Influence of placental malaria infection on foetal outcome in the Gambia: twenty years after Ian Mcgregor
Okoko, B.J.; Ota, M.O.; Yamuah, L.K.; Idiong, D.; Mkpanam, S.N.; Avieka, A.; Banya, W.A.S.; Osinusi, K.
Journal of Health Population and Nutrition 20(1): 4-11
2002
ISSN/ISBN: 1606-0997 PMID: 12022158 Document Number: 243675
Malaria infection in pregnancy has serious health consequences among mothers and offspring. The influence of placental malaria infection on fetal outcome was studied in a Gambian rural setting where few pregnant women take antimalarial chemoprophylaxis. During July-December 1997, three hundred thirteen mother-newborn pairs (singletons only) were consecutively recruited into a study of the effects of placental malaria infection on the outcome of pregnancy. Placental blood and tissue were collected at delivery. Babies were clinically assessed until discharge. The overall prevalence of placental malaria infection was 51.1% by placental histology and 37.1% by blood smear. The primigravid women were more susceptible to placental malaria than the multigravidae (65.3% vs. 44.7%, P=0.01). Placental malaria was significantly associated with pre-term delivery and intrauterine growth retardation (P<0.01) and there was a four-fold risk of delivering low-birth weight babies if mothers had parasitized placentae (OR=4.42, 95% confidence interval, CI 2.10-9.27). A reduction of mean birth weight of babies by 320 g was associated with placental malaria infection (P<0.001). Similarly, a two-fold risk of stillbirth delivery (OR=2.22, 95% CI 1.04-4.72) was observed among the infected mothers. The results show that there is still an overall poor fetal outcome associated with placental malaria infection. This study confirms the findings of McGregor in Gambia that low birth weight rate is significantly higher if the placenta is parasitized. In addition, this study shows that high stillbirth and prematurity rates are associated with placental malaria infection. It is suggested that effective malaria control strategies during pregnancy, such as use of insecticide-impregnated bednets, intermittent and early treatment for malaria and antimalarial chemoprophylaxis, should be undertaken in Gambia.