Risk factors and pregnancy outcomes associated with placental malaria in a prospective cohort of Papua New Guinean women

Lufele, Elvin; Umbers, Alexandra J.; Ordi, Jaume; Ome-Kaius, Maria; Wangnapi, Regina; Unger, Holger W.; Tarongka, Nandao; Siba, Peter; Müeller, Ivo; Robinson, Leanne J.; Rogerson, Stephen J.

doi:10.1186/s12936-017-2077-4

Cited by 53 publications

(85 citation statements)

References 37 publications

(74 reference statements)

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“…[5][6][7] Previous studies have shown that primigravidity is a risk factor for placental malaria and resulting obstetric morbidity. 8,9 In a prior analysis of this study cohort, we reported that placental malaria was more likely in women with high malaria burden (defined as ≥2 episodes of symptomatic malaria or ≥50% positive loop-mediated isothermal amplification (LAMP) samples) and was associated with increased rates of preterm birth and a trend towards higher rates of small for gestational age (SGA) neonates. 10 However, little is known about whether the effect of gravidity on placental malaria varies by timing and symptomatology of P. falciparum.…”

Section: Introductionmentioning

confidence: 92%

The Impact of Gravidity, Symptomatology and Timing of Infection on Placental Malaria

Tran

Cheeks

Kakuru

et al. 2020

Preprint

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Background : Placental malaria is associated with increased risk of adverse perinatal outcomes. While primigravidity has been reported as a risk factor for placental malaria, little is known regarding the relationship between gravidity, symptomatology and timing of Plasmodium falciparum infection and the development of placental malaria. Methods : Our aim was to investigate the relationship between the development of placental malaria and gravidity, timing of infection, and presence of symptoms. This is a secondary analysis of data from a double-blind randomized control trial of intermittent preventive therapy during pregnancy in Uganda. Women were enrolled from 12 to 20 weeks gestation and followed through delivery. Exposure to malaria parasites was defined as symptomatic (fever with positive blood smear) or asymptomatic (based on molecular detection of parasitemia done routinely every 4 weeks). The primary outcome was placental malaria diagnosed by histopathology, placental blood smear, and/or placental blood loop-mediated isothermal amplification. We performed subgroup analysis based on the presence of symptomatic malaria, gravidity, and timing of infection. Results : Of the 228 patients with documented maternal infection with malaria parasites during pregnancy, 101 (44.3%) had placental malaria. Primigravidity was strongly associated with placental malaria (aOR 8.90, 95% CI 4.34-18.2, p<0.001), and each episode of malaria was associated with over a 2-fold increase in placental malaria (aOR 2.35, 95% CI 1.69-3.26, p<0.001). Among multigravid women, the odds of placental malaria increased by 14% with each advancing week of gestation at first documented infection (aOR 1.14, 95% CI 1.02-1.27, p=0.02). When stratified by the presence of symptoms, primigravidity was only associated with placental malaria in asymptomatic women, who had a 12-fold increase in the odds of placental malaria (aOR 12.19, 95% CI 5.23-28.43, p<0.001). Conclusions : Total number of Plasmodium falciparum infections in pregnancy is a significant predictor of placental malaria. The importance of timing of infection on the development of placental malaria varies based on gravidity. In primigravidas, earlier asymptomatic infections were associated with placental malaria, whereas in multigravidas, parasitemias detected later in gestation were associated with placental malaria. Earlier initiation of an effective intermittent preventive therapy may help to prevent placental malaria and improve birth outcomes, particularly in primigravid women.

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Section: Introductionmentioning

confidence: 92%

The Impact of Gravidity, Symptomatology and Timing of Infection on Placental Malaria

Tran

Cheeks

Kakuru

et al. 2020

Preprint

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“…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,…”

Section: Mortality Indicatorsmentioning

confidence: 99%

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

Robbers

Vogel

Mola

et al. 2019

Sexual and Reproductive Health Matters

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Papua New Guinea (PNG) is the most populous country in the Pacific with more than 9 million people. Difficult terrain, poor roads and limited infrastructure mean providing effective health careespecially in rural areas, where most people liveis challenging. Women and newborns in PNG experience high rates of preventable morbidity and mortality; however, reliable data are often limited or unavailable. The aim of this paper is to provide an overview of research on key maternal and neonatal health (MNH) indicators conducted approximately over the past 11 years in PNG comparing research findings to global MNH estimates of the indicators. There was considerable variation in mortality indicators (maternal mortality ratio, neonatal mortality rate and stillbirth) reported across studies in PNG. Mortality was generally higher in rural areas. Rates of sexually transmitted infections (STIs) in pregnancy were consistently high, while anaemia in pregnancy, preterm birth and low birth weight varied widely between studies and settings. Breastfeeding seems to have been under-researched. There was a lack of data available on other indicators such as the adolescent birth rate, postnatal care provided to women and newborns, intermittent preventative treatment to prevent malaria in pregnancy and treatment to prevent mother-to-child transmission of HIV. Studies demonstrate the high burden of preventable maternal and newborn morbidity and mortality across PNG. Efforts to improve MNH outcomes need to be escalated.

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“…Previous studies have shown that primigravidity is a risk factor for placental malaria and resulting obstetric morbidity [8,9]. A prior analysis of this study cohort found that placental malaria was more likely in women with high malaria burden (de ned as ≥2 episodes of symptomatic malaria or ≥50% positive loop-mediated isothermal ampli cation (LAMP) samples) and was associated with increased rates of preterm birth and a trend towards higher rates of small for gestational age (SGA) neonates [10].…”

Section: Introductionmentioning

confidence: 85%

The impact of gravidity, symptomatology and timing of infection on placental malaria

Tran

Cheeks

Kakuru

et al. 2020

Preprint

View full text Add to dashboard Cite

Background Placental malaria is associated with increased risk of adverse perinatal outcomes. While primigravidity has been reported as a risk factor for placental malaria, little is known regarding the relationship between gravidity, symptomatology and timing of Plasmodium falciparum infection and the development of placental malaria. Methods The aim of this study was to investigate the relationship between the development of placental malaria and gravidity, timing of infection, and presence of symptoms. This is a secondary analysis of data from a double-blind randomized control trial of intermittent preventive therapy during pregnancy in Uganda. Women were enrolled from 12 to 20 weeks gestation and followed through delivery. Exposure to malaria parasites was defined as symptomatic (fever with positive blood smear) or asymptomatic (based on molecular detection of parasitemia done routinely every 4 weeks). The primary outcome was placental malaria diagnosed by histopathology, placental blood smear, and/or placental blood loop-mediated isothermal amplification. Multivariate analyses were performed using logistic regression models. Subgroup analysis was performed based on the presence of symptomatic malaria, gravidity, and timing of infection. Results Of the 228 patients with documented maternal infection with malaria parasites during pregnancy, 101 (44.3%) had placental malaria. Primigravidity was strongly associated with placental malaria (aOR 8.90, 95% CI 4.34-18.2, p<0.001), and each episode of malaria was associated with over a 2-fold increase in placental malaria (aOR 2.35, 95% CI 1.69-3.26, p<0.001). Among multigravid women, the odds of placental malaria increased by 14% with each advancing week of gestation at first documented infection (aOR 1.14, 95% CI 1.02-1.27, p=0.02). When stratified by the presence of symptoms, primigravidity was only associated with placental malaria in asymptomatic women, who had a 12-fold increase in the odds of placental malaria (aOR 12.19, 95% CI 5.23-28.43, p<0.001). Conclusions Total number of Plasmodium falciparum infections in pregnancy is a significant predictor of placental malaria. The importance of timing of infection on the development of placental malaria varies based on gravidity. In primigravidas, earlier asymptomatic infections were more frequently identified in those with placental malaria, whereas in multigravidas, parasitemias detected later in gestation were associated with placental malaria. Earlier initiation of an effective intermittent preventive therapy may help to prevent placental malaria and improve birth outcomes, particularly in primigravid women.

show abstract

Risk factors and pregnancy outcomes associated with placental malaria in a prospective cohort of Papua New Guinean women

Cited by 53 publications

References 37 publications

The Impact of Gravidity, Symptomatology and Timing of Infection on Placental Malaria

The Impact of Gravidity, Symptomatology and Timing of Infection on Placental Malaria

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

The impact of gravidity, symptomatology and timing of infection on placental malaria

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