterm deliveries (7). Similarly, in areas with low malaria transmission such as Southeast Asia, P. falciparum infection during late pregnancy was also associated with preterm delivery (24).…”

“…Of note, the precise mechanisms behind MiPassociated preterm birth and SGA remains unclear. P. falciparum infection can cause inflammation and potentially disrupt the fine immunological balance required to maintain pregnancy to term (5)(6)(7). On the other hand, SGA is often linked to placental insufficiency and there is also substantial evidence to suggest dysregulated placental development in mothers with MiP (8,9).…”

Prevalence of Malaria and Associated Factors among Delivering Mothers in Northwest Ethiopia

“…Particularly P. falciparum adheres to placental villi and reduces the placental blood flow to cause birth defects like LBW [2,11,12]. Malaria in pregnancy has many maternal and fetal complications like abortion, still birth, intrauterine growth restriction (IUGR), preterm delivery, LBW, and maternal death [2,[11][12][13].…”

“…Since the placenta is affected by several mechanisms such as cellular adhesion, cytokine production, and mononuclear cell infiltration, malaria parasites can cross the placenta and infect the fetus [ 9 , 10 ]. Particularly P. falciparum adheres to placental villi and reduces the placental blood flow to cause birth defects like LBW [ 2 , 11 , 12 ]. Malaria in pregnancy has many maternal and fetal complications like abortion, still birth, intrauterine growth restriction (IUGR), preterm delivery, LBW, and maternal death [ 2 , 11 – 13 ].…”