Placental infections with histologically confirmed Plasmodium falciparum are associated with adverse birth outcomes in India: a cross-sectional study

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Ahmed, Rukhsana ; Singh, Neeru ; ter Kuile, Feiko O ; Bharti, Praveen K ; Singh, Pushpendra P ; Desai, Meghna ; Udhayakumar, Venkatachalam ; Terlouw, Dianne J (2014)
  • Publisher: BioMed Central
  • Journal: Malaria Journal, volume 13, pages 232-232 (eissn: 1475-2875)
  • Related identifiers: doi: 10.1186/1475-2875-13-232, pmc: PMC4065549
  • Subject: Birth weight | Infectious Diseases | Pregnancy | Histopathology | wa_395 | Malaria | India | wa_310 | Research | wc_750 | Haemoglobin | Placenta | wq_256 | Gestational age | ws_420 | Parasitology
    mesheuropmc: parasitic diseases

Background\ud Few studies have assessed placental malaria infections from low transmission areas by histopathology to define their impact and underlying mechanisms.\ud \ud Methods\ud Peripheral smears and rapid diagnostic tests (RDTs), placental smears and histological samples, birth weight and gestational age were collected from 2,282 deliveries in three hospitals during a one-year (2006–2007) continuous cross-sectional survey in Madhya Pradesh. Placental histopathology included all 50 cases positive by microscopy or RDT plus 456 randomly selected samples of women negative for malaria by microscopy or RDT. Histological examination included parasites, inflammatory cells, pigment in fibrin, and morphological changes.\ud \ud Results\ud There were 52 histology-positive cases; 38 (73.1%) active (acute and chronic) and 14 past infections. Intervillous parasitaemia was low (60% had < 1% parasitaemia) and monocytosis mostly mild (63%). Compared with uninfected placentas, acute Plasmodium falciparum infections were associated with stillbirth (RR 3.8, 95% CI 1.2-12.1), lower maternal haemoglobin (mean difference: 1.5 g/dL, 95% CI 0.5-2.5), lower birth weight (mean difference 451 g, 95% CI 169–609) and shorter gestation (mean difference 0.8 weeks, 95% CI 0.2-1.4). Chronic or past infections were not associated with these outcomes. Among the 11 peripheral Plasmodium vivax cases, placental parasites were absent, but they were associated with increased placental polymorphonuclear cells.\ud \ud Conclusions\ud Malaria associated stillbirth and low birth weight in women with low protective immunity may result, at least in part, from a shortened gestation triggered by acute infection, stressing the importance of early malaria detection.
  • References (41)
    41 references, page 1 of 5

    1. Dellicour S, Tatem AJ, Guerra CA, Snow RW, ter Kuile FO: Quantifying the number of pregnancies at risk of malaria in 2007: a demographic study. PLoS Med 2010, 7:e1000221.

    2. Desai M, ter Kuile FO, Nosten F, McGready R, Asamoa K, Brabin B, Newman RD: Epidemiology and burden of malaria in pregnancy. Lancet Infect Dis 2007, 7:93-104.

    3. Bulmer JN, Rasheed FN, Francis N, Morrison L, Greenwood BM: Placental malaria. I. Pathological classification. Histopathology 1993, 22:211-218.

    4. Ismail MR, Ordi J, Menendez C, Ventura PJ, Aponte JJ, Kahigwa E, Hirt R, Cardesa A, Alonso PL: Placental pathology in malaria: A histological, immunohistochemical, and quantitative study. Hum Pathol 2000, 31:85-93.

    5. Leopardi O, Naughten W, Salvia L, Colecchia M, Matteelli A, Zucchi A, Shein A, Muchi JA, Carosi G, Ghione M: Malaric placentas. A quantitative study and clinico-pathological correlations. Pathol Res Pract 1996, 192:892-898. discussion 899-900.

    6. Menendez C, Ordi J, Ismail MR, Ventura PJ, Aponte JJ, Kahigwa E, Font F, Alonso PL: The impact of placental malaria on gestational age and birth weight. J Infect Dis 2000, 181:1740-1745.

    7. Rogerson SJ, Pollina E, Getachew A, Tadesse E, Lema VM, Molyneux ME: Placental monocyte infiltrates in response to Plasmodium falciparum malaria infection and their association with adverse pregnancy outcomes. Am J Trop Med Hyg 2003, 68:115-119.

    8. Watkinson M, Rushton DI: Plasmodial pigmentation of placenta and outcome of pregnancy in West African mothers. BMJ 1983, 287:251-254.

    9. Ordi J, Ismail MR, Menendez C, Ventura PJ, Cardesa A: Massive chronic intervillositis associated with malaria infection. Modern Pathology 1998, 11:146A.

    10. McGready R, Davison BB, Stepniewska K, Shee TCF, Brockman A, Udomsangpetch R, Loareesuwan S, White NJ, Meshnick SR, Nosten F: The effects of Plasmodium falciparum and P. vivax infections on placental histopathology in an area of low malaria transmission. Am J Trop Med Hyg e 2004, 70:398-407.

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