Microscopic and submicroscopic Plasmodium falciparum infection, maternal anaemia and adverse pregnancy outcomes in Papua New Guinea: a cohort study
Abstract Background Infection during pregnancy with Plasmodium falciparum is associated with maternal anaemia and adverse birth outcomes including low birth weight (LBW). Studies using polymerase chain reaction (PCR) techniques indicate that at least half of all infections in maternal venous blood a...
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BMC
2019-09-01
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| Series: | Malaria Journal |
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| Online Access: | http://link.springer.com/article/10.1186/s12936-019-2931-7 |
| _version_ | 1818942175340134400 |
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| author | Holger W. Unger Anna Rosanas-Urgell Leanne J. Robinson Maria Ome-Kaius Shadrach Jally Alexandra J. Umbers Willie Pomat Ivo Mueller Eline Kattenberg Stephen J. Rogerson |
| author_facet | Holger W. Unger Anna Rosanas-Urgell Leanne J. Robinson Maria Ome-Kaius Shadrach Jally Alexandra J. Umbers Willie Pomat Ivo Mueller Eline Kattenberg Stephen J. Rogerson |
| author_sort | Holger W. Unger |
| collection | DOAJ |
| description | Abstract Background Infection during pregnancy with Plasmodium falciparum is associated with maternal anaemia and adverse birth outcomes including low birth weight (LBW). Studies using polymerase chain reaction (PCR) techniques indicate that at least half of all infections in maternal venous blood are missed by light microscopy or rapid diagnostic tests. The impact of these subpatent infections on maternal and birth outcomes remains unclear. Methods In a cohort of women co-enrolled in a clinical trial of intermittent treatment with sulfadoxine–pyrimethamine (SP) plus azithromycin for the prevention of LBW (< 2500 g) in Papua New Guinea (PNG), P. falciparum infection status at antenatal enrolment and delivery was assessed by routine light microscopy and real-time quantitative PCR. The impact of infection status at enrolment and delivery on adverse birth outcomes and maternal haemoglobin at delivery was assessed using logistic and linear regression models adjusting for potential confounders. Together with insecticide-treated bed nets, women had received up to 3 monthly intermittent preventive treatments with SP plus azithromycin or a single clearance treatment with SP plus chloroquine. Results A total of 9.8% (214/2190) of women had P. falciparum (mono-infection or mixed infection with Plasmodium vivax) detected in venous blood at antenatal enrolment at 14–26 weeks’ gestation. 4.7% of women had microscopic, and 5.1% submicroscopic P. falciparum infection. At delivery (n = 1936), 1.5% and 2.0% of women had submicroscopic and microscopic P. falciparum detected in peripheral blood, respectively. Submicroscopic P. falciparum infections at enrolment or at delivery in peripheral or placental blood were not associated with maternal anaemia or adverse birth outcomes such as LBW. Microscopic P. falciparum infection at antenatal enrolment was associated with anaemia at delivery (adjusted odds ratio [aOR] 2.00, 95% confidence interval [CI] 1.09, 3.67; P = 0.025). Peripheral microscopic P. falciparum infection at delivery was associated with LBW (aOR 2.75, 95% CI 1.27; 5.94, P = 0.010) and preterm birth (aOR 6.58, 95% CI 2.46, 17.62; P < 0.001). Conclusions A substantial proportion of P. falciparum infections in pregnant women in PNG were submicroscopic. Microscopic, but not submicroscopic, infections were associated with adverse outcomes in women receiving malaria preventive treatment and insecticide-treated bed nets. Current malaria prevention policies that combine insecticide-treated bed nets, intermittent preventive treatment and prompt treatment of symptomatic infections appear to be appropriate for the management of malaria in pregnancy in settings like PNG. |
| first_indexed | 2024-12-20T07:07:15Z |
| format | Article |
| id | doaj.art-a4f931299ddc415f929ce42053652827 |
| institution | Directory Open Access Journal |
| issn | 1475-2875 |
| language | English |
| last_indexed | 2024-12-20T07:07:15Z |
| publishDate | 2019-09-01 |
| publisher | BMC |
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| series | Malaria Journal |
| spelling | doaj.art-a4f931299ddc415f929ce420536528272022-12-21T19:49:00ZengBMCMalaria Journal1475-28752019-09-011811910.1186/s12936-019-2931-7Microscopic and submicroscopic Plasmodium falciparum infection, maternal anaemia and adverse pregnancy outcomes in Papua New Guinea: a cohort studyHolger W. Unger0Anna Rosanas-Urgell1Leanne J. Robinson2Maria Ome-Kaius3Shadrach Jally4Alexandra J. Umbers5Willie Pomat6Ivo Mueller7Eline Kattenberg8Stephen J. Rogerson9Centre for Maternal and Newborn Health, Liverpool School of Tropical MedicineInstitute of Tropical MedicineVector Borne Diseases Unit, PNG Institute of Medical ResearchVector Borne Diseases Unit, PNG Institute of Medical ResearchVector Borne Diseases Unit, PNG Institute of Medical ResearchBurnet InstituteVector Borne Diseases Unit, PNG Institute of Medical ResearchWalter and Eliza Hall Institute of Medical ResearchInstitute of Tropical MedicineDepartment of Medicine, (RMH), Peter Doherty Institute for Infection and Immunity, The University of MelbourneAbstract Background Infection during pregnancy with Plasmodium falciparum is associated with maternal anaemia and adverse birth outcomes including low birth weight (LBW). Studies using polymerase chain reaction (PCR) techniques indicate that at least half of all infections in maternal venous blood are missed by light microscopy or rapid diagnostic tests. The impact of these subpatent infections on maternal and birth outcomes remains unclear. Methods In a cohort of women co-enrolled in a clinical trial of intermittent treatment with sulfadoxine–pyrimethamine (SP) plus azithromycin for the prevention of LBW (< 2500 g) in Papua New Guinea (PNG), P. falciparum infection status at antenatal enrolment and delivery was assessed by routine light microscopy and real-time quantitative PCR. The impact of infection status at enrolment and delivery on adverse birth outcomes and maternal haemoglobin at delivery was assessed using logistic and linear regression models adjusting for potential confounders. Together with insecticide-treated bed nets, women had received up to 3 monthly intermittent preventive treatments with SP plus azithromycin or a single clearance treatment with SP plus chloroquine. Results A total of 9.8% (214/2190) of women had P. falciparum (mono-infection or mixed infection with Plasmodium vivax) detected in venous blood at antenatal enrolment at 14–26 weeks’ gestation. 4.7% of women had microscopic, and 5.1% submicroscopic P. falciparum infection. At delivery (n = 1936), 1.5% and 2.0% of women had submicroscopic and microscopic P. falciparum detected in peripheral blood, respectively. Submicroscopic P. falciparum infections at enrolment or at delivery in peripheral or placental blood were not associated with maternal anaemia or adverse birth outcomes such as LBW. Microscopic P. falciparum infection at antenatal enrolment was associated with anaemia at delivery (adjusted odds ratio [aOR] 2.00, 95% confidence interval [CI] 1.09, 3.67; P = 0.025). Peripheral microscopic P. falciparum infection at delivery was associated with LBW (aOR 2.75, 95% CI 1.27; 5.94, P = 0.010) and preterm birth (aOR 6.58, 95% CI 2.46, 17.62; P < 0.001). Conclusions A substantial proportion of P. falciparum infections in pregnant women in PNG were submicroscopic. Microscopic, but not submicroscopic, infections were associated with adverse outcomes in women receiving malaria preventive treatment and insecticide-treated bed nets. Current malaria prevention policies that combine insecticide-treated bed nets, intermittent preventive treatment and prompt treatment of symptomatic infections appear to be appropriate for the management of malaria in pregnancy in settings like PNG.http://link.springer.com/article/10.1186/s12936-019-2931-7AnaemiaDiagnosisFetal growth retardationLow birth weightMalariaPlasmodium falciparum |
| spellingShingle | Holger W. Unger Anna Rosanas-Urgell Leanne J. Robinson Maria Ome-Kaius Shadrach Jally Alexandra J. Umbers Willie Pomat Ivo Mueller Eline Kattenberg Stephen J. Rogerson Microscopic and submicroscopic Plasmodium falciparum infection, maternal anaemia and adverse pregnancy outcomes in Papua New Guinea: a cohort study Malaria Journal Anaemia Diagnosis Fetal growth retardation Low birth weight Malaria Plasmodium falciparum |
| title | Microscopic and submicroscopic Plasmodium falciparum infection, maternal anaemia and adverse pregnancy outcomes in Papua New Guinea: a cohort study |
| title_full | Microscopic and submicroscopic Plasmodium falciparum infection, maternal anaemia and adverse pregnancy outcomes in Papua New Guinea: a cohort study |
| title_fullStr | Microscopic and submicroscopic Plasmodium falciparum infection, maternal anaemia and adverse pregnancy outcomes in Papua New Guinea: a cohort study |
| title_full_unstemmed | Microscopic and submicroscopic Plasmodium falciparum infection, maternal anaemia and adverse pregnancy outcomes in Papua New Guinea: a cohort study |
| title_short | Microscopic and submicroscopic Plasmodium falciparum infection, maternal anaemia and adverse pregnancy outcomes in Papua New Guinea: a cohort study |
| title_sort | microscopic and submicroscopic plasmodium falciparum infection maternal anaemia and adverse pregnancy outcomes in papua new guinea a cohort study |
| topic | Anaemia Diagnosis Fetal growth retardation Low birth weight Malaria Plasmodium falciparum |
| url | http://link.springer.com/article/10.1186/s12936-019-2931-7 |
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