scholarly journals Poor Birth Outcomes in Malaria in Pregnancy: Recent Insights Into Mechanisms and Prevention Approaches

2021 ◽  
Vol 12 ◽  
Author(s):  
Caroline L. L. Chua ◽  
Wina Hasang ◽  
Stephen J. Rogerson ◽  
Andrew Teo
Keyword(s):  
Birth Outcomes ◽  
Low Birthweight ◽  
Management Strategies ◽  
Malaria In Pregnancy ◽  
Therapeutic Interventions ◽  
Host Responses ◽  
Future Research ◽  
Placental Development ◽  
One Step ◽  
In Pregnancy

Pregnant women in malaria-endemic regions are susceptible to malaria in pregnancy, which has adverse consequences on birth outcomes, including having small for gestational age and preterm babies. These babies are likely to have low birthweights, which predisposes to infant mortality and lifelong morbidities. During malaria in pregnancy, Plasmodium falciparum-infected erythrocytes express a unique variant surface antigen, VAR2CSA, that mediates sequestration in the placenta. This process may initiate a range of host responses that contribute to placental inflammation and dysregulated placental development, which affects placental vasculogenesis, angiogenesis and nutrient transport. Collectively, these result in the impairment of placental functions, affecting fetal development. In this review, we provide an overview of malaria in pregnancy and the different pathological pathways leading to malaria in pregnancy-associated low birthweight. We also discuss current prevention and management strategies for malaria in pregnancy, and some potential therapeutic interventions that may improve birth outcomes. Lastly, we outline some priorities for future research that could bring us one step closer to reducing this health burden.

scholarly journals Maternal and Neonatal Outcomes Associated with Psychostimulant Use in Pregnancy

2020 ◽  
Vol 5 (5) ◽  
Author(s):  
Ximena Camacho ◽  
Alys Havard ◽  
Helga Zoega ◽  
Margaret Wilson ◽  
Tara Gomes ◽  
...  
Keyword(s):  
Birth Outcomes ◽  
Neonatal Intensive Care ◽  
Low Birthweight ◽  
Cohort Analysis ◽  
Neonatal Outcomes ◽  
Increased Risk ◽  
The Usa ◽  
Maternal And Neonatal Outcomes ◽  
Adverse Pregnancy ◽  
In Pregnancy

IntroductionRecent evidence from the USA and Nordic countries suggests a possible association between psychostimulant use during gestation and adverse pregnancy and birth outcomes. Objectives and ApproachWe employed a distributed cohort analysis using linked administrative data for women who gave birth in New South Wales (NSW; Australia) and Ontario (Canada), whereby a common protocol was implemented separately in each jurisdiction. The study population comprised women who were hospitalized for a singleton delivery over an 8 (NSW) and 4 (Ontario) year period, respectively, with the NSW cohort restricted to social security beneficiaries. Psychostimulant exposure was defined as at least one dispensing of methylphenidate, amphetamine, dextroamphetamine or lisdexamfetamine during pregnancy. We examined the risk of maternal and neonatal outcomes among psychostimulant exposed mothers compared with unexposed mothers. ResultsThere were 140,356 eligible deliveries in NSW and 449,499 in Ontario during the respective study periods. Fewer than 1% of these pregnancies were exposed to psychostimulants during gestation, although use was higher in Ontario (0.30% vs 0.11% in NSW). Preliminary unadjusted analyses indicated possible associations between psychostimulant use in pregnancy and higher risks of pre-term birth (relative risk [RR] 1.7, 95% confidence interval [CI] 1.4-2.0 (Ontario); RR 1.8, 95% CI 1.2-2.6 (NSW)) and pre-eclampsia (RR 2.0, 95% CI 1.5-2.6 (Ontario); RR 2.0, 95% CI 1.2-3.5 (NSW)). Similarly, psychostimulant use was associated with higher risks of low birthweight (RR 1.6, 95% CI 1.3-1.9 (Ontario); RR 2.0, 95% CI 1.3-3.0 (NSW)) and admission to neonatal intensive care (RR 2.1, 95% CI 1.9-2.3 (Ontario); RR 1.5, 95% CI 1.1-1.9 (NSW)). Conclusion / ImplicationsUnadjusted analyses indicate an increased risk of adverse maternal and birth outcomes associated with psychostimulant exposure during pregnancy, potentially representing a placental effect. We are currently refining the analyses, employing propensity score methods to adjust for confounding.

scholarly journals Reductions in malaria in pregnancy and adverse birth outcomes following indoor residual spraying of insecticide in Uganda

2016 ◽  
Vol 15 (1) ◽  
Author(s):  
Mary K. Muhindo ◽  
Abel Kakuru ◽  
Paul Natureeba ◽  
Patricia Awori ◽  
Peter Olwoch ◽  
...  
Keyword(s):  
Birth Outcomes ◽  
Indoor Residual Spraying ◽  
Malaria In Pregnancy ◽  
Adverse Birth Outcomes ◽  
In Pregnancy

New approaches to pathogenesis of malaria in pregnancy

Parasitology ◽  
2007 ◽  
Vol 134 (13) ◽  
pp. 1883-1893 ◽  
Author(s):  
S. J. ROGERSON ◽  
P. BOEUF
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Growth Restriction ◽  
Malaria In Pregnancy ◽  
Future Research ◽  
Foetal Growth ◽  
Dimensional Interaction ◽  
Foetal Growth Restriction ◽  
Consequences Of Disease ◽  
In Pregnancy

SUMMARYMalaria infection during pregnancy is associated with poor maternal and foetal outcomes including low birth weight. In malaria-endemic areas, low birth weight is primarily a consequence of foetal growth restriction. Little is known on the pathogenesis of foetal growth restriction and our understanding of the relationship between epidemiological observations and the pathogenesis or consequences of disease is incomplete. In this review, we describe these gaps in our knowledge and also try to identify goals for future research into malaria in pregnancy. Foetal growth restriction results from a complex four-dimensional interaction between the foetus, the mother and the malaria parasite over gestation, and research into its pathogenesis may be advanced by combining longitudinal studies with techniques and approaches new to the field of malaria in pregnancy. Such approaches would greatly increase our knowledge on the pathogenesis of this disease and may provide new avenues for intervention strategies.

scholarly journals Plasmodium falciparum malaria during pregnancy: the impact of parasitaemia and anaemia on birthweight

2021 ◽  
Author(s):  
Dawood Ackom Abass ◽  
Abdul-Hakim Mutala ◽  
Christian Kwasi Owusu ◽  
Bernard Walter Lartekwei Lawson ◽  
Kingsley Badu
Keyword(s):  
Risk Factors ◽  
Pregnant Women ◽  
Falciparum Malaria ◽  
Low Birthweight ◽  
Young Age ◽  
Malaria In Pregnancy ◽  
Cross Sectional ◽  
Longitudinal Cohort ◽  
The Impact ◽  
In Pregnancy

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.

scholarly journals The Angiopoietin-Tie2 axis contributes to placental vascular disruption and adverse birth outcomes in malaria in pregnancy

EBioMedicine ◽  
2021 ◽  
Vol 73 ◽  
pp. 103683
Author(s):  
Vanessa Tran ◽  
Andrea M. Weckman ◽  
Valerie M. Crowley ◽  
Lindsay S. Cahill ◽  
Kathleen Zhong ◽  
...  
Keyword(s):  
Birth Outcomes ◽  
Malaria In Pregnancy ◽  
Adverse Birth Outcomes ◽  
Vascular Disruption ◽  
In Pregnancy

scholarly journals Pathogenesis of malaria in pregnancy

2008 ◽  
Vol 29 (4) ◽  
pp. 204
Author(s):  
Steven R Meshnick ◽  
Stephen J Rogerson
Keyword(s):  
Plasmodium Falciparum ◽  
Pregnant Women ◽  
Birth Outcomes ◽  
Preventive Therapy ◽  
Malaria In Pregnancy ◽  
Bed Nets ◽  
Common Disease ◽  
Protective Measures ◽  
Poor Countries ◽  
In Pregnancy

Even though we have good tools to prevent and treat malaria, it remains a tragically common disease in poor countries, especially in Africa. Pregnant women are particularly susceptible to malaria, causing anaemia and poor birth outcomes. There is marked sequestration of Plasmodium falciparum-infected erythrocytes (IEs) in the placenta, but the pathogenesis of malaria in pregnancy is still incompletely understood. Both intermittent preventive therapy and insecticide-impregnated bed nets are effective protective measures, but new measures are also needed.

scholarly journals Pregnancy-specific malarial immunity and risk of malaria in pregnancy and adverse birth outcomes: a systematic review

BMC Medicine ◽  
2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Julia C. Cutts ◽  
Paul A. Agius ◽  
Zaw Lin ◽  
Rosanna Powell ◽  
Kerryn Moore ◽  
...  
Keyword(s):  
Systematic Review ◽  
Birth Outcomes ◽  
Malaria In Pregnancy ◽  
Adverse Birth Outcomes ◽  
In Pregnancy

scholarly journals A systematic review and meta-analysis protocol on the association of malaria in pregnancy and adverse birth outcomes

2020 ◽  
Author(s):  
Vikas Yadav ◽  
Mohan Bairwa ◽  
Deepti Dabar ◽  
Akhil Dhanesh Goel ◽  
Sarika Palepu ◽  
...  
Keyword(s):  
Birth Outcomes ◽  
Effect Size ◽  
Observational Studies ◽  
Randomised Controlled Trials ◽  
Malaria In Pregnancy ◽  
Forest Plot ◽  
Controlled Trials ◽  
Adverse Birth Outcomes ◽  
Randomised Controlled ◽  
In Pregnancy

Abstract: Introduction: Malaria in pregnancy contributes to significant adverse birth outcomes. This study is aimed to quantify the relationship between malaria in pregnancy and occurrence of adverse birth outcomes, including preterm delivery, low birth weight, small for gestational age, miscarriages, and stillbirth. Methods and analysis: Observational studies and Randomised controlled trials reporting data on selected birth outcomes separately for pregnancies, with or without malaria will be included. We will search for studies over various information sources and data extraction will be done from included studies. Pooled odds ratio (OR) will be calculated for each birth outcomes using fixed effect model or random effects models, based on the level of heterogeneity. Forest plot will be prepared with effect size (with 95 percent confidence interval) of each study and pooled effect size. The methodological quality will be assessed for included observational studies using the Newcastle-Ottawa scale (NOS). Cochrane Risk of Bias tool will be used to evaluate bias in randomised controlled trials. For publication bias, funnel plot will be prepared and assessed for asymmetry, along with Egger′s test. Discussion: This study will provide an estimate of the risk of adverse birth outcomes in pregnancies with malaria. Results of this study will contribute towards planning effective service delivery in areas with a higher risk of malaria transmission. Ethics and dissemination: The current study is a review of published literature, and it does not require ethical committee approval. Results of this review will be published in a peer-reviewed journal. PROSPERO registration number: CRD42020153009

scholarly journals Malaria in Pregnancy: From Placental Infection to Its Abnormal Development and Damage

2021 ◽  
Vol 12 ◽  
Author(s):  
Caroline Lin Lin Chua ◽  
Sebastian Kah Ming Khoo ◽  
Jun Long Ernest Ong ◽  
Gaurav Kumar Ramireddi ◽  
Tsin Wen Yeo ◽  
...  
Keyword(s):  
Placental Malaria ◽  
Parasitic Infection ◽  
Malaria In Pregnancy ◽  
Abnormal Development ◽  
Placental Development ◽  
Mortality And Morbidity ◽  
Effective Interventions ◽  
Histopathological Studies ◽  
And Function ◽  
In Pregnancy

Malaria remains a global health burden with Plasmodium falciparum accounting for the highest mortality and morbidity. Malaria in pregnancy can lead to the development of placental malaria, where P. falciparum-infected erythrocytes adhere to placental receptors, triggering placental inflammation and subsequent damage, causing harm to both mother and her infant. Histopathological studies of P. falciparum-infected placentas revealed various placental abnormalities such as excessive perivillous fibrinoid deposits, breakdown of syncytiotrophoblast integrity, trophoblast basal lamina thickening, increased syncytial knotting, and accumulation of mononuclear immune cells within intervillous spaces. These events in turn, are likely to impair placental development and function, ultimately causing placental insufficiency, intrauterine growth restriction, preterm delivery and low birth weight. Hence, a better understanding of the mechanisms behind placental alterations and damage during placental malaria is needed for the design of effective interventions. In this review, using evidence from human studies and murine models, an integrated view on the potential mechanisms underlying placental pathologies in malaria in pregnancy is provided. The molecular, immunological and metabolic changes in infected placentas that reflect their responses to the parasitic infection and injury are discussed. Finally, potential models that can be used by researchers to improve our understanding on the pathogenesis of malaria in pregnancy and placental pathologies are presented.

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