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Microscopic and submicroscopic Plasmodium falciparum infection, maternal anaemia and adverse pregnancy outcomes in Papua New Guinea: a cohort study.
Malar J. 2019 Sep 02; 18(1):302.MJ

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.

Authors+Show Affiliations

Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK.Institute of Tropical Medicine, Antwerp, Belgium.Vector Borne Diseases Unit, PNG Institute of Medical Research, Goroka, Papua New Guinea. Burnet Institute, Melbourne, Australia.Vector Borne Diseases Unit, PNG Institute of Medical Research, Goroka, Papua New Guinea. Walter and Eliza Hall Institute of Medical Research, Parkville, Australia.Vector Borne Diseases Unit, PNG Institute of Medical Research, Goroka, Papua New Guinea.Burnet Institute, Melbourne, Australia.Vector Borne Diseases Unit, PNG Institute of Medical Research, Goroka, Papua New Guinea.Walter and Eliza Hall Institute of Medical Research, Parkville, Australia. Department of Medical Biology, University of Melbourne, Parkville, Australia. Institut Pasteur, Paris, France.Institute of Tropical Medicine, Antwerp, Belgium.Department of Medicine, (RMH), Peter Doherty Institute for Infection and Immunity, The University of Melbourne, 792 Elizabeth Street, Melbourne, VIC, 3000, Australia. sroger@unimelb.edu.au.

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

31477117

Citation

Unger, Holger W., et al. "Microscopic and Submicroscopic Plasmodium Falciparum Infection, Maternal Anaemia and Adverse Pregnancy Outcomes in Papua New Guinea: a Cohort Study." Malaria Journal, vol. 18, no. 1, 2019, p. 302.
Unger HW, Rosanas-Urgell A, Robinson LJ, et al. Microscopic and submicroscopic Plasmodium falciparum infection, maternal anaemia and adverse pregnancy outcomes in Papua New Guinea: a cohort study. Malar J. 2019;18(1):302.
Unger, H. W., Rosanas-Urgell, A., Robinson, L. J., Ome-Kaius, M., Jally, S., Umbers, A. J., Pomat, W., Mueller, I., Kattenberg, E., & Rogerson, S. J. (2019). Microscopic and submicroscopic Plasmodium falciparum infection, maternal anaemia and adverse pregnancy outcomes in Papua New Guinea: a cohort study. Malaria Journal, 18(1), 302. https://doi.org/10.1186/s12936-019-2931-7
Unger HW, et al. Microscopic and Submicroscopic Plasmodium Falciparum Infection, Maternal Anaemia and Adverse Pregnancy Outcomes in Papua New Guinea: a Cohort Study. Malar J. 2019 Sep 2;18(1):302. PubMed PMID: 31477117.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Microscopic and submicroscopic Plasmodium falciparum infection, maternal anaemia and adverse pregnancy outcomes in Papua New Guinea: a cohort study. AU - Unger,Holger W, AU - Rosanas-Urgell,Anna, AU - Robinson,Leanne J, AU - Ome-Kaius,Maria, AU - Jally,Shadrach, AU - Umbers,Alexandra J, AU - Pomat,Willie, AU - Mueller,Ivo, AU - Kattenberg,Eline, AU - Rogerson,Stephen J, Y1 - 2019/09/02/ PY - 2019/05/21/received PY - 2019/08/22/accepted PY - 2019/9/4/entrez PY - 2019/9/4/pubmed PY - 2019/9/4/medline KW - Anaemia KW - Diagnosis KW - Fetal growth retardation KW - Low birth weight KW - Malaria KW - Plasmodium falciparum KW - Pregnancy outcome KW - Premature birth SP - 302 EP - 302 JF - Malaria journal JO - Malar. J. VL - 18 IS - 1 N2 - 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. SN - 1475-2875 UR - https://www.unboundmedicine.com/medline/citation/31477117/Microscopic_and_submicroscopic_Plasmodium_falciparum_infection_maternal_anaemia_and_adverse_pregnancy_outcomes_in_Papua_New_Guinea:_a_cohort_study_ L2 - https://malariajournal.biomedcentral.com/articles/10.1186/s12936-019-2931-7 DB - PRIME DP - Unbound Medicine ER -