Epidemiology and burden of malaria in pregnancy

Malaria Branch, Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
The Lancet Infectious Diseases (Impact Factor: 22.43). 03/2007; 7(2):93-104. DOI: 10.1016/S1473-3099(07)70021-X
Source: PubMed


We reviewed evidence of the clinical implications and burden of malaria in pregnancy. Most studies come from sub-Saharan Africa, where approximately 25 million pregnant women are at risk of Plasmodium falciparum infection every year, and one in four women have evidence of placental infection at the time of delivery. P falciparum infections during pregnancy in Africa rarely result in fever and therefore remain undetected and untreated. Meta-analyses of intervention trials suggest that successful prevention of these infections reduces the risk of severe maternal anaemia by 38%, low birthweight by 43%, and perinatal mortality by 27% among paucigravidae. Low birthweight associated with malaria in pregnancy is estimated to result in 100,000 infant deaths in Africa each year. Although paucigravidae are most affected by malaria, the consequences for infants born to multigravid women in Africa may be greater than previously appreciated. This is because HIV increases the risk of malaria and its adverse effects, particularly in multigravidae, and recent observational studies show that placental infection almost doubles the risk of malaria infection and morbidity in infants born to multigravidae. Outside Africa, malaria infection rates in pregnant women are much lower but are more likely to cause severe disease, preterm births, and fetal loss. Plasmodium vivax is common in Asia and the Americas and, unlike P falciparum, does not cytoadhere in the placenta, yet, is associated with maternal anaemia and low birthweight. The effect of infection in the first trimester, and the longer term effects of malaria beyond infancy, are largely unknown and may be substantial. Better estimates are also needed of the effects of malaria in pregnancy outside Africa, and on maternal morbidity and mortality in Africa. Global risk maps will allow better estimation of potential impact of successful control of malaria in pregnancy.

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    • "particularly interesting that experimental bacterial (LPS), viral (Poly I:C) and PGE 2 fevers in several species are reduced late in pregnancy (for review Mouihate et al., 2008; Spencer et al., 2008). It is not known if there is a similar suppression of the febrile response in late gestation in pregnant women, but it is reported that malarial infections during pregnancy are often asymptomatic, i.e. presenting without fever (Desai et al., 2007). Thus one might conclude that there is normally a natural means, through fever suppression, to prevent the complications associated with fever at parturition that are reported in the clinical literature. "
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    • "Infection with malaria also increases risk of spontaneous abortion (McGready et al. 2012), stillbirth (Goldenberg & Thompson 2003) and intrauterine growth retardation (Steketee et al. 2001) and leads to anaemia in newborns (van Eijk et al. 2002). Systematic reviews of malaria prevention show significant reductions in severe maternal anaemia, low birthweight, perinatal mortality (Desai et al. 2007) and stillbirth (Menezes et al. 2009; Barros et al. 2010; Ishaque et al. 2011). Mosquitoes that transmit dengue breed in water-storage containers. "
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