Burden and impact of Plasmodium vivax in pregnancy: a multi-centre prospective observational study

Bardají, Azucena, Martínez-Espinosa, Flor Ernestina, Arévalo-Herrera, Myriam, Padilla, Norma, Kochar, Swati, Ome-Kaius, Maria, Bôtto-Menezes, Camila, Castellanos, María Eugenia, Kochar, Dhanpat Kumar, Kochar, Sanjay Kumar, Betuela, Inoni, Mueller, Ivo, Rogerson, Stephen, Chitnis, Chetan, Hans, Dhiraj, Menegon, Michela, Severini, Carlo, del Portillo, Hernando, Dobaño, Carlota, Mayor, Alfredo, Ordi, Jaume, Piqueras, Mireia, Sanz, Sergi, Wahlgren, Mats, Slutsker, Laurence, Desai, Meghna, and Menéndez, Clara (2017) Burden and impact of Plasmodium vivax in pregnancy: a multi-centre prospective observational study. PLoS Neglected Tropical Diseases, 11 (6). e0005606.

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Abstract

Background: Despite that over 90 million pregnancies are at risk of Plasmodium vivax infection annually, little is known about the epidemiology and impact of the infection in pregnancy.

Methodology and principal findings: We undertook a health facility-based prospective observational study in pregnant women from Guatemala (GT), Colombia (CO), Brazil (BR), India (IN) and Papua New Guinea PNG). Malaria and anemia were determined during pregnancy and fetal outcomes assessed at delivery. A total of 9388 women were enrolled at antennal care (ANC), of whom 53% (4957) were followed until delivery. Prevalence of P. vivax monoinfection in maternal blood at delivery was 0.4% (20/4461) by microscopy [GT 0.1%, CO 0.5%, BR 0.1%, IN 0.2%, PNG 1.2%] and 7% (104/1488) by PCR. P. falciparum monoinfection was found in 0.5% (22/4463) of women by microscopy [GT 0%, CO 0.5%, BR 0%, IN 0%, PNG 2%]. P. vivax infection was observed in 0.4% (14/3725) of placentas examined by microscopy and in 3.7% (19/508) by PCR. P. vivax in newborn blood was detected in 0.02% (1/4302) of samples examined by microscopy [in cord blood; 0.05% (2/4040) by microscopy, and 2.6% (13/497) by PCR]. Clinical P. vivax infection was associated with increased risk of maternal anemia (Odds Ratio-OR, 5.48, [95% CI 1.83–16.41]; p = 0.009), while submicroscopic vivax infection was not associated with increased risk of moderate-severe anemia (Hb<8g/dL) (OR, 1.16, [95% CI 0.52–2.59]; p = 0.717), or low birth weight (<2500g) (OR, 0.52, [95% CI, 0.23–1.16]; p = 0.110).

Conclusions: In this multicenter study, the prevalence of P. vivax infection in pregnancy by microscopy was overall low across all endemic study sites; however, molecular methods revealed a significant number of submicroscopic infections. Clinical vivax infection in pregnancy was associated with maternal anemia, which may be deleterious for infant’s health. These results may help to guide maternal health programs in settings where vivax malaria is endemic; they also highlight the need of addressing a vulnerable population such as pregnant women while embracing malaria elimination in endemic countries.

Item ID: 66559
Item Type: Article (Research - C1)
ISSN: 1935-2735
Copyright Information: This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.
Funders: European Union Seventh Framework Programme (EU FP7), Malaria in Pregnancy Consortium (MiPc), Bill and Melinda Gates Foundation (BMGF), Ministry of Science and Innovation, Spain (MCIN), National Health and Medical Research Council (NHMRC), Centro Latino Americano de Investigación en Malaria (CLAIM), Spanish Government (SG)
Projects and Grants: EU FP7 (FP7/2007-2013) under grant agreement number PREGVAX FP7-HEALTH-201588, MiPc/BMGF Grant No. 46099, NHMRC Senior Research Fellowship, CLAIM NIAID/ICEMR (U19AI089702), SG Ramon y Cajal Fellowship [Grant No. RYC-2013-14512]
Date Deposited: 23 Mar 2021 00:17
FoR Codes: 42 HEALTH SCIENCES > 4202 Epidemiology > 420207 Major global burdens of disease @ 100%
SEO Codes: 20 HEALTH > 2004 Public health (excl. specific population health) > 200499 Public health (excl. specific population health) not elsewhere classified @ 100%
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