Burden and impact of Plasmodium vivax in pregnancy

A multi-centre prospective observational study

on behalf of the PregVax Study Group

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Background: Despite that over 90 million pregnancies are at risk of Plasmodium vivax infection annually, little is known about the epidemiology and impact of the infection in pregnancy. Methodology and principal findings: We undertook a health facility-based prospective observational study in pregnant women from Guatemala (GT), Colombia (CO), Brazil (BR), India (IN) and Papua New Guinea PNG). Malaria and anemia were determined during pregnancy and fetal outcomes assessed at delivery. A total of 9388 women were enrolled at antennal care (ANC), of whom 53% (4957) were followed until delivery. Prevalence of P. vivax monoinfection in maternal blood at delivery was 0.4% (20/4461) by microscopy [GT 0.1%, CO 0.5%, BR 0.1%, IN 0.2%, PNG 1.2%] and 7% (104/1488) by PCR. P. falciparum monoinfection was found in 0.5% (22/4463) of women by microscopy [GT 0%, CO 0.5%, BR 0%, IN 0%, PNG 2%]. P. vivax infection was observed in 0.4% (14/3725) of placentas examined by microscopy and in 3.7% (19/508) by PCR. P. vivax in newborn blood was detected in 0.02% (1/4302) of samples examined by microscopy [in cord blood; 0.05% (2/4040) by microscopy, and 2.6% (13/497) by PCR]. Clinical P. vivax infection was associated with increased risk of maternal anemia (Odds Ratio-OR, 5.48, [95% CI 1.83–16.41]; p = 0.009), while submicroscopic vivax infection was not associated with increased risk of moderate-severe anemia (Hb<8g/dL) (OR, 1.16, [95% CI 0.52–2.59]; p = 0.717), or low birth weight (<2500g) (OR, 0.52, [95% CI, 0.23–1.16]; p = 0.110). Conclusions: In this multicenter study, the prevalence of P. vivax infection in pregnancy by microscopy was overall low across all endemic study sites; however, molecular methods revealed a significant number of submicroscopic infections. Clinical vivax infection in pregnancy was associated with maternal anemia, which may be deleterious for infant’s health. These results may help to guide maternal health programs in settings where vivax malaria is endemic; they also highlight the need of addressing a vulnerable population such as pregnant women while embracing malaria elimination in endemic countries.

Original languageEnglish
Article numbere0005606
JournalPLoS Neglected Tropical Diseases
Volume11
Issue number6
DOIs
Publication statusPublished - Jun 12 2017

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Plasmodium vivax
Malaria
Observational Studies
Microscopy
Prospective Studies
Guatemala
Pregnancy
Colombia
Anemia
Brazil
India
Mothers
Infection
Polymerase Chain Reaction
Pregnant Women
Vivax Malaria
Papua New Guinea
Health Facilities
Low Birth Weight Infant
Vulnerable Populations

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Infectious Diseases

Cite this

Burden and impact of Plasmodium vivax in pregnancy : A multi-centre prospective observational study. / on behalf of the PregVax Study Group.

In: PLoS Neglected Tropical Diseases, Vol. 11, No. 6, e0005606, 12.06.2017.

Research output: Contribution to journalArticle

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title = "Burden and impact of Plasmodium vivax in pregnancy: A multi-centre prospective observational study",
abstract = "Background: Despite that over 90 million pregnancies are at risk of Plasmodium vivax infection annually, little is known about the epidemiology and impact of the infection in pregnancy. Methodology and principal findings: We undertook a health facility-based prospective observational study in pregnant women from Guatemala (GT), Colombia (CO), Brazil (BR), India (IN) and Papua New Guinea PNG). Malaria and anemia were determined during pregnancy and fetal outcomes assessed at delivery. A total of 9388 women were enrolled at antennal care (ANC), of whom 53{\%} (4957) were followed until delivery. Prevalence of P. vivax monoinfection in maternal blood at delivery was 0.4{\%} (20/4461) by microscopy [GT 0.1{\%}, CO 0.5{\%}, BR 0.1{\%}, IN 0.2{\%}, PNG 1.2{\%}] and 7{\%} (104/1488) by PCR. P. falciparum monoinfection was found in 0.5{\%} (22/4463) of women by microscopy [GT 0{\%}, CO 0.5{\%}, BR 0{\%}, IN 0{\%}, PNG 2{\%}]. P. vivax infection was observed in 0.4{\%} (14/3725) of placentas examined by microscopy and in 3.7{\%} (19/508) by PCR. P. vivax in newborn blood was detected in 0.02{\%} (1/4302) of samples examined by microscopy [in cord blood; 0.05{\%} (2/4040) by microscopy, and 2.6{\%} (13/497) by PCR]. Clinical P. vivax infection was associated with increased risk of maternal anemia (Odds Ratio-OR, 5.48, [95{\%} CI 1.83–16.41]; p = 0.009), while submicroscopic vivax infection was not associated with increased risk of moderate-severe anemia (Hb<8g/dL) (OR, 1.16, [95{\%} CI 0.52–2.59]; p = 0.717), or low birth weight (<2500g) (OR, 0.52, [95{\%} CI, 0.23–1.16]; p = 0.110). Conclusions: In this multicenter study, the prevalence of P. vivax infection in pregnancy by microscopy was overall low across all endemic study sites; however, molecular methods revealed a significant number of submicroscopic infections. Clinical vivax infection in pregnancy was associated with maternal anemia, which may be deleterious for infant’s health. These results may help to guide maternal health programs in settings where vivax malaria is endemic; they also highlight the need of addressing a vulnerable population such as pregnant women while embracing malaria elimination in endemic countries.",
author = "{on behalf of the PregVax Study Group} and Azucena Bardaj{\'i} and Mart{\'i}nez-Espinosa, {Flor Ernestina} and Myriam Ar{\'e}valo-Herrera and Norma Padilla and Swati Kochar and Maria Ome-Kaius and Camila B{\^o}tto-Menezes and Castellanos, {Mar{\'i}a Eugenia} and Kochar, {Dhanpat Kumar} and Kochar, {Sanjay Kumar} and Inoni Betuela and Ivo Mueller and Stephen Rogerson and Chetan Chitnis and Dhiraj Hans and Michela Menegon and Carlo Severini and {del Portillo}, Hernando and Carlota Doba{\~n}o and Alfredo Mayor and Jaume Ordi and Mireia Piqueras and Sergi Sanz and Mats Wahlgren and Laurence Slutsker and Meghna Desai and Clara Men{\'e}ndez",
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T1 - Burden and impact of Plasmodium vivax in pregnancy

T2 - A multi-centre prospective observational study

AU - on behalf of the PregVax Study Group

AU - Bardají, Azucena

AU - Martínez-Espinosa, Flor Ernestina

AU - Arévalo-Herrera, Myriam

AU - Padilla, Norma

AU - Kochar, Swati

AU - Ome-Kaius, Maria

AU - Bôtto-Menezes, Camila

AU - Castellanos, María Eugenia

AU - Kochar, Dhanpat Kumar

AU - Kochar, Sanjay Kumar

AU - Betuela, Inoni

AU - Mueller, Ivo

AU - Rogerson, Stephen

AU - Chitnis, Chetan

AU - Hans, Dhiraj

AU - Menegon, Michela

AU - Severini, Carlo

AU - del Portillo, Hernando

AU - Dobaño, Carlota

AU - Mayor, Alfredo

AU - Ordi, Jaume

AU - Piqueras, Mireia

AU - Sanz, Sergi

AU - Wahlgren, Mats

AU - Slutsker, Laurence

AU - Desai, Meghna

AU - Menéndez, Clara

PY - 2017/6/12

Y1 - 2017/6/12

N2 - Background: Despite that over 90 million pregnancies are at risk of Plasmodium vivax infection annually, little is known about the epidemiology and impact of the infection in pregnancy. Methodology and principal findings: We undertook a health facility-based prospective observational study in pregnant women from Guatemala (GT), Colombia (CO), Brazil (BR), India (IN) and Papua New Guinea PNG). Malaria and anemia were determined during pregnancy and fetal outcomes assessed at delivery. A total of 9388 women were enrolled at antennal care (ANC), of whom 53% (4957) were followed until delivery. Prevalence of P. vivax monoinfection in maternal blood at delivery was 0.4% (20/4461) by microscopy [GT 0.1%, CO 0.5%, BR 0.1%, IN 0.2%, PNG 1.2%] and 7% (104/1488) by PCR. P. falciparum monoinfection was found in 0.5% (22/4463) of women by microscopy [GT 0%, CO 0.5%, BR 0%, IN 0%, PNG 2%]. P. vivax infection was observed in 0.4% (14/3725) of placentas examined by microscopy and in 3.7% (19/508) by PCR. P. vivax in newborn blood was detected in 0.02% (1/4302) of samples examined by microscopy [in cord blood; 0.05% (2/4040) by microscopy, and 2.6% (13/497) by PCR]. Clinical P. vivax infection was associated with increased risk of maternal anemia (Odds Ratio-OR, 5.48, [95% CI 1.83–16.41]; p = 0.009), while submicroscopic vivax infection was not associated with increased risk of moderate-severe anemia (Hb<8g/dL) (OR, 1.16, [95% CI 0.52–2.59]; p = 0.717), or low birth weight (<2500g) (OR, 0.52, [95% CI, 0.23–1.16]; p = 0.110). Conclusions: In this multicenter study, the prevalence of P. vivax infection in pregnancy by microscopy was overall low across all endemic study sites; however, molecular methods revealed a significant number of submicroscopic infections. Clinical vivax infection in pregnancy was associated with maternal anemia, which may be deleterious for infant’s health. These results may help to guide maternal health programs in settings where vivax malaria is endemic; they also highlight the need of addressing a vulnerable population such as pregnant women while embracing malaria elimination in endemic countries.

AB - Background: Despite that over 90 million pregnancies are at risk of Plasmodium vivax infection annually, little is known about the epidemiology and impact of the infection in pregnancy. Methodology and principal findings: We undertook a health facility-based prospective observational study in pregnant women from Guatemala (GT), Colombia (CO), Brazil (BR), India (IN) and Papua New Guinea PNG). Malaria and anemia were determined during pregnancy and fetal outcomes assessed at delivery. A total of 9388 women were enrolled at antennal care (ANC), of whom 53% (4957) were followed until delivery. Prevalence of P. vivax monoinfection in maternal blood at delivery was 0.4% (20/4461) by microscopy [GT 0.1%, CO 0.5%, BR 0.1%, IN 0.2%, PNG 1.2%] and 7% (104/1488) by PCR. P. falciparum monoinfection was found in 0.5% (22/4463) of women by microscopy [GT 0%, CO 0.5%, BR 0%, IN 0%, PNG 2%]. P. vivax infection was observed in 0.4% (14/3725) of placentas examined by microscopy and in 3.7% (19/508) by PCR. P. vivax in newborn blood was detected in 0.02% (1/4302) of samples examined by microscopy [in cord blood; 0.05% (2/4040) by microscopy, and 2.6% (13/497) by PCR]. Clinical P. vivax infection was associated with increased risk of maternal anemia (Odds Ratio-OR, 5.48, [95% CI 1.83–16.41]; p = 0.009), while submicroscopic vivax infection was not associated with increased risk of moderate-severe anemia (Hb<8g/dL) (OR, 1.16, [95% CI 0.52–2.59]; p = 0.717), or low birth weight (<2500g) (OR, 0.52, [95% CI, 0.23–1.16]; p = 0.110). Conclusions: In this multicenter study, the prevalence of P. vivax infection in pregnancy by microscopy was overall low across all endemic study sites; however, molecular methods revealed a significant number of submicroscopic infections. Clinical vivax infection in pregnancy was associated with maternal anemia, which may be deleterious for infant’s health. These results may help to guide maternal health programs in settings where vivax malaria is endemic; they also highlight the need of addressing a vulnerable population such as pregnant women while embracing malaria elimination in endemic countries.

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