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.

scholarly journals Malaria in pregnancy regulates P-glycoprotein (P-gp/Abcb1a) and ABCA1 efflux transporters in the mouse visceral yolk sac

2020 ◽  
Author(s):  
Lilian M. Martinelli ◽  
Klaus N. Fontes ◽  
Mila W. Reginatto ◽  
Cherley B. V. Andrade ◽  
Victoria R. S. Monteiro ◽  
...  
Keyword(s):  
Blood Vessels ◽  
Yolk Sac ◽  
Malaria In Pregnancy ◽  
Efflux Transporters ◽  
Fetal Membrane ◽  
Toxic Substances ◽  
Cancer Resistance ◽  
P Glycoprotein ◽  
And Function ◽  
In Pregnancy

AbstractMalaria in pregnancy (MiP) induces intrauterine growth restriction (IUGR) and preterm labor (PTL). However, its effects on yolk sac morphology and function are largely unexplored. We hypothesized that MiP modifies yolk sac morphology and efflux transport potential by modulating ABC efflux transporters. C57BL/6 mice injected with Plasmodium berghei ANKA (5×105 infected-erythrocytes) at gestational day (GD) 13.5, were subjected to yolk sac membrane harvesting at GD18.5 for histology, qPCR and immunohistochemistry. MiP did not alter the volumetric proportion of the yolk sac’s histological components. However, it increased levels of Abcb1a mRNA (encoding P-glycoprotein) and macrophage migration inhibitory factor (Mif-chemokine), whilst decreasing Abcg1 (P<0.05); without altering Abca1, Abcb1b, Abcg2, Snat1, Snat2, interleukin (Il)-1 β and C-C Motif Chemokine Ligand 2 (Ccl2). Transcripts of Il-6, chemokine (C-X-C motif) ligand 1 (Cxcl1), Glut1 and Snat4 were not detectible. ABCA1, ABCG1, breast cancer resistance protein (BCRP) and P-gp, were primarily immunolocalized to the cell membranes and cytoplasm of endodermic epithelium but also in the mesothelium and in the endothelium of mesodermic blood vessels. Intensity of P-gp labeling was stronger in both endodermic epithelium and mesothelium, whereas ABCA1 labeling increased in the endothelium of the mesodermic blood vessels. The presence of ABC transporters in the yolk sac wall suggest that this fetal membrane acts as an important protective gestational barrier. Changes in ABCA1 and P-gp in MiP may alter the biodistribution of toxic substances, xenobiotics, nutrients and immunological factors within the fetal compartment and participate in the pathogenesis of malaria induced-IUGR and PTL.

Adaptability and potential for treatment of placental functions to improve embryonic development and postnatal health

2016 ◽  
Vol 28 (2) ◽  
pp. 75 ◽  
Author(s):  
James C. Cross
Keyword(s):  
Fetal Growth ◽  
Growth And Development ◽  
Association Studies ◽  
Experimental Studies ◽  
Placental Development ◽  
Experimental Animals ◽  
And Function ◽  
The Impact ◽  
Lines Of Evidence ◽  
In Pregnancy

For an organ that is so critical for life in eutherian mammals, the placenta hardly gets the attention that it deserves. The placenta does a series of remarkable things, including implanting the embryo in the uterus, negotiating with the mother for nutrients but also protecting her health during pregnancy, helping establish normal metabolic and cardiovascular function for life postnatally (developmental programming) and initiating changes that prepare the mother to care for and suckle her young after birth. Different lines of evidence in experimental animals suggest that the development and function of the placenta are adaptable. This means that some of the changes observed in pathological pregnancies may represent attempts to mitigate the impact of fetal growth and development. Key and emerging concepts are reviewed here concerning how we may view the placenta diagnostically and therapeutically in pregnancy complications, focusing on information from experimental studies in mice, sheep and cattle, as well as association studies from humans. Hundreds of different genes have been shown to underlie normal placental development and function, some of which have promise as tractable targets for intervention in pregnancies at risk for poor fetal growth.

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 Effects of Malaria in pregnancy on newborn anthropometry

2010 ◽  
Vol 4 (07) ◽  
pp. 448-453 ◽  
Author(s):  
Catherine Olufunke Falade ◽  
Olukemi O Tongo ◽  
Oluwatoyin O Ogunkunle ◽  
Adebola Emmanuel Orimadegun
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Geometric Mean ◽  
Placental Malaria ◽  
Care Facility ◽  
Malaria In Pregnancy ◽  
Intrauterine Death ◽  
Malaria Parasitaemia ◽  
Newborn Anthropometry ◽  
In Pregnancy

Background: Malaria in pregnancy remains a major cause of infant mortality through its contribution to preterm delivery, low birth weight and intrauterine death. Methodology: During a cross-sectional study of 983 mothers delivering in a secondary health care facility in Ibadan, southwestern Nigeria, an area of high malaria transmission, the effect of maternal and placental malaria parasitaemia on newborn anthropometry was evaluated. Malaria parasitemia was detected by microscopy of Giemsa stained thick blood smears. Results: Placental, maternal and combined placental and maternal malaria parasitaemia rates at the time of delivery were 13.1%, 12.7% and 11.1% respectively. The geometric mean parasite densities in maternal and placental smears were significantly higher in primigravid mothers than others (p = 0.004 and 0.002 respectively). Low birth weight rate was higher among babies born to mothers with maternal parasitaemia compared to those without (8.0 % versus 6.3%, p < 0.05). The mean birth weight was lower in neonates of mothers with peripheral and placental parasitaemia by 138 g and 122 g (p = 0.01 and 0.02) respectively, while the respective difference was up to 168 g and 151 g among primigravidae (p = 0.03 and 0.04). Neonates of mothers with maternal and placental parasitaemia had a lower mean length than those without parasitaemia (48.2 vs 49.2cm, p = < 0.0001 and 48.5 vs 49.2cm p = 0.02 respectively). Occiptofrontal circumference and ponderal indices were not significantly affected by maternal malaria parasitaemia. Conclusion: Malaria in pregnancy results in symmetric foetal growth restriction and the effect is more marked among primigravid mothers. 

scholarly journals Development of ovine chorionic somatomammotropin hormone-deficient pregnancies

2016 ◽  
Vol 310 (9) ◽  
pp. R837-R846 ◽  
Author(s):  
Callie M. Baker ◽  
Lindsey N. Goetzmann ◽  
Jeremy D. Cantlon ◽  
Kimberly M. Jeckel ◽  
Quinton A. Winger ◽  
...  
Keyword(s):  
Intrauterine Growth Restriction ◽  
Fetal Liver ◽  
Secretory Product ◽  
Placental Development ◽  
Mortality And Morbidity ◽  
Chorionic Somatomammotropin ◽  
Near Term ◽  
High Concentrations ◽  
And Function

Intrauterine growth restriction (IUGR) is a leading cause of neonatal mortality and morbidity. Chorionic somatomammotropin hormone (CSH), a placenta-specific secretory product found at high concentrations in maternal and fetal circulation throughout gestation, is significantly reduced in human and sheep IUGR pregnancies. The objective of this study was to knock down ovine CSH ( oCSH) expression in vivo using lentiviral-mediated short-hairpin RNA to test the hypothesis that oCSH deficiency would result in IUGR of near-term fetal lambs. Three different lentiviral oCSH-targeting constructs were used and compared with pregnancies ( n = 8) generated with a scrambled control (SC) lentiviral construct. Pregnancies were harvested at 135 days of gestation. The most effective targeting sequence, “target 6” (tg6; n = 8), yielded pregnancies with significant reductions ( P ≤ 0.05) in oCSH mRNA (50%) and protein (38%) concentrations, as well as significant reductions ( P ≤ 0.05) in placental (52%) and fetal (32%) weights compared with the SC pregnancies. Fetal liver weights were reduced 41% ( P ≤ 0.05), yet fetal liver insulin-like growth factor-I ( oIGF1) and -II mRNA concentrations were reduced ( P ≤ 0.05) 82 and 71%, respectively, and umbilical artery oIGF1 concentrations were reduced 62% ( P ≤ 0.05) in tg6 pregnancies. Additionally, fetal liver oIGF-binding protein ( oIGFBP) 2 and oIGFBP3 mRNA concentrations were reduced ( P ≤ 0.05), whereas fetal liver oIGFBP1 mRNA concentration was not impacted nor was maternal liver o IGF and o IGFBP mRNA concentrations or uterine artery oIGF1 concentrations ( P ≥ 0.10). Based on our results, it appears that oCSH deficiency does result in IUGR, by impacting placental development as well as fetal liver development and function.

The placenta

2020 ◽  
pp. 120-132
Author(s):  
Eric Jauniaux ◽  
Amarnath Bhide ◽  
Graham J. Burton
Keyword(s):  
Steroid Hormones ◽  
Fetal Growth ◽  
Placenta Praevia ◽  
Direct Impact ◽  
Perinatal Complications ◽  
Placental Development ◽  
Vast Array ◽  
Antenatal Detection ◽  
And Function ◽  
In Pregnancy

Abnormal placental development and function are widely recognized as having immediate consequences on the outcome of a pregnancy, and more recently to influence the lifelong health of the offspring. The development of the placenta starts from implantation, when the embryonic pole of the blastocyst enters into contact with the maternal uterine epithelium. The placenta provides the fetus with all essential nutrients, water, and oxygen, and a route for clearance of fetal excretory products, but it also produces a vast array of protein and steroid hormones and factors necessary for the maintenance of pregnancy. Placental-related disorders of pregnancy affect around a third of human pregnancies, primarily including miscarriages, pre-eclampsia, and fetal growth restriction. Placental and umbilical cord structural anomalies that are associated with perinatal complications can now be diagnosed from early in pregnancy with ultrasonography and the antenatal detection of anomalies such as placenta praevia and placenta accreta has a direct impact on the outcome of pregnancy.

scholarly journals Prevalence of Plasmodium falciparum Malaria among Pregnant Students in Dodoma Region, Tanzania: No Cases Have Been Detected

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Karen N. Zablon ◽  
Charles Kakilla ◽  
Tatiana Lykina ◽  
Victoria Minakova ◽  
Alphaxad Chibago ◽  
...  
Keyword(s):  
Placental Malaria ◽  
Intermittent Preventive Treatment ◽  
Rapid Test ◽  
Preventive Treatment ◽  
Plasmodium Falciparum Malaria ◽  
Malaria In Pregnancy ◽  
African Countries ◽  
Pregnant Students ◽  
Low Prevalence ◽  
In Pregnancy

Malaria in pregnancy, being often asymptomatic, is a major problem in endemic African countries. It is characterized by anemia and placental malaria leading to poor pregnancy outcomes. In 2001 Tanzania adopted an intermittent-preventive treatment of malaria in pregnancy (IPTp) policy, which recommends receiving doses of antimalarial drugs every planned visit to the antenatal care centre (ANC), starting from the second trimester. Currently the policy is valid across the whole country, regardless that there are regions with very low malaria endemicity in Tanzania, such as Dodoma region. The current study aimed to show the real prevalence of malaria among young pregnant women in Dodoma region, by measuring the prevalence of malaria among University of Dodoma (UDOM) students, and to describe the social health care features of student female community. Two methods of malaria diagnostic, microscopy, and rapid test, as well as retrospective inspection of ANC registry book, showed the very low prevalence of malaria disease among pregnant students, approximately 0.3%. Additionally, the sociodemographic data from the questionnaires showed that all students use different malaria preventive measures, and most of them have the regular sexual partner. This fact approves the correlation between illiteracy of woman and the risk of malaria infection transmission.

scholarly journals Effectiveness of intermittent screening and treatment for the control of malaria in pregnancy: a cluster randomised trial in India

2019 ◽  
Vol 4 (4) ◽  
pp. e001399 ◽  
Author(s):  
Irene Kuepfer ◽  
Neelima Mishra ◽  
Jane Bruce ◽  
Vinit Mishra ◽  
Anupkumar R Anvikar ◽  
...  
Keyword(s):  
Gestational Age ◽  
Controlled Trial ◽  
Placental Malaria ◽  
Randomised Trial ◽  
Cluster Randomised Controlled Trial ◽  
Malaria In Pregnancy ◽  
Cluster Randomised Trial ◽  
Cluster Randomised ◽  
Secondary Endpoints ◽  
In Pregnancy

BackgroundThe control of malaria in pregnancy (MiP) in India relies on testing women who present with symptoms or signs suggestive of malaria. We hypothesised that intermittent screening and treatment for malaria at each antenatal care visit (ISTp) would improve on this approach and reduce the adverse effects of MiP.MethodsA cluster randomised controlled trial comparing ISTp versus passive case detection (PCD) was conducted in Jharkhand state. Pregnant women of all parities with a gestational age of 18–28 weeks were enrolled. Women in the ISTp group were screened with a rapid diagnostic test (RDT) for malaria at each antenatal clinic visit and those in the PCD group were screened only if they had symptoms or signs suggestive of malaria. All RDT positive women were treated with artesunate/sulfadoxine–pyrimethamine. The primary endpoint was placental malaria, determined by placental histology, and the key secondary endpoints were birth weight, gestational age, vital status of the newborn baby and maternal anaemia.ResultsBetween April 2012 and September 2015, 6868 women were enrolled; 3300 in 46 ISTp clusters and 3568 in 41 PCD clusters. In the ISTp arm, 4.9% of women were tested malaria positive and 0.6% in the PCD arm. There was no difference in the prevalence of placental malaria in the ISTp (87/1454, 6.0%) and PCD (65/1560, 4.2%) groups (6.0% vs 4.2%; OR 1.34, 95% CI 0.78 to 2.29, p=0.29) or in any of the secondary endpoints.ConclusionISTp detected more infections than PCD, but monthly ISTp with the current generation of RDT is unlikely to reduce placental malaria or impact on pregnancy outcomes. ISTp trials with more sensitive point-of-care diagnostic tests are needed.

scholarly journals Placental Plasmodium Parasitemia and Pregnancy Outcome In Asymptomatic Parturients at Term In A Tertiary Institution South East Nigeria

2021 ◽  
Author(s):  
Wilson Ndukwe Nwigboji ◽  
John Okafor Egede ◽  
Peace Chinyere Igwe ◽  
Matthew Nwali Igwe ◽  
Gregory Chinedu Nwigwe ◽  
...  
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Pregnancy Outcome ◽  
Placental Malaria ◽  
Malaria In Pregnancy ◽  
Sub Saharan Africa ◽  
Categorical Variables ◽  
Maternal Anaemia ◽  
Congenital Malaria ◽  
In Pregnancy

Abstract Background: Malaria in pregnancy is a major public health problem in sub-Saharan Africa and can result in placental malaria with its associated adverse pregnancy outcomes.Method: This was a case control study involving 190 consenting, asymptomatic, booked parturients, recruited consecutively at 36 week. The aim was to determine the effect of placental malaria on pregnancy outcome in asymptomatic women delivering at term. The participants were screened for malaria parasites using peripheral blood film. Based on their results, the participants were grouped into parasitemia positive cases (Group 1) and parasitemia negative controls (Group 2). Both groups were then followed up in the clinic till they presented in labour at term. In labour, participants’ peripheral venous blood sample were collected and used to determine intrapartum haematocrit and peripheral parasitemia. After delivery, cord blood and a section of the placenta were collected for investigation. Data analysis: Collected data were analysed using Statistical Product and service solutions (SPSS) software (version 20). Numerical variables were presented as mean and standard deviation (Mean SD), while categorical variables were presented as numbers and percentages. Chi-square test(X2) was used to compare qualitative variables. Odds ratio (OR) and Confidence interval(CI) were used to observe the odds of outcomes. A p-value 0.05 was considered statistically significant.Results: The prevalence of placental malaria and congenital malaria were 41.05% and 29.47% respectively. Birth weight, APGAR score, NICU admission or congenital malaria were not statistically significant between the two groups. The mean birth weight was 3.16 ± 0.5 kg while 17.89% had low birth weight. There was also no significant difference between the two groups in terms of the association of placental parasitaemia and maternal anaemia or dose of IPT taken. There was no significant association between placental parasitaemia and low parity. Multivariate logistic regression analysis of maternal anaemia and low birth weight showed significant placental parasitaemia in both cases (p = 0.004). Conclusion: Placental parasitaemia is a major complication of malaria in pregnancy and is associated with adverse feto-maternal effects. Early booking and uptake of intermittent preventive therapy with sulphadoxine-pyrimethamine may help reduce the adverse effects.

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