IMPRINT: the impact of malaria in pregnancy on infant neurodevelopment

Abstract Malaria in pregnancy remains a major problem of public health concern in Sub-Saharan Africa due to its endemicity and the diverse consequences on both the mother and the baby. Much attention, therefore, is needed to fully understand the epidemiology of the disease and to mitigate the devastating outcomes. The present study aimed at investigating malaria in pregnancy, its adverse effects on pregnant women and the impact on birthweight of babies. A total of 222 pregnant women gave their consent and were recruited into the study during their routine Antenatal care visits. This study employed a combination of cross-sectional and longitudinal cohort study designs. For 122 women in the cross-sectional arm, blood samples and data were obtained once, whilst 100 women in the longitudinal cohort arm were followed up from recruitment until delivery. Demographic information, obstetric history and risk factors were obtained by administering questionnaires. About 1.0 ml of venous blood was drawn to determine malaria parasitaemia and anaemia status of the participants. The birthweights of the babies were also taken at delivery. The prevalence of malaria and anaemia was 19.8% and 27.0% respectively at registration for all 222 participants. All infections were P. falciparum malaria. One hundred and forty-six (65.8%) of participants had ITN but only 72 (32.4%) used it the previous night. Young age and rural settings were risk factors for malaria. Young age and malaria positive pregnant women had increased risk of anaemia. In the follow-up group which ended with 54 participants, the overall prevalence of malaria and anaemia were 18.7% and 32.4% respectively. Fifty-two (96.3%) of pregnant women attended ANC ≥ 4 times and 55.6% took ≥ 3 doses of SP. There were two cases of miscarriage. Low birthweight occurred in 5.6% of babies. Both malaria and anaemia during pregnancy had no significant impact on birthweight of the babies. Although few of the babies had low birthweight, this number can be further reduced when pregnant women attend ANC and take SP at the recommended number of times.

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Sub-optimal Intermittent Preventive Treatment in pregnancy (IPTp) is associated with an increased risk of submicroscopic P. falciparum infection in pregnant women: a prospective cohort study in Benin

Clinical Infectious Diseases ◽

10.1093/cid/ciaa1355 ◽

2020 ◽

Author(s):

Cornélia P A Hounkonnou ◽

Nicaise Tuikue Ndam ◽

Nadine Fievet ◽

Manfred Accrombessi ◽

Emmanuel Yovo ◽

...

Keyword(s):

Gestational Age ◽

Negative Binomial ◽

Intermittent Preventive Treatment ◽

Preventive Treatment ◽

Malaria In Pregnancy ◽

Sub Saharan Africa ◽

Increased Risk ◽

Sub Saharan ◽

The Impact ◽

In Pregnancy

Abstract Background Harmful maternal and neonatal health outcomes result from malaria in pregnancy, the prevention of which primarily relies on intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP). WHO recommends IPTp-SP in sub-Saharan Africa, but implementation is highly heterogeneous and often sub-optimal in terms of the number of doses and their timing. In this study, we assessed the impact of this heterogeneity on malaria in pregnancy, mainly with respect to submicroscopic Plasmodium falciparum infections. Methods We used data from 273 Beninese women followed throughout pregnancy. Screening for P. falciparum infections, using both microscopy- and polymerase chain reaction (PCR) -based methods, was performed monthly, and information on IPTp-SP dose was collected. Gestational age was estimated by repeated ultrasound scans. Using a negative binomial model, we investigated the effect of IPTp-SP doses and timing, after 17 weeks of gestation, on the number of P. falciparum infections, focusing on submicroscopic infections detectable only by PCR. Results At least two IPTp-SP doses were taken by 77.3% of the women. The median gestational age at first IPTp-SP dose was 22 weeks. A late first IPTp-SP dose (>21.2 weeks) was marginally associated with an increased number of P. falciparum infections (adjusted incidence rate ratio [aIRR] =1.3; p=0.098). The number of IPTp-SP doses was not associated with the number of submicroscopic infections (aIRR=1.2, p=0.543). Conclusion A late first IPTp-SP dose fail to provide optimal protection against P. falciparum, especially submicroscopic infections. This highlights the need for a new antimalarial drug for IPTp that could be taken early in pregnancy.

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

PLoS Medicine ◽

10.1371/journal.pmed.1003701 ◽

2021 ◽

Vol 18 (9) ◽

pp. e1003701

Author(s):

Andrea M. Weckman ◽

Andrea L. Conroy ◽

Mwayiwawo Madanitsa ◽

Bruno Gnaneswaran ◽

Chloe R. McDonald ◽

...

Keyword(s):

Immune Activation ◽

Malaria Infection ◽

Placental Malaria ◽

Malaria In Pregnancy ◽

Neurodevelopmental Delay ◽

Maternal Immune Activation ◽

Malaria During Pregnancy ◽

The Impact ◽

In Pregnancy

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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Faculty Opinions recommendation of Fetal and maternal innate immunity receptors have opposing effects in severity of experimental malaria in pregnancy: Beneficial roles for fetal-derived TLR4 and IFNAR1.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.732665427.793543151 ◽

2018 ◽

Author(s):

Ana Claudia Zenclussen

Keyword(s):

Innate Immunity ◽

Malaria In Pregnancy ◽

Opposing Effects ◽

In Pregnancy

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Impact of Malaria in Pregnancy on Risk of Malaria in Young Children: Systematic Review and Meta-Analyses

SSRN Electronic Journal ◽

10.2139/ssrn.3457411 ◽

2019 ◽

Author(s):

Sangshin Park ◽

Christina E. Nixon ◽

Olivia Miller ◽

Nam-Kyong Choi ◽

Jonathan D. Kurtis ◽

...

Keyword(s):

Systematic Review ◽

Young Children ◽

Malaria In Pregnancy ◽

Meta Analyses ◽

In Pregnancy

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Treatment of Malaria in Pregnancy: Knowledge of Community Pharmacists in Ibadan, Nigeria

SSRN Electronic Journal ◽

10.2139/ssrn.3522107 ◽

2019 ◽

Author(s):

Wuraola Akande-Sholabi ◽

Olayinka S. Ilesanmi ◽

Ayandare S. Ayanleke

Keyword(s):

Community Pharmacists ◽

Malaria In Pregnancy ◽

In Pregnancy ◽

Ibadan Nigeria

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Insulin Therapy in Pregnancy Hypertensive Diseases and its Effect on the Offspring and Mother Later in Life

Current Vascular Pharmacology ◽

10.2174/1570161117666181114125109 ◽

2019 ◽

Vol 17 (5) ◽

pp. 455-464 ◽

Cited By ~ 8

Author(s):

Alfonso Mate ◽

Antonio J. Blanca ◽

Rocío Salsoso ◽

Fernando Toledo ◽

Pablo Stiefel ◽

...

Keyword(s):

Diabetes Mellitus ◽

Insulin Resistance ◽

Polycystic Ovary Syndrome ◽

Insulin Therapy ◽

Polycystic Ovary ◽

Ovary Syndrome ◽

Insulin Resistant ◽

Hypertensive Disorders ◽

The Impact ◽

In Pregnancy

Pregnancy hypertensive disorders such as Preeclampsia (PE) are strongly correlated with insulin resistance, a condition in which the metabolic handling of D-glucose is deficient. In addition, the impact of preeclampsia is enhanced by other insulin-resistant disorders, including polycystic ovary syndrome and obesity. For this reason, there is a clear association between maternal insulin resistance, polycystic ovary syndrome, obesity and the development of PE. However, whether PE is a consequence or the cause of these disorders is still unclear. Insulin therapy is usually recommended to pregnant women with diabetes mellitus when dietary and lifestyle measures have failed. The advantage of insulin therapy for Gestational Diabetes Mellitus (GDM) patients with hypertension is still controversial; surprisingly, there are no studies in which insulin therapy has been used in patients with hypertension in pregnancy without or with an established GDM. This review is focused on the use of insulin therapy in hypertensive disorders in the pregnancy and its effect on offspring and mother later in life. PubMed and relevant medical databases have been screened for literature covering research in the field especially in the last 5-10 years.

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