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Epidemiology and burden of malaria in pregnancy

Desai, M., terKuile, Feiko ORCID: https://orcid.org/0000-0003-3663-5617, Nosten, F., McGready, R., Asamoa, K., Brabin, Bernard and Newman, R. D. (2007) 'Epidemiology and burden of malaria in pregnancy'. Lancet Infectious Diseases, Vol 7, Issue 2, pp. 93-104.

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Abstract

We reviewed evidence of the clinical implications and burden of malaria in pregnancy. Most studies come from sub-Saharan Africa, where approximately 25 million pregnant women are at risk of Plasmodium falciparum infection every year, and one in four women have evidence of placental infection at the time of delivery. P falciparum infections during pregnancy in Africa rarely result in fever and therefore remain undetected and untreated. Meta-analyses of intervention trials suggest that successful prevention of these infections reduces the risk of severe maternal anaemia by 38%, low birthweight by 43%, and perinatal mortality by 27% among paucigravidae. Low birthweight associated with malaria in pregnancy is estimated to result in 100 000 infant deaths in Africa each year. Although paucigravidae are most affected by malaria, the consequences for infants born to multigravid women in Africa may be greater than previously appreciated. This is because HIV increases the risk of malaria and its adverse effects, particularly in multigravidae, and recent observational studies show that placental infection almost doubles the risk of malaria infection and morbidity in infants born to multigravidae. Outside Africa, malaria infection rates in pregnant women are much lower but are more likely to cause severe disease, preterm births, and fetal loss. Plasmodium vivax is common in Asia and the Americas and, unlike P falciparum, does not cytoadhere in the placenta, yet, is associated with maternal anaemia and low birthweight. The effect of infection in the first trimester, and the longer term effects of malaria beyond infancy, are largely unknown and may be substantial. Better estimates are also needed of the effects of malaria in pregnancy outside Africa, and on maternal morbidity and mortality in Africa. Global risk maps will allow better estimation of potential impact of successful control of malaria in pregnancy.

Item Type: Article
Uncontrolled Keywords: low-birth-weight sub-saharan africa plasmodium-falciparum infection rapid diagnostic-test treated bed nets placental malaria congenital malaria western kenya risk-factors unstable transmission
Subjects: WA Public Health > Health Problems of Special Population Groups > WA 310 Maternal welfare
WC Communicable Diseases > Tropical and Parasitic Diseases > WC 750 Malaria
WQ Obstetrics > Pregnancy Complications > WQ 256 Infectious diseases
Digital Object Identifer (DOI): https://doi.org/10.1016/S1473-3099(07)70021-X
Depositing User: Ms Julia Martin
Date Deposited: 24 Nov 2010 15:47
Last Modified: 31 May 2018 13:43
URI: http://archive.lstmed.ac.uk/id/eprint/1188

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