Neurocognitive outcomes in Malawian children exposed to malaria during pregnancy: An observational birth cohort study

Background Annually 125 million pregnancies are at risk of malaria infection. However, the impact of exposure to malaria in pregnancy on neurodevelopment in children is not well understood. We hypothesized that malaria in pregnancy and associated maternal immune activation result in neurodevelopmental delay in exposed offspring. Methods and findings Between April 2014 and April 2015, we followed 421 Malawian mother–baby dyads (median [IQR] maternal age: 21 [19, 28] years) who were previously enrolled (median [IQR] gestational age at enrollment: 19.7 [17.9, 22.1] weeks) in a randomized controlled malaria prevention trial with 5 or 6 scheduled assessments of antenatal malaria infection by PCR. Children were evaluated at 12, 18, and/or 24 months of age with cognitive tests previously validated in Malawi: the Malawi Developmental Assessment Tool (MDAT) and the MacArthur–Bates Communicative Development Inventories (MCAB-CDI). We assessed the impact of antenatal malaria (n [%] positive: 240 [57.3]), placental malaria (n [%] positive: 112 [29.6]), and maternal immune activation on neurocognitive development in children. Linear mixed-effects analysis showed that children exposed to antenatal malaria between 33 and 37 weeks gestation had delayed language development across the 2-year follow-up, as measured by MCAB-CDI (adjusted beta estimate [95% CI], −7.53 [−13.04, −2.02], p = 0.008). Maternal immune activation, characterized by increased maternal sTNFRII concentration, between 33 and 37 weeks was associated with lower MCAB-CDI language score (adjusted beta estimate [95% CI], −8.57 [−13.09, −4.06], p < 0.001). Main limitations of this study include a relatively short length of follow-up and a potential for residual confounding that is characteristic of observational studies. Conclusions This mother–baby cohort presents evidence of a relationship between malaria in pregnancy and neurodevelopmental delay in offspring. Malaria in pregnancy may be a modifiable risk factor for neurodevelopmental injury independent of birth weight or prematurity. Successful interventions to prevent malaria during pregnancy may reduce the risk of neurocognitive delay in children.

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The Impact of Malaria in Pregnancy on Infant Susceptibility to Malaria Infection

Journal of thee Medical Sciences (Berkala Ilmu Kedokteran) ◽

10.19106/jmedsci005002201807 ◽

2018 ◽

Vol 50 (2) ◽

Author(s):

Ratni Indrawanti ◽

Mahardika Wijayanti ◽

Mochamad Hakimi ◽

Mohammad Juffrie ◽

Enny Kenangalem ◽

...

Keyword(s):

Malaria Infection ◽

Malaria In Pregnancy ◽

The Impact ◽

In Pregnancy

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Ovarian Dysgerminoma in Pregnant Women with Viable Fetus: A Rare Case Report

Case Reports in Oncology ◽

10.1159/000513622 ◽

2021 ◽

pp. 141-146

Author(s):

Reda Youssef ◽

Gamal Sayed Ahmed ◽

Samir Alhyassat ◽

Sanaa Badr ◽

Ahmed Sabry ◽

...

Keyword(s):

Gestational Age ◽

Ovarian Neoplasms ◽

Imaging Modality ◽

Reproductive Age ◽

Diagnostic Challenge ◽

Short Period ◽

Ovarian Dysgerminoma ◽

The Impact ◽

In Pregnancy

Dysgerminoma is an uncommon malignant tumor arising from the germ cells of the ovary. Its association with pregnancy is extremely rare, with a reported incidence of about 0.2–1 per 100,000 pregnancies. Women in the reproductive age group are more commonly affected. It can be extremely rare to conceive naturally, without assisted reproductive interventions, in cases with ovarian dysgerminoma. If a pregnancy does occur with a concurrent dysgerminoma, it is even more unusual to carry the pregnancy to viability or childbirth without fetal or maternal compromise. We report a case of right ovarian dysgerminoma in a young female with a viable intrauterine pregnancy at 10 weeks, which is rarely diagnosed and managed at this gestational age. Numerous factors played a role in her favorable outcome, including early suspicion by ultrasound and presenting history, surgery, histopathological assessment, imaging, and involvement of the multidisciplinary oncology team. Ovarian neoplasms may rapidly increase in size within a short period with little or no symptoms. This poses a diagnostic challenge for obstetricians and oncologists. Hence, we aimed to evaluate the role of imaging in pregnancy using ultrasound as an imaging modality for both early detection of ovarian neoplasms and for follow-up. In conclusion, patients with ovarian dysgerminoma in pregnancy can have favorable outcomes. Treatment should be individualized on a case-to-case basis, depending on many factors; cancer stage, previous reproductive history, the impact of imaging in staging or follow-up of tumor on the fetus, fetal gestational age, and whether termination of the pregnancy can improve survival or morbidity for the mother.

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The Effect of Maternal Immune Activation on Social Play-Induced Ultrasonic Vocalization in Rats

Brain Sciences ◽

10.3390/brainsci11030344 ◽

2021 ◽

Vol 11 (3) ◽

pp. 344

Author(s):

Kinga Gzielo ◽

Agnieszka Potasiewicz ◽

Ewa Litwa ◽

Diana Piotrowska ◽

Piotr Popik ◽

...

Keyword(s):

Immune Activation ◽

Social Play ◽

Autism Spectrum ◽

Repetitive Behaviors ◽

Male Rats ◽

Poly I:C ◽

Maternal Immune Activation ◽

Increased Risk ◽

Adolescent Rats ◽

The Impact

Prenatal maternal infection is associated with an increased risk of various neurodevelopmental disorders, including autism spectrum disorders (ASD). Maternal immune activation (MIA) can be experimentally induced by prenatal administration of polyinosinic:polycytidylic acid (poly I:C), a synthetic viral-like double-stranded RNA. Although this MIA model is adopted in many studies, social and communicative deficits, included in the first diagnostic criterion of ASD, are poorly described in the offspring of poly(I:C)-exposed dams. This study aimed to characterize the impact of prenatal poly(I:C) exposure on socio-communicative behaviors in adolescent rats. For this purpose, social play behavior was assessed in both males and females. We also analyzed quantitative and structural changes in ultrasonic vocalizations (USVs) emitted by rats during the play test. Deficits of social play behaviors were evident only in male rats. Males also emitted a significantly decreased number of USVs during social encounters. Prenatal poly(I:C) exposure also affected acoustic call parameters, as reflected by the increased peak frequencies. Additionally, repetitive behaviors were demonstrated in autistic-like animals regardless of sex. This study demonstrates that prenatal poly(I:C) exposure impairs socio-communicative functioning in adolescent rats. USVs may be a useful tool for identifying early autistic-like abnormalities.

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A brief review on features of falciparum malaria during pregnancy

Journal of Public Health in Africa ◽

10.4081/jphia.2017.668 ◽

2017 ◽

Cited By ~ 2

Author(s):

Alexandre Manirakiza ◽

Eugène Serdouma ◽

Richard Norbert Ngbalé ◽

Sandrine Moussa ◽

Samuel Gondjé ◽

...

Keyword(s):

Falciparum Malaria ◽

Public Health Problem ◽

Malaria In Pregnancy ◽

Sub Saharan Africa ◽

Malaria During Pregnancy ◽

Concurrent Infections ◽

Tropical Areas ◽

Sub Saharan ◽

Protection Against Infection ◽

In Pregnancy

Malaria in pregnancy is a serious public health problem in tropical areas. Frequently, the placenta is infected by accumulation of Plasmodium falciparum-infected erythrocytes in the intervillous space. Falciparum malaria acts during pregnancy by a range of mechanisms, and chronic or repeated infection and co-infections have insidious effects. The susceptibility of pregnant women to malaria is due to both immunological and humoral changes. Until a malaria vaccine becomes available, the deleterious effects of malaria in pregnancy can be avoided by protection against infection and prompt treatment with safe, effective antimalarial agents; however, concurrent infections such as with HIV and helminths during pregnancy are jeopardizing malaria control in sub-Saharan Africa.

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Clients’ satisfaction with preventive services for malaria during pregnancy in Anambra state, Nigeria

BMC Public Health ◽

10.1186/s12889-020-09767-2 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Emmanuel Chijioke Obagha ◽

IkeOluwakpo Ajayi ◽

Gobir A. Abdullahi ◽

Chukwuma David Umeokonkwo

Keyword(s):

Health Workers ◽

Interpersonal Relationship ◽

Intermittent Preventive Treatment ◽

Preventive Services ◽

Malaria In Pregnancy ◽

Composite Score ◽

Bed Nets ◽

Anambra State ◽

Malaria During Pregnancy ◽

In Pregnancy

Abstract Background Burden of Malaria in pregnancy (MIP) is still high despite availability of proven cost-effective interventions. Considerable progress has been made on improving antenatal attendance, but MIP preventive services utilization remains low. Factors responsible for this include dissatisfaction with the services provided. We assessed clients’ satisfaction with preventative services for malaria during pregnancy delivered at antenatal clinics (ANC) in Anambra State Nigeria. Method We conducted a cross-sectional study among 284 pregnant women attending ANC using multistage sampling technique. Pre-tested semi-structured interviewer-administered questionnaire was used to collect information on socio-demographics, knowledge of malaria in pregnancy services and satisfaction with services. Responses to questions on satisfaction was on a 5-point Likert scale. A cut off of ≥75% of composite score was used to classify respondents as satisfied. For knowledge, every correct answer was scored 1 and incorrect 0; ≥75% of the composite score was graded as good knowledge. Chi square and logistic regression were used to test for association between client satisfaction and independent variables. Results The mean age of participants is 28 years±4.4 years. Overall, 62.2% were satisfied with quality of preventive services for malaria during pregnancy. However, 64.8 and 57.8% were dissatisfied with cost of healthcare and interpersonal relationship with the health workers (HWs). Majority of the respondents (88.73%) had poor knowledge of malaria preventive services during pregnancy. Type of facility (Adjusted odds ratio [aOR] = 2.11; 95%CI: 1.20–3.71) and knowledge (aOR: 0.41; 95%CI: 0.18–0.90) were independently associated with satisfaction with interpersonal relationship. Type of facility (aOR: 0.47; 95%CI: 0.27–0.80) and employment status (aOR: 3.07; 95%CI: 1.39–6.74) were also independently associated with satisfaction with cost of healthcare. Conclusion A fair proportion of respondents were satisfied with the preventive services for malaria during pregnancy provided even though most were dissatisfied with the cost of assessing care and interpersonal relationship with health workers. Uninterrupted availability of long lasting insecticide treated bed nets and intermittent preventive treatment for malaria at all health facilities, subsidized cost of malaria-related commodities, and incentives for good customer satisfaction ratings may remediate the described barriers to seeking preventative care for malaria during pregnancy.

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Neurodevelopmental Disorders Induced by Maternal Immune Activation: Toward a Prevention Strategy in the Era of the COVID-19 Pandemic

Psychiatry International ◽

10.3390/psychiatryint1010003 ◽

2020 ◽

Vol 1 (1) ◽

pp. 24-26

Author(s):

Kazuhiro Sakurada ◽

Yoshihiro Noda

Keyword(s):

Immune Activation ◽

Neurodevelopmental Disorders ◽

Data Science ◽

Biological Effects ◽

Global Scale ◽

Maternal Infection ◽

Public Health Perspective ◽

Daily Lives ◽

Maternal Immune Activation ◽

The Impact

As of summer 2020, the COVID-19 pandemic is having a major impact on our daily lives on a global scale, forcing us to change to the new normal. However, the effects are not only detrimental to our present socioeconomic conditions but also have the risk of having negative biological effects on our descendants. Of concern is the effect of maternal immune activation following maternal infection with COVID-19 on the fetus’ cerebral nervous system. While we are currently occupied with countering the imminent threats in front of us, we also need to take steps from a public health perspective to reduce the impact of maternal infection on the fetus, especially the risk of neurodevelopmental disorders. However, such a risk can be prevented and managed through the digital transformation of the nation’s health data and the strategic application of sophisticated data science approaches to those big data.

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Malaria in pregnancy in rural Gabon: a cross-sectional survey on the impact of seasonality in high-risk groups

Malaria Journal ◽

10.1186/1475-2875-12-412 ◽

2013 ◽

Vol 12 (1) ◽

pp. 412 ◽

Cited By ~ 9

Author(s):

Mario J Jäckle ◽

Christian G Blumentrath ◽

Rella M Zoleko ◽

Daisy Akerey-Diop ◽

Jean-Rodolphe Mackanga ◽

...

Keyword(s):

High Risk ◽

Risk Groups ◽

Malaria In Pregnancy ◽

Cross Sectional Survey ◽

Cross Sectional ◽

The Impact ◽

In Pregnancy

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Subtle alterations in neonatal neurodevelopment following early or late exposure to prenatal maternal immune activation

10.1101/2021.08.12.456095 ◽

2021 ◽

Author(s):

Elisa Guma ◽

Emily Snook ◽

Shoshana Spring ◽

Jason P Lerch ◽

Brian J Nieman ◽

...

Keyword(s):

Immune Activation ◽

Neonatal Period ◽

Ex Vivo ◽

Brain Anatomy ◽

Cross Sectional ◽

Maternal Immune Activation ◽

Communicative Ability ◽

Late Exposure ◽

Magnetic Resonance Imaging Mri ◽

The Impact

Prenatal exposure to maternal immune activation (MIA) is a risk factor for a variety of neurodevelopmental and psychiatric disorders. The timing of MIA-exposure has been shown to affect adolescent and adult offspring neurodevelopment, however, less is known about these effects in the neonatal period. To better understand the impact of MIA-exposure on neonatal brain development, we first assess neonate communicative abilities with the ultrasonic vocalization task, followed by high-resolution ex vivo magnetic resonance imaging (MRI) on the neonatal (postnatal day 8) brain. Early exposed offspring displayed decreased communicative ability, while brain anatomy appeared largely unaffected, apart from some subtle alterations. By integrating MRI and behavioural assays to investigate the effects of MIA-exposure on neonatal neurodevelopment we show that offspring neuroanatomy and behaviour are only subtly affected by both early and late exposure. This suggests that the deficits often observed in later stages of life may be dormant, not yet developed in the neonatal period, or not as easily detectable using a cross-sectional approach.

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Malaria in Pregnancy in Nigeria: A Literature Review

International Healthcare Research Journal ◽

10.26440/ihrj/0311.02315 ◽

2020 ◽

Vol 3 (11) ◽

pp. 346-348

Author(s):

Joseph Omang ◽

Antor O Ndep ◽

Dominic Offiong ◽

Fidelis Otu ◽

Kenneth Onyejose

Keyword(s):

Pregnant Women ◽

Malaria Infection ◽

Well Being ◽

Malaria In Pregnancy ◽

Sub Saharan Africa ◽

Infected Mosquito ◽

Insecticide Treated Nets ◽

Health Seeking ◽

Systematic Analysis ◽

In Pregnancy

Malaria is caused by the parasite plasmodium which can be spread to humans through the bite of an infected mosquito. Of the five types of plasmodium (P. Falciparium, P.Ovale, P. Malaria, P. Vivax and P. Knowlesi), the plasmodium falciparium is the deadliest and affects the lives of almost 40 per cent of the world’s population with pregnant women and children under-five years of age being the most affected. This mini-review involved the collation of findings from recent studies in regards to the prevalence of malaria infection among pregnant women and infants. A systematic analysis of recent literature on the prevalence of malaria in pregnancy from many authors was carried out and the facts synthesized to make an easy read. From the analysis of literature, Ten Thousand women and 200,000 babies were reported to be dying annually from complications of malaria in pregnancy which recorded a prevalence of 85 per cent in sub-Saharan Africa. More so, Fifty per cent of pregnant women were discovered to be carrying plasmodium falciparium in their placenta without even experiencing malaria signs/ symptoms, and this development was reported to have been responsible for Twenty per cent of stillbirths and 11 per cent of all maternal deaths. Malaria infection is considered a major threat to the lives and well-being of pregnant women and infants. Therefore, stakeholders should ensure that every clinical diagnosis of malaria in pregnancy is confirmed with a laboratory plasmodium falciparium-based diagnosis before the administration of antimalarial drugs. Furthermore there should be a stepping –up on the distribution of insecticide treated nets alongside enlightenment of pregnant women on ways of preventing mosquito bite. Instituting the aforementioned approaches is key to improving the health- seeking behaviour of pregnant women in particular and the wider population in general thus enabling them to stay malaria free throughout the period of pregnancy and infancy.

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Trends of malaria infection in pregnancy in Ghana over the past two decades: a review

Malaria Journal ◽

10.1186/s12936-021-04031-3 ◽

2022 ◽

Vol 21 (1) ◽

Author(s):

Joseph Osarfo ◽

Gifty Dufie Ampofo ◽

Harry Tagbor

Keyword(s):

Malaria Transmission ◽

Malaria Infection ◽

Low Birthweight ◽

Parasite Prevalence ◽

Forest Zone ◽

The Past ◽

Apparent Reduction ◽

The Impact ◽

Submicroscopic Parasitaemia ◽

In Pregnancy

Abstract Background There has been a global decline in malaria transmission over the past decade. However, not much is known of the impact of this observation on the burden of malaria infection in pregnancy in endemic regions including Ghana. A narrative review was undertaken to help describe trends in malaria infection in pregnancy in Ghana. Among others, such information is important in showing any progress made in malaria in pregnancy control. Methods To describe trends in pregnancy-associated malaria infection in Ghana, a search and review of literature reporting data on the prevalence of asymptomatic Plasmodium falciparum infection in pregnancy was conducted. Results Thirty-six (36) studies, conducted over 1994–2019, were included in the review. In the northern savannah zone with largely seasonal malaria transmission, prevalence appeared to reduce from about 50–60% in 1994–2010 to 13–26% by 2019. In the middle transitional/forest zone, where transmission is perennial with peaks in the rainy season, prevalence apparently reduced from 60% in the late 1990 s to about 5–20% by 2018. In the coastal savannah area, there was apparent reduction from 28 to 35% in 2003–2010 to 5–11% by 2018–2019. The burden of malaria infection in pregnancy continues to be highest among teenagers and younger-aged pregnant women and paucigravidae. Conclusions There appears to be a decline in asymptomatic parasite prevalence in pregnancy in Ghana though this has not been uniform across the different transmission zones. The greatest declines were noticeably in urban settings. Submicroscopic parasitaemia remains a challenge for control efforts. Further studies are needed to evaluate the impact of the reduced parasite prevalence on maternal anaemia and low birthweight and to assess the local burden of submicroscopic parasitaemia in relation to pregnancy outcomes.

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