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Retrospective study of toxoplasmosis prevalence in pregnant women in Benin and its relation with malaria. PLoS One 2022; 17:e0262018. [PMID: 34995295 PMCID: PMC8741053 DOI: 10.1371/journal.pone.0262018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 12/15/2021] [Indexed: 11/19/2022] Open
Abstract
Background
Globally distributed with variable prevalence depending on geography, toxoplasmosis is a zoonosis caused by an obligate intracellular protozoan parasite, Toxoplasma gondii. This disease is usually benign but poses a risk for immunocompromised people and for newborns of mothers with a primary infection during pregnancy because of the risk of congenital toxoplasmosis (CT). CT can cause severe damage to fetuses-newborns. To our knowledge, no study has been conducted in sub-Saharan Africa on toxoplasmosis seroprevalence, seroconversion and CT in a large longitudinal cohort and furthermore, no observation has been made of potential relationships with malaria.
Methods
We performed a retrospective toxoplasmosis serological study using available samples from a large cohort of 1,037 pregnant women who were enrolled in a malaria follow-up during the 2008–2010 period in a rural area in Benin. We also used some existing data to investigate potential relationships between the maternal toxoplasmosis serological status and recorded malaria infections.
Results
Toxoplasmosis seroprevalence, seroconversion and CT rates were 52.6%, 3.4% and 0.2%, respectively, reflecting the population situation of toxoplasmosis, without targeted medical intervention. The education level influences the toxoplasmosis serological status of women, with women with little or no formal education have greater immunity than others. Surprisingly, toxoplasmosis seropositive pregnant women tended to present lower malaria infection during pregnancy (number) or at delivery (presence) and to have lower IgG levels to Plasmodium falciparum Apical Membrane Antigen 1, compared to toxoplasmosis seronegative women.
Conclusions
The high toxoplasmosis seroprevalence indicates that prevention against this parasite remains important to deploy and must be accessible and understandable to and for all individuals (educated and non-educated). A potential protective role against malaria conferred by a preexisting toxoplasmosis infection needs to be explored more precisely to examine the environmental, parasitic and/or immune aspects.
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Bone JN, Pickerill K, Woo Kinshella ML, Vidler M, Craik R, Poston L, Stones W, Sevene E, Temmerman M, Koech Etyang A, Roca A, Russell D, Tribe RM, von Dadelszen P, Magee LA. Pregnancy cohorts and biobanking in sub-Saharan Africa: a systematic review. BMJ Glob Health 2021; 5:bmjgh-2020-003716. [PMID: 33243854 PMCID: PMC7692823 DOI: 10.1136/bmjgh-2020-003716] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/22/2020] [Accepted: 09/23/2020] [Indexed: 12/17/2022] Open
Abstract
Background Technological advances and high throughput biological assays can facilitate discovery science in biobanks from population cohorts, including pregnant women. Biological pathways associated with health outcomes differ depending on geography, and high-income country data may not generalise to low-resource settings. We conducted a systematic review to identify prospective pregnancy cohorts in sub-Saharan Africa (SSA) that include biobanked samples with potential to enhance discovery science opportunity. Methods Inclusion criteria were prospective data collection during pregnancy, with associated biobanking in SSA. Data sources included: scientific databases (with comprehensive search terms), grey literature, hand searching applicable reference lists and expert input. Results were screened in a three-stage process based on title, abstract and full text by two independent reviewers. The review is registered on PROSPERO (CRD42019147483). Results Fourteen SSA studies met the inclusion criteria from database searches (n=8), reference list searches (n=2) and expert input (n=4). Three studies have ongoing data collection. The most represented countries were South Africa and Mozambique (Southern Africa) (n=3), Benin (Western Africa) (n=4) and Tanzania (Eastern Africa) (n=4); including an estimated 31 763 women. Samples commonly collected were blood, cord blood and placenta. Seven studies collected neonatal samples. Common clinical outcomes included maternal and perinatal mortality, malaria and preterm birth. Conclusions Increasingly numerous pregnancy cohorts in SSA that include biobanking are generating a uniquely valuable resource for collaborative discovery science, and improved understanding of the high regional risks of maternal, fetal and neonatal morbidity and mortality. Future studies should align protocols and consider their added value and distinct contributions.
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Affiliation(s)
- Jeffrey N Bone
- Department of Obstetrics and Gynaecology, The University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Kelly Pickerill
- Department of Obstetrics and Gynaecology, The University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Mai-Lei Woo Kinshella
- Department of Obstetrics and Gynaecology, The University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Marianne Vidler
- Department of Obstetrics and Gynaecology, The University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Rachel Craik
- Department of Women and Children's Health, King's College London, School of Life Course Sciences, Faculty of Life Sciences and Medicine, London, UK
| | - Lucilla Poston
- Department of Women and Children's Health, King's College London, School of Life Course Sciences, Faculty of Life Sciences and Medicine, London, UK
| | - William Stones
- Centre for Reproductive Health, University of Malawi College of Medicine, Blantyre, Malawi
| | - Esperanca Sevene
- Centro de Investigação em Saúde de Manhiça, Manhiça, Maputo, Mozambique.,Department of Physiologic Sciences, Faculty of Medicine, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Marleen Temmerman
- Department of Obstetrics and Gynaecology, Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya
| | - Angela Koech Etyang
- Department of Obstetrics and Gynaecology, Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya
| | - Anna Roca
- Medical Research Council Unit, The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | | | - Rachel M Tribe
- Department of Women and Children's Health, King's College London, School of Life Course Sciences, Faculty of Life Sciences and Medicine, London, UK
| | - Peter von Dadelszen
- Department of Women and Children's Health, King's College London, School of Life Course Sciences, Faculty of Life Sciences and Medicine, London, UK
| | - Laura A Magee
- Department of Women and Children's Health, King's College London, School of Life Course Sciences, Faculty of Life Sciences and Medicine, London, UK
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Moussiliou A, Turner L, Cottrell G, Doritchamou J, Gbédandé K, Fievet N, Luty AJF, Massougbodji A, Theander TG, Deloron P, Lavstsen T, Tuikue Ndam N. Dynamics of PfEMP1 Antibody Profile From Birth to 12 Months of Age in Beninese Infants. J Infect Dis 2021; 221:2010-2017. [PMID: 32002541 DOI: 10.1093/infdis/jiaa043] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 01/24/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Plasmodium falciparum-infected erythrocytes bind to specific endothelial cell receptors via members of the PfEMP1 family exported onto the erythrocyte surface. These interactions are mediated by different types of cysteine-rich interdomain region (CIDR) domains found in the N-terminal region of all PfEMP1. CIDRα1 domains bind endothelial protein C receptor (EPCR), CIDRα2-6 domains bind CD36, whereas the receptor specificity of CIDRβ/γ/δ domains is unknown. METHODS In this study, we investigated the level of immunoglobulin (Ig)G targeting the different types of PfEMP1 CIDR during the first year of life. We used plasma collected longitudinally from children of pregnant women who had been followed closely through pregnancy. RESULTS Antibodies to CIDRα1 domains were more frequent in cord blood compared with antibodies to CIDRα2-6 domains. Higher IgG levels to EPCR-binding CIDRα1 variants positively correlated with the timing of first infections. Antibodies to all PfEMP1 types declined at similar rates to the point of disappearance over the first 6 months of life. At 12 months, children had acquired antibody to all types of CIDR domains, mostly in children with documented P falciparum infections. CONCLUSIONS These observations agree with the notion that the timing and phenotype of first P falciparum infections in life are influenced by the immune status of the mother.
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Affiliation(s)
| | - L Turner
- Centre for Medical Parasitology at Department of Immunology and Microbiology (ISIM), Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - G Cottrell
- Université de Paris, MERIT, IRD, Paris, France
| | - J Doritchamou
- Institut de Recherche Clinique du Bénin, Université d'Abomey-Calavi, Cotonou, Bénin
| | - K Gbédandé
- Institut de Recherche Clinique du Bénin, Université d'Abomey-Calavi, Cotonou, Bénin
| | - N Fievet
- Université de Paris, MERIT, IRD, Paris, France
| | - A J F Luty
- Université de Paris, MERIT, IRD, Paris, France
| | - A Massougbodji
- Institut de Recherche Clinique du Bénin, Université d'Abomey-Calavi, Cotonou, Bénin
| | - T G Theander
- Centre for Medical Parasitology at Department of Immunology and Microbiology (ISIM), Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - P Deloron
- Université de Paris, MERIT, IRD, Paris, France
| | - T Lavstsen
- Centre for Medical Parasitology at Department of Immunology and Microbiology (ISIM), Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
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Circulating Cytokines Associated with Poor Pregnancy Outcomes in Beninese Exposed to Infection with Plasmodium falciparum. Infect Immun 2020; 88:IAI.00042-20. [PMID: 32513854 DOI: 10.1128/iai.00042-20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 05/29/2020] [Indexed: 01/30/2023] Open
Abstract
Malaria during pregnancy is a major cause of maternal morbidity as well as fetal and neonatal mortality. Previous studies, including our own, suggested that placental and peripheral cytokine and chemokine levels measured at delivery can be used as biomarkers for pregnancy outcomes. However, the timing of malaria infection during pregnancy matters, and these studies do not address the effect of different cytokines in peripheral blood plasma samples taken at early and midpregnancy and at delivery. Here, we aimed to investigate whether peripheral plasma cytokine levels were associated with pregnancy outcomes in a cohort of 400 Beninese pregnant women. Using a high-sensitivity cytometry-based method, we quantified the levels of interleukin-4 (IL-4), IL-5, IL-10, IL-12p70, and gamma interferon (IFN-γ) in peripheral plasma samples taken at two time points during pregnancy and at delivery in various groups of pregnant women identified with Plasmodium falciparum infection, with anemia, with preterm births, or giving birth to babies who are small for their gestational age. We found that, consistently at all time points, elevated levels of IL-10 were strongly and significantly associated with P. falciparum infection, while the levels of IFN-γ at inclusion and delivery were weakly but also significantly associated. Low levels of IL-5 at delivery were associated with a greater risk of both preterm births and small-for-gestational-age babies. The immunosuppressive effects of IL-10 likely affect the overall cytokine equilibrium during pregnancy in women harboring P. falciparum infections. Our findings highlight the peripheral signature of pregnancy outcomes and strengthen the idea of using cytokines as diagnostic or prognostic markers.
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Dynamics of Plasmodium falciparum gametocyte carriage in pregnant women under intermittent preventive treatment with sulfadoxine-pyrimethamine in Benin. Malar J 2018; 17:356. [PMID: 30305101 PMCID: PMC6180446 DOI: 10.1186/s12936-018-2498-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 09/29/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In sub-Saharan Africa, malaria is a major cause of morbidity and mortality, in particular in children and pregnant women. During pregnancy, Plasmodium falciparum infected red blood cells expressing VAR2CSA are selected from circulation by selective cytoadherence to chondroitin sulfate proteoglycan receptors expressed in the placenta, leading to an increased susceptibility to malaria, long-lasting infections and poor pregnancy outcome. Partly because of these long-lasting infections, women were reported to have a higher density of gametocytes in their peripheral blood, and are considered as a potential reservoir for malaria transmission. To improve pregnancy outcome in areas of high malaria transmission, The WHO recommends intermittent preventive treatment with sulfadoxine/pyrimethamine (IPTp-SP) during antenatal care visits. The effect of IPTp-SP on gametocyte carriage in infected pregnant women was studied. METHODS The levels of transcription of three gametocytes stage-specific genes Pfs16 (expressed by sexually-committed ring stage parasites and fully matured gametocytes), Pfs25 (expressed by female mature gametocytes) and Pfs230 (expressed by male mature gametocytes) were assessed by real-time PCR in 50 P. falciparum infected women at early pregnancy (before implementation of IPTp-SP), and in 50 infected women at delivery. Sex ratios of male and female gametocytes were determined in these women to assess the effect of IPTp-SP on the gametocyte populations. RESULTS The data show that the three transcript types specific to Pfs16, Pfs25 and Pfs230 were detected in all samples, both at inclusion and delivery. Levels of Pfs25 and Pfs230 transcripts were higher at delivery than at inclusion (p = 0.042 and p = 0.003), while the opposite was observed for Pfs16 (p = 0.048). The ratio of male/female gametocyte transcript levels was higher at delivery than at inclusion (p = 0.018). Since a mixed gender late stage gametocyte culture was used as a positive control, male and female gametocytes could not be quantified in an absolute way in the samples. However, the amplification reliability of the Pfs25 and Pfs230 markers in the samples could be checked. A relative quantity of each type of Pfs transcript was, therefore, used to calculate the sex ratio proxy. CONCLUSION This study demonstrates that IPTp-SP treatment contributes to modify the parasite populations' structure during pregnancy. In line with previous studies, we suggest that the continued use of SP in pregnant women as IPTp, despite having a beneficial effect on the pregnancy outcome, could be a risk factor for increased transmission. This reinforces the need for an alternative to the SP drug for malaria prevention during pregnancy.
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Doritchamou JYA, Akuffo RA, Moussiliou A, Luty AJF, Massougbodji A, Deloron P, Tuikue Ndam NG. Submicroscopic placental infection by non-falciparum Plasmodium spp. PLoS Negl Trop Dis 2018; 12:e0006279. [PMID: 29432484 PMCID: PMC5825172 DOI: 10.1371/journal.pntd.0006279] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 02/23/2018] [Accepted: 01/29/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Among the Plasmodium species that infect humans, adverse effects of P. falciparum and P. vivax have been extensively studied and reported with respect to poor outcomes particularly in first time mothers and in pregnant women living in areas with unstable malaria transmission. Although, other non-falciparum malaria infections during pregnancy have sometimes been reported, little is known about the dynamics of these infections during pregnancy. METHODS AND FINDINGS Using a quantitative PCR approach, blood samples collected from Beninese pregnant women during the first antenatal visit (ANV) and at delivery including placental blood were screened for Plasmodium spp. Risk factors associated with Plasmodium spp. infection during pregnancy were assessed as well as the relationships with pregnancy outcomes. P. falciparum was the most prevalent Plasmodium species detected during pregnancy, irrespective either of parity, of age or of season during which the infection occurred. Although no P. vivax infections were detected in this cohort, P. malariae (9.2%) and P. ovale (5.8%) infections were observed in samples collected during the first ANV. These non-falciparum infections were also detected in maternal peripheral blood (1.3% for P. malariae and 1.2% for P. ovale) at delivery. Importantly, higher prevalence of P. malariae (5.5%) was observed in placental than peripheral blood while that of P. ovale was similar (1.8% in placental blood). Among the non-falciparum infected pregnant women with paired peripheral and placental samples, P. malariae infections in the placental blood was significantly higher than in the peripheral blood, suggesting a possible affinity of P. malariae for the placenta. However, no assoctiation of non-falciparum infections and the pregnancy outcomes was observed. CONCLUSIONS Overall this study provided insights into the molecular epidemiology of Plasmodium spp. infection during pregnancy, indicating placental infection by non-falciparum Plasmodium and the lack of association of these infections with adverse pregnancy outcomes.
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Affiliation(s)
- Justin Y. A. Doritchamou
- MERIT, Intitut de Recherche pour le Developpement—Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- Centre d’Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l’Enfance (CERPAGE), Faculté des Sciences de la Santé, Université d’Abomey-Calavi, Cotonou, Benin
| | - Richard A. Akuffo
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Azizath Moussiliou
- MERIT, Intitut de Recherche pour le Developpement—Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- Centre d’Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l’Enfance (CERPAGE), Faculté des Sciences de la Santé, Université d’Abomey-Calavi, Cotonou, Benin
| | - Adrian J. F. Luty
- MERIT, Intitut de Recherche pour le Developpement—Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- Centre d’Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l’Enfance (CERPAGE), Faculté des Sciences de la Santé, Université d’Abomey-Calavi, Cotonou, Benin
| | - Achille Massougbodji
- Centre d’Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l’Enfance (CERPAGE), Faculté des Sciences de la Santé, Université d’Abomey-Calavi, Cotonou, Benin
| | - Philippe Deloron
- MERIT, Intitut de Recherche pour le Developpement—Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Nicaise G. Tuikue Ndam
- MERIT, Intitut de Recherche pour le Developpement—Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- Centre d’Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l’Enfance (CERPAGE), Faculté des Sciences de la Santé, Université d’Abomey-Calavi, Cotonou, Benin
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
- * E-mail:
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Moore KA, Simpson JA, Scoullar MJL, McGready R, Fowkes FJI. Quantification of the association between malaria in pregnancy and stillbirth: a systematic review and meta-analysis. LANCET GLOBAL HEALTH 2017; 5:e1101-e1112. [PMID: 28967610 DOI: 10.1016/s2214-109x(17)30340-6] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 08/15/2017] [Accepted: 08/17/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND 2·6 million stillbirths occur annually worldwide. The association between malaria in pregnancy and stillbirth has yet to be comprehensively quantified. We aimed to quantify the association between malaria in pregnancy and stillbirth, and to assess the influence of malaria endemicity on the association. METHODS We did a systematic review of the association between confirmed malaria in pregnancy and stillbirth. We included population-based cross-sectional, cohort, or case-control studies (in which cases were stillbirths or perinatal deaths), and randomised controlled trials of malaria in pregnancy interventions, identified before Feb 28, 2017. We excluded studies in which malaria in pregnancy was not confirmed by PCR, light microscopy, rapid diagnostic test, or histology. The primary outcome was stillbirth. We pooled estimates of the association between malaria in pregnancy and stillbirth using meta-analysis. We used meta-regression to assess the influence of endemicity. The study protocol is registered with PROSPERO, protocol number CRD42016038742. FINDINGS We included 59 studies of 995 records identified, consisting of 141 415 women and 3387 stillbirths. Plasmodium falciparum malaria detected at delivery in peripheral samples increased the odds of stillbirth (odds ratio [OR] 1·81 [95% CI 1·42-2·30]; I2=26·1%; 34 estimates), as did P falciparum detected in placental samples (OR 1·95 [1·48-2·57]; I2=33·6%; 31 estimates). P falciparum malaria detected and treated during pregnancy was also associated with stillbirth, but to a lesser extent (OR 1·47 [95% CI 1·13-1·92]; 19 estimates). Plasmodium vivax malaria increased the odds of stillbirth when detected at delivery (2·81 [0·77-10·22]; three estimates), but not when detected and treated during pregnancy (1·09 [0·76-1·57]; four estimates). The association between P falciparum malaria in pregnancy and stillbirth was two times greater in areas of low-to-intermediate endemicity than in areas of high endemicity (ratio of ORs 1·96 [95% CI 1·34-2·89]). Assuming all women with malaria are still parasitaemic at delivery, an estimated 20% of the 1 059 700 stillbirths in malaria-endemic sub-Saharan Africa are attributed to P falciparum malaria in pregnancy; the population attributable fraction decreases to 12%, assuming all women with malaria are treated during pregnancy. INTERPRETATION P falciparum and P vivax malaria in pregnancy both increase stillbirth risk. The risk of malaria-associated stillbirth is likely to increase as endemicity declines. There is a pressing need for context-appropriate, evidence-based interventions for malaria in pregnancy in low-endemicity settings. FUNDING Australian Commonwealth Government, National Health and Medical Research Council, Australian Research Council.
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Affiliation(s)
- Kerryn A Moore
- Maternal and Child Health Program, Public Health, Burnet Institute, Melbourne, VIC, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.
| | - Julie A Simpson
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Michelle J L Scoullar
- Maternal and Child Health Program, Public Health, Burnet Institute, Melbourne, VIC, Australia; Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
| | - Rose McGready
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Freya J I Fowkes
- Maternal and Child Health Program, Public Health, Burnet Institute, Melbourne, VIC, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia; Department of Epidemiology and Preventive Medicine and Department of Infectious Diseases, Monash University, Melbourne, VIC, Australia
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8
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Cates JE, Unger HW, Briand V, Fievet N, Valea I, Tinto H, D’Alessandro U, Landis SH, Adu-Afarwuah S, Dewey KG, ter Kuile FO, Desai M, Dellicour S, Ouma P, Gutman J, Oneko M, Slutsker L, Terlouw DJ, Kariuki S, Ayisi J, Madanitsa M, Mwapasa V, Ashorn P, Maleta K, Mueller I, Stanisic D, Schmiegelow C, Lusingu JPA, van Eijk AM, Bauserman M, Adair L, Cole SR, Westreich D, Meshnick S, Rogerson S. Malaria, malnutrition, and birthweight: A meta-analysis using individual participant data. PLoS Med 2017; 14:e1002373. [PMID: 28792500 PMCID: PMC5549702 DOI: 10.1371/journal.pmed.1002373] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 07/11/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Four studies previously indicated that the effect of malaria infection during pregnancy on the risk of low birthweight (LBW; <2,500 g) may depend upon maternal nutritional status. We investigated this dependence further using a large, diverse study population. METHODS AND FINDINGS We evaluated the interaction between maternal malaria infection and maternal anthropometric status on the risk of LBW using pooled data from 14,633 pregnancies from 13 studies (6 cohort studies and 7 randomized controlled trials) conducted in Africa and the Western Pacific from 1996-2015. Studies were identified by the Maternal Malaria and Malnutrition (M3) initiative using a convenience sampling approach and were eligible for pooling given adequate ethical approval and availability of essential variables. Study-specific adjusted effect estimates were calculated using inverse probability of treatment-weighted linear and log-binomial regression models and pooled using a random-effects model. The adjusted risk of delivering a baby with LBW was 8.8% among women with malaria infection at antenatal enrollment compared to 7.7% among uninfected women (adjusted risk ratio [aRR] 1.14 [95% confidence interval (CI): 0.91, 1.42]; N = 13,613), 10.5% among women with malaria infection at delivery compared to 7.9% among uninfected women (aRR 1.32 [95% CI: 1.08, 1.62]; N = 11,826), and 15.3% among women with low mid-upper arm circumference (MUAC <23 cm) at enrollment compared to 9.5% among women with MUAC ≥ 23 cm (aRR 1.60 [95% CI: 1.36, 1.87]; N = 9,008). The risk of delivering a baby with LBW was 17.8% among women with both malaria infection and low MUAC at enrollment compared to 8.4% among uninfected women with MUAC ≥ 23 cm (joint aRR 2.13 [95% CI: 1.21, 3.73]; N = 8,152). There was no evidence of synergism (i.e., excess risk due to interaction) between malaria infection and MUAC on the multiplicative (p = 0.5) or additive scale (p = 0.9). Results were similar using body mass index (BMI) as an anthropometric indicator of nutritional status. Meta-regression results indicated that there may be multiplicative interaction between malaria infection at enrollment and low MUAC within studies conducted in Africa; however, this finding was not consistent on the additive scale, when accounting for multiple comparisons, or when using other definitions of malaria and malnutrition. The major limitations of the study included availability of only 2 cross-sectional measurements of malaria and the limited availability of ultrasound-based pregnancy dating to assess impacts on preterm birth and fetal growth in all studies. CONCLUSIONS Pregnant women with malnutrition and malaria infection are at increased risk of LBW compared to women with only 1 risk factor or none, but malaria and malnutrition do not act synergistically.
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Affiliation(s)
- Jordan E. Cates
- Department of Epidemiology, UNC-Chapel Hill, Chapel Hill, North Carolina, United States of America
- * E-mail:
| | - Holger W. Unger
- Department of Obstetrics and Gynaecology, Edinburgh Royal Infirmary, Edinburgh, United Kingdom
- Department of Medicine at the Doherty Institute, The University of Melbourne, Parkville, Victoria, Australia
| | - Valerie Briand
- UMR216-MERIT, French National Research Institute for Sustainable Development (IRD), Paris Descartes University, Paris, France
| | - Nadine Fievet
- UMR216-MERIT, French National Research Institute for Sustainable Development (IRD), Paris Descartes University, Paris, France
| | - Innocent Valea
- Unite de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé-DRO, Bobo-Dioulasso, Burkina Faso
- Departement de Recherche Clinique, Centre Muraz, Bobo-Dioulasso, Burkina Faso
| | - Halidou Tinto
- Unite de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé-DRO, Bobo-Dioulasso, Burkina Faso
- Departement de Recherche Clinique, Centre Muraz, Bobo-Dioulasso, Burkina Faso
| | - Umberto D’Alessandro
- Medical Research Council Unit, The Gambia; London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sarah H. Landis
- Worldwide Epidemiology, GlaxoSmithKline, Uxbridge, United Kingdom
| | - Seth Adu-Afarwuah
- Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana
| | - Kathryn G. Dewey
- Department of Nutrition, University of California, Davis, California, United States of America
| | - Feiko O. ter Kuile
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Meghna Desai
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Stephanie Dellicour
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Peter Ouma
- Kenya Medical Research Institute (KEMRI)/ Centre for Global Health Research, Kisumu, Kenya
| | - Julie Gutman
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Martina Oneko
- Kenya Medical Research Institute (KEMRI)/ Centre for Global Health Research, Kisumu, Kenya
| | - Laurence Slutsker
- Malaria and Neglected Tropical Diseases, Center for Malaria Control and Elimination, PATH, Seattle, Washington, United States of America
| | - Dianne J. Terlouw
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Simon Kariuki
- Kenya Medical Research Institute (KEMRI)/ Centre for Global Health Research, Kisumu, Kenya
| | - John Ayisi
- Kenya Medical Research Institute (KEMRI)/ Centre for Global Health Research, Kisumu, Kenya
| | - Mwayiwawo Madanitsa
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Victor Mwapasa
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Per Ashorn
- Center for Child Health Research University of Tampere School of Medicine and Tampere University Hospital, Tampere, Finland
| | - Kenneth Maleta
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Ivo Mueller
- Walter and Eliza Hall Institute, Parkville, Victoria, Australia
| | - Danielle Stanisic
- Institute for Glycomics, Griffith University, Gold Coast, Queensland, Australia
| | - Christentze Schmiegelow
- Centre for Medical Parasitology, Depart. Of Immunology and Microbiology, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| | - John P. A. Lusingu
- Centre for Medical Parasitology, Depart. Of Immunology and Microbiology, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
- National Institute for Medical Research, Tanga Centre, Tanga, Tanzania
| | - Anna Maria van Eijk
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Melissa Bauserman
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, School of Medicine, UNC-Chapel Hill, Chapel Hill, North Carolina, United States of America
- Department of Nutrition, UNC-Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Linda Adair
- Department of Nutrition, UNC-Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Stephen R. Cole
- Department of Epidemiology, UNC-Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Daniel Westreich
- Department of Epidemiology, UNC-Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Steven Meshnick
- Department of Epidemiology, UNC-Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Stephen Rogerson
- Department of Medicine at the Doherty Institute, The University of Melbourne, Parkville, Victoria, Australia
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Pehrson C, Salanti A, Theander TG, Nielsen MA. Pre-clinical and clinical development of the first placental malaria vaccine. Expert Rev Vaccines 2017; 16:613-624. [PMID: 28434376 DOI: 10.1080/14760584.2017.1322512] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Malaria during pregnancy is a massive health problem in endemic areas. Placental malaria infections caused by Plasmodium falciparum are responsible for up to one million babies being born with a low birth weight every year. Significant efforts have been invested into preventing the condition. Areas covered: Pub Med was searched using the broad terms 'malaria parasite placenta' to identify studies of interactions between parasite and host, 'prevention of placental malaria' to identify current strategies to prevent placental malaria, and 'placental malaria vaccine' to identify pre-clinical vaccine development. However, all papers from these searches were not systematically included. Expert commentary: The first phase I clinical trials of vaccines are well underway. Trials testing efficacy are more complicated to carry out as only women that are exposed to parasites during pregnancy will contribute to endpoint measurements, further it may require extensive follow-up to establish protection. Future second generation vaccines may overcome the inherent challenges in making an effective placental malaria vaccine.
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Affiliation(s)
- Caroline Pehrson
- a Centre for Medical Parasitology at Department of Immunology and Microbiology, Faculty of Health and Medical Science , University of Copenhagen , Copenhagen , Denmark.,b Department of Infectious Diseases , Copenhagen University Hospital (Rigshospitalet) , Copenhagen , Denmark
| | - Ali Salanti
- a Centre for Medical Parasitology at Department of Immunology and Microbiology, Faculty of Health and Medical Science , University of Copenhagen , Copenhagen , Denmark.,b Department of Infectious Diseases , Copenhagen University Hospital (Rigshospitalet) , Copenhagen , Denmark
| | - Thor G Theander
- a Centre for Medical Parasitology at Department of Immunology and Microbiology, Faculty of Health and Medical Science , University of Copenhagen , Copenhagen , Denmark.,b Department of Infectious Diseases , Copenhagen University Hospital (Rigshospitalet) , Copenhagen , Denmark
| | - Morten A Nielsen
- a Centre for Medical Parasitology at Department of Immunology and Microbiology, Faculty of Health and Medical Science , University of Copenhagen , Copenhagen , Denmark.,b Department of Infectious Diseases , Copenhagen University Hospital (Rigshospitalet) , Copenhagen , Denmark
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10
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Briand V, Saal J, Ghafari C, Huynh BT, Fievet N, Schmiegelow C, Massougbodji A, Deloron P, Zeitlin J, Cot M. Fetal Growth Restriction Is Associated With Malaria in Pregnancy: A Prospective Longitudinal Study in Benin. J Infect Dis 2016; 214:417-25. [DOI: 10.1093/infdis/jiw158] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 04/13/2016] [Indexed: 11/14/2022] Open
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11
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Nouatin O, Gbédandé K, Ibitokou S, Vianou B, Houngbegnon P, Ezinmegnon S, Borgella S, Akplogan C, Cottrell G, Varani S, Massougbodji A, Moutairou K, Troye-Blomberg M, Deloron P, Luty AJF, Fievet N. Infants' Peripheral Blood Lymphocyte Composition Reflects Both Maternal and Post-Natal Infection with Plasmodium falciparum. PLoS One 2015; 10:e0139606. [PMID: 26580401 PMCID: PMC4651557 DOI: 10.1371/journal.pone.0139606] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 09/14/2015] [Indexed: 11/19/2022] Open
Abstract
Maternal parasitoses modulate fetal immune development, manifesting as altered cellular immunological activity in cord blood that may be linked to enhanced susceptibility to infections in early life. Plasmodium falciparum typifies such infections, with distinct placental infection-related changes in cord blood exemplified by expanded populations of parasite antigen-specific regulatory T cells. Here we addressed whether such early-onset cellular immunological alterations persist through infancy. Specifically, in order to assess the potential impacts of P. falciparum infections either during pregnancy or during infancy, we quantified lymphocyte subsets in cord blood and in infants' peripheral blood during the first year of life. The principal age-related changes observed, independent of infection status, concerned decreases in the frequencies of CD4+, NKdim and NKT cells, whilst CD8+, Treg and Teff cells' frequencies increased from birth to 12 months of age. P. falciparum infections present at delivery, but not those earlier in gestation, were associated with increased frequencies of Treg and CD8+ T cells but fewer CD4+ and NKT cells during infancy, thus accentuating the observed age-related patterns. Overall, P. falciparum infections arising during infancy were associated with a reversal of the trends associated with maternal infection i.e. with more CD4+ cells, with fewer Treg and CD8+ cells. We conclude that maternal P. falciparum infection at delivery has significant and, in some cases, year-long effects on the composition of infants' peripheral blood lymphocyte populations. Those effects are superimposed on separate and independent age- as well as infant infection-related alterations that, respectively, either match or run counter to them.
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MESH Headings
- Adult
- Antigens, Protozoan/genetics
- Antigens, Protozoan/immunology
- Benin
- CD8-Positive T-Lymphocytes/immunology
- CD8-Positive T-Lymphocytes/pathology
- Female
- Fetal Blood/immunology
- Fetal Blood/parasitology
- Humans
- Immunophenotyping
- Infant
- Killer Cells, Natural/immunology
- Killer Cells, Natural/pathology
- Lymphocyte Count
- Malaria, Falciparum/immunology
- Malaria, Falciparum/parasitology
- Malaria, Falciparum/pathology
- Natural Killer T-Cells/immunology
- Natural Killer T-Cells/pathology
- Placenta/immunology
- Placenta/parasitology
- Placenta/pathology
- Plasmodium falciparum/immunology
- Pregnancy
- Pregnancy Complications, Parasitic/immunology
- Pregnancy Complications, Parasitic/parasitology
- Pregnancy Complications, Parasitic/pathology
- Retrospective Studies
- T-Lymphocyte Subsets/immunology
- T-Lymphocyte Subsets/pathology
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Affiliation(s)
- Odilon Nouatin
- Centre d’Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l’Enfance (CERPAGE), Faculté des Sciences de la Santé, Université d’Abomey-Calavi, Cotonou, Benin
- Département de Biochimie et de Biologie Cellulaire, Faculté des Sciences et Techniques, Université d’Abomey-Calavi, Cotonou, Bénin
| | - Komi Gbédandé
- Centre d’Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l’Enfance (CERPAGE), Faculté des Sciences de la Santé, Université d’Abomey-Calavi, Cotonou, Benin
- Département de Biochimie et de Biologie Cellulaire, Faculté des Sciences et Techniques, Université d’Abomey-Calavi, Cotonou, Bénin
| | - Samad Ibitokou
- Centre d’Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l’Enfance (CERPAGE), Faculté des Sciences de la Santé, Université d’Abomey-Calavi, Cotonou, Benin
- Département de Biochimie et de Biologie Cellulaire, Faculté des Sciences et Techniques, Université d’Abomey-Calavi, Cotonou, Bénin
| | - Bertin Vianou
- Centre d’Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l’Enfance (CERPAGE), Faculté des Sciences de la Santé, Université d’Abomey-Calavi, Cotonou, Benin
- Département de Biochimie et de Biologie Cellulaire, Faculté des Sciences et Techniques, Université d’Abomey-Calavi, Cotonou, Bénin
| | - Parfait Houngbegnon
- Centre d’Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l’Enfance (CERPAGE), Faculté des Sciences de la Santé, Université d’Abomey-Calavi, Cotonou, Benin
- Département de Biochimie et de Biologie Cellulaire, Faculté des Sciences et Techniques, Université d’Abomey-Calavi, Cotonou, Bénin
| | - Sem Ezinmegnon
- Centre d’Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l’Enfance (CERPAGE), Faculté des Sciences de la Santé, Université d’Abomey-Calavi, Cotonou, Benin
- Département de Biochimie et de Biologie Cellulaire, Faculté des Sciences et Techniques, Université d’Abomey-Calavi, Cotonou, Bénin
| | - Sophie Borgella
- Centre d’Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l’Enfance (CERPAGE), Faculté des Sciences de la Santé, Université d’Abomey-Calavi, Cotonou, Benin
- Institut de Recherche pour le Développement, MERIT UMR D216 Mère et enfant face aux infections tropicales, Paris, France
| | - Carine Akplogan
- Centre d’Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l’Enfance (CERPAGE), Faculté des Sciences de la Santé, Université d’Abomey-Calavi, Cotonou, Benin
- Département de Biochimie et de Biologie Cellulaire, Faculté des Sciences et Techniques, Université d’Abomey-Calavi, Cotonou, Bénin
| | - Gilles Cottrell
- Centre d’Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l’Enfance (CERPAGE), Faculté des Sciences de la Santé, Université d’Abomey-Calavi, Cotonou, Benin
- Institut de Recherche pour le Développement, MERIT UMR D216 Mère et enfant face aux infections tropicales, Paris, France
- PRES Sorbonne Paris Cité, Université Paris Descartes, Faculté de Pharmacie, Paris, France
| | - Stefania Varani
- Unit of Microbiology, Department of Diagnostic, Experimental and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Achille Massougbodji
- Centre d’Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l’Enfance (CERPAGE), Faculté des Sciences de la Santé, Université d’Abomey-Calavi, Cotonou, Benin
| | - Kabirou Moutairou
- Département de Biochimie et de Biologie Cellulaire, Faculté des Sciences et Techniques, Université d’Abomey-Calavi, Cotonou, Bénin
| | - Marita Troye-Blomberg
- Department of Molecular Biosciences, the Wenner-Gren Institute, Stockholm University, Stockholm, Sweden
| | - Philippe Deloron
- Institut de Recherche pour le Développement, MERIT UMR D216 Mère et enfant face aux infections tropicales, Paris, France
- PRES Sorbonne Paris Cité, Université Paris Descartes, Faculté de Pharmacie, Paris, France
| | - Adrian J. F. Luty
- Department of Medical Microbiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Nadine Fievet
- Centre d’Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l’Enfance (CERPAGE), Faculté des Sciences de la Santé, Université d’Abomey-Calavi, Cotonou, Benin
- Institut de Recherche pour le Développement, MERIT UMR D216 Mère et enfant face aux infections tropicales, Paris, France
- PRES Sorbonne Paris Cité, Université Paris Descartes, Faculté de Pharmacie, Paris, France
- * E-mail:
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12
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Anchang-Kimbi JK, Nkweti VN, Ntonifor HN, Apinjoh TO, Tata RB, Chi HF, Achidi EA. Plasmodium falciparum parasitaemia and malaria among pregnant women at first clinic visit in the mount Cameroon Area. BMC Infect Dis 2015; 15:439. [PMID: 26494140 PMCID: PMC4619095 DOI: 10.1186/s12879-015-1211-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 10/13/2015] [Indexed: 11/15/2022] Open
Abstract
Background Pregnant women in malaria endemic areas are at high risk of P. falciparum infection and its complications. This study investigated the prevalence and risk factors for P. falciparum infection and malaria among pregnant women reporting for first antenatal care (ANC) clinic visit in the mount Cameroon area. Methods Venous blood samples from consented pregnant women were screened for malaria parasitaemia by light microscopy. Haemoglobin levels, white blood cell (WBC) counts, lymphocyte counts and percentage were determined using an automated haematology analyser. Socio-demographic/economic data, environmental factors and use of malaria control measures were documented. Univariate and multivariate statistical analyses were used. Results Sixty-eight (22.4 %; N = 303) of the women enrolled were positive for P. falciparum parasitaemia. Malaria parasitaemia was significantly (P < 0.001) associated with febrile illness. The overall prevalence of malaria and asymptomatic infection was 16.0 % (95 % CI = 11-20 %) and 10.5 % (95 % CI = 7.3-15 %) respectively. A greater proportion of the malaria cases (61 %) reported at the clinic during unscheduled days meanwhile women with asymptomatic parasitaemia mostly (92.8 %) seek for ANC during scheduled clinic days. Lower lymphocyte percentage was significantly associated with increase parasite density (r = − 0.34; P = 0.011) and febrile status (MU = 2.46; P = 0.014). While age and gravidity were significant factors associated with P. falciparum infection and/or malaria, the presence of bush and/or standing water around human residence was an independent risk factor of P. falciparum parasitaemia (OR = 3.3: 95 % CI = 1.6 – 7.0; P = 0.002) and malaria ( OR = 5.2: 95 % CI = 2.0 – 14; P = 0.001). Being unmarried was significantly associated with increase risk (OR = 2.6:95 % CI = 1.1 – 6.0; P = 0.032) of P. falciparum parasitaemia. Similarly, single women (938) had a significantly higher (t = 2.70; P = 0.009) geometric mean parasite density (GMPD) compared with married women (338). Conclusion Marital status and human residence in areas with bushes and/or standing water modify risk of P. falciparum infection and malaria. Education on early ANC attendance and environmental sanitation are important public health targets for malaria control in pregnancy in this setting.
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Affiliation(s)
| | - Vera Ngenwie Nkweti
- Department of Zoology and Animal Physiology, University of Buea, Buea, 63, Cameroon.
| | - Helen Ngum Ntonifor
- Department of Biological Sciences, University of Bamenda, Bamenda, Cameroon.
| | - Tobias O Apinjoh
- Department of Biochemistry and Molecular Biology, University of Buea, Buea, 63, Cameroon.
| | - Rolland Bantar Tata
- Department of Molecular Parasitology, University of Buea, Buea, 63, Cameroon.
| | - Hanesh Fru Chi
- Department of Molecular Parasitology, University of Buea, Buea, 63, Cameroon.
| | - Eric Akum Achidi
- Department of Biochemistry and Molecular Biology, University of Buea, Buea, 63, Cameroon.
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13
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Cottrell G, Moussiliou A, Luty AJF, Cot M, Fievet N, Massougbodji A, Deloron P, Tuikue Ndam N. Submicroscopic Plasmodium falciparum Infections Are Associated With Maternal Anemia, Premature Births, and Low Birth Weight. Clin Infect Dis 2015; 60:1481-8. [PMID: 25694651 DOI: 10.1093/cid/civ122] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 02/02/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Molecular, as opposed to microscopic, detection measures the real prevalence of Plasmodium falciparum infections. Such occult infections are common during pregnancy but their impact on pregnancy outcomes is unclear. We performed a longitudinal study to describe that impact. METHODS In a cohort of 1037 Beninese pregnant women, we used ultrasound to accurately estimate gestational ages. Infection with P. falciparum, hemoglobin concentration, use of intermittent preventive treatment during pregnancy (IPTp) for malaria, and other parameters were recorded during pregnancy. Using multivariate analyses, we evaluated the impact of submicroscopic infections on maternal anemia, premature birth, and low birth weight. RESULTS At inclusion, polymerase chain reaction (PCR) and microscopy detected infection in 40% and 16% of women, respectively. The proportion infected declined markedly after 2 doses of IPTp but rebounded to 34% (by PCR) at delivery. Submicroscopic infections during pregnancy were associated with lower mean hemoglobin irrespective of gravidity, and with increased anemia risk in primigravidae (odds ratio [OR], 2.23; 95% confidence interval [CI], .98-5.07). Prospectively, submicroscopic infections at inclusion were associated with significantly increased risks of low birth weight in primigravidae (OR, 6.09; 95% CI, 1.16-31.95) and premature births in multigravidae (OR, 2.25; 95% CI, 1.13-4.46). CONCLUSIONS In this detailed longitudinal study, we document the deleterious impact of submicroscopic P. falciparum parasitemia during pregnancy on multiple pregnancy outcomes. Parasitemia occurs frequently during pregnancy, but routine microscopic and rapid diagnostic tests fail to detect the vast majority of episodes. Our findings imply caution in any revision of the current strategies for prevention of pregnancy-associated malaria.
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Affiliation(s)
- Gilles Cottrell
- PRES Sorbonne Paris Cité, Faculté de Pharmacie, Université Paris Descartes Institut de Recherche pour le Développement, UMR216-MERIT
| | - Azizath Moussiliou
- Institut de Recherche pour le Développement, UMR216-MERIT Université Pierre et Marie Curie, Paris, France
| | - Adrian J F Luty
- PRES Sorbonne Paris Cité, Faculté de Pharmacie, Université Paris Descartes Institut de Recherche pour le Développement, UMR216-MERIT
| | - Michel Cot
- PRES Sorbonne Paris Cité, Faculté de Pharmacie, Université Paris Descartes Institut de Recherche pour le Développement, UMR216-MERIT
| | - Nadine Fievet
- PRES Sorbonne Paris Cité, Faculté de Pharmacie, Université Paris Descartes Institut de Recherche pour le Développement, UMR216-MERIT
| | - Achille Massougbodji
- Centre d'Etude et de Recherche sur le paludisme associé à la Grossesse et à l'Enfance, Université d'Abomey-Calavi, Cotonou, Benin
| | - Philippe Deloron
- PRES Sorbonne Paris Cité, Faculté de Pharmacie, Université Paris Descartes Institut de Recherche pour le Développement, UMR216-MERIT
| | - Nicaise Tuikue Ndam
- PRES Sorbonne Paris Cité, Faculté de Pharmacie, Université Paris Descartes Institut de Recherche pour le Développement, UMR216-MERIT
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14
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Duvignaud A, Denoeud-Ndam L, Akakpo J, Agossou KV, Afangnihoun A, Komongui DG, Atadokpédé F, Dossou-Gbété L, Girard PM, Zannou DM, Cot M. Incidence of malaria-related fever and morbidity due to Plasmodium falciparum among HIV1-infected pregnant women: a prospective cohort study in South Benin. Malar J 2014; 13:255. [PMID: 24996807 PMCID: PMC4089929 DOI: 10.1186/1475-2875-13-255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 06/30/2014] [Indexed: 11/28/2022] Open
Abstract
Background Malaria and HIV are two major causes of morbidity and mortality among pregnant women in sub-Saharan Africa. Foetal and neonatal outcomes of this co-infection have been extensively studied. However, little is known about maternal morbidity due to clinical malaria in pregnancy, especially malaria-related fever, in the era of generalized access to antiretroviral therapy and anti-malarial preventive strategies. Methods A cohort study was conducted in order to estimate the incidence rate and to determine the factors associated with malaria-related fever, as well as the maternal morbidity attributable to malaria in a high-transmission setting of South Benin among HIV-infected pregnant women. Four-hundred and thirty-two women who participated in a randomized trial testing strategies to prevent malaria in pregnancy were included and followed until delivery, with at least three scheduled visits during pregnancy. Confirmed malaria-related fever was defined as axillary temperature >37.5°C and a concomitant, positive, thick blood smear or rapid diagnostic test for Plasmodium falciparum. Suspected malaria-related fever was defined as an axillary temperature >37.5°C and the concomitant administration of an anti-malarial treatment in the absence of parasitological investigation. Results Incidence rate for confirmed malaria-related fever was of 127.9 per 1,000 person-year (PY) (95% confidence interval (CI): 77.4-211.2). In multivariate analysis, CD4 lymphocytes (Relative Risk (RR) for a 50 cells/mm3 variation = 0.82; CI: 0.71-0.96), antiretroviral treatment started before inclusion (RR = 0.34; CI: 0.12-0.98) and history of symptomatic malaria in early pregnancy (RR = 7.10; CI: 2.35-22.49) were associated with the incidence of confirmed or suspected malaria-related fever. More than a half of participants with parasitaemia were symptomatic, with fever being the most common symptom. The crude fraction of febrile episodes attributable to malaria was estimated at 91%. Conclusions This work highlights that malaria is responsible for a substantial morbidity in HIV-infected pregnant women, with cellular immunodepression as a major determinant, and establishes the possible advantage offered by the early initiation of antiretroviral treatment. Trial registration PACOME Study has been registered under the number NCT00970879.
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15
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Placental cytokine and chemokine profiles reflect pregnancy outcomes in women exposed to Plasmodium falciparum infection. Infect Immun 2014; 82:3783-9. [PMID: 24958713 DOI: 10.1128/iai.01922-14] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Pregnancy-associated malaria (PAM) can lead to severe complications for both mother and baby. Certain placental cytokine/chemokine profiles have been shown to reflect poor pregnancy outcomes, including maternal anemia and low birth weight. In intervillous plasma samples from 400 Beninese women living in an area where Plasmodium falciparum is endemic, we quantified 16 cytokines/chemokines. We assessed their profiles in groups with PAM, with maternal anemia, with preterm births, or with a low birth weight for gestational age. Repeated ultrasound measurements ensured that prematurity and low birth weight were highly accurate. Preliminary analyses revealed trends for lower cytokine/chemokine concentrations in placental plasma associated both with babies with low birth weight for gestational age and with P. falciparum infection during pregnancy, while, as a function of the latter, the concentration of gamma interferon (IFN-γ)-inducible protein 10 (IP-10) was higher. Multivariate analyses showed that (i) higher placental plasma interleukin-10 (IL-10) levels were associated with P. falciparum infections and (ii) independently of P. falciparum infections, lower concentrations of both IFN-γ and IL-5 were associated with low birth weight for gestational age. Our data further strengthen the idea that IL-10 and IP-10 could be useful diagnostic markers of P. falciparum infection during pregnancy. The concentrations of cytokines/chemokines in placental plasma may represent previously unrecognized markers of poor fetal growth.
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16
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Tahita MC, Tinto H, Menten J, Ouedraogo JB, Guiguemde RT, van Geertruyden JP, Erhart A, D'Alessandro U. Clinical signs and symptoms cannot reliably predict Plasmodium falciparum malaria infection in pregnant women living in an area of high seasonal transmission. Malar J 2013; 12:464. [PMID: 24373481 PMCID: PMC3877878 DOI: 10.1186/1475-2875-12-464] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 12/19/2013] [Indexed: 11/16/2022] Open
Abstract
Background Malaria in pregnancy is a major public health problem in endemic countries. Though the signs and symptoms of malaria among pregnant women have been already described, clinical presentation may vary according to intensity of transmission and local perceptions. Therefore, determining common signs and symptoms among pregnant women with a malaria infection may be extremely useful to identify those in need of further investigation by rapid diagnostic test or microscopy. Methods Six hundred pregnant women attending the maternity clinic of Nanoro District Hospital, Burkina Faso were recruited, 200 with suspected clinical malaria and 400 as controls. Cases were matched with controls by gestational age and parity. Signs and symptoms were collected and a blood sample taken for rapid diagnostic test, microscopy and haemoglobin measurement. A multivariate model was used to assess the predictive value of signs and symptoms for malaria infection. Results The overall prevalence of malaria was 42.6% (256/600) while anaemia was found in 60.8% (365/600) of the women. Nearly half (49%) of the cases and 39.5% of the controls had a malaria infection (p = 0.03). The most common signs and symptoms among the cases were fever (36%,72/200), history of fever (29%,58/200) and headache (52%,104/200). The positive predictive value for fever was 53% (95% CI:41–64), history of fever 58% (95% CI:37–63) and headache 51% (95% CI:41–61). Conclusion Signs and symptoms suggestive of malaria are frequent among pregnant women living in areas of intense transmission. Common malaria symptoms are not strong predictors of infection. For a better management of malaria in pregnancy, active screening to detect and treat malaria infection early should be performed on all pregnant women attending a health facility.
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Affiliation(s)
| | | | | | | | | | | | | | - Umberto D'Alessandro
- Department of Public Health, Institute of Tropical Medicine, Nationalstraat155, B-2000 Antwerpen, Belgium.
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Borgella S, Fievet N, Huynh BT, Ibitokou S, Hounguevou G, Affedjou J, Sagbo JC, Houngbegnon P, Guezo-Mévo B, Massougbodji A, Luty AJF, Cot M, Deloron P. Impact of pregnancy-associated malaria on infant malaria infection in southern Benin. PLoS One 2013; 8:e80624. [PMID: 24236190 PMCID: PMC3827421 DOI: 10.1371/journal.pone.0080624] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 10/04/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Infants of mothers with placental Plasmodium falciparum infections at delivery are themselves more susceptible to malaria attacks or to infection in early life. METHODOLOGY/ PRINCIPAL FINDINGS To assess the impact of either the timing or the number of pregnancy-associated malaria (PAM) infections on the incidence of parasitemia or malaria attacks in infancy, we followed 218 mothers through pregnancy (monthly visits) up to delivery and their infants from birth to 12 months of age (fortnightly visits), collecting detailed clinical and parasitological data. After adjustment on location, mother's age, birth season, bed net use, and placental malaria, infants born to a mother with PAM during the third trimester of pregnancy had a significantly increased risk of infection (OR [95% CI]: 4.2 [1.6; 10.5], p = 0.003) or of malaria attack (4.6 [1.7; 12.5], p = 0.003). PAM during the first and second trimesters had no such impact. Similarly significant results were found for the effect of the overall number of PAM episodes on the time to first parasitemia and first malaria attack (HR [95% CI]: 2.95 [1.58; 5.50], p = 0.001 and 3.19 [1.59; 6.38], p = 0.001) respectively. CONCLUSIONS/ SIGNIFICANCE This study highlights the importance of protecting newborns by preventing repeated episodes of PAM in their mothers.
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Affiliation(s)
- Sophie Borgella
- Centre d’étude et de recherche sur le paludisme associé à la grossesse et à l’enfance (CERPAGE), Faculté des Sciences de la Santé, Université d’Abomey-Calavi, Cotonou, Benin
- Institut de Recherche pour le Développement, UMR 216, Mère et enfant face aux infections tropicales, Paris, France
- PRES Sorbonne Paris Cité, Université Paris Descartes, Faculté de Pharmacie, Paris, France
| | - Nadine Fievet
- Centre d’étude et de recherche sur le paludisme associé à la grossesse et à l’enfance (CERPAGE), Faculté des Sciences de la Santé, Université d’Abomey-Calavi, Cotonou, Benin
- Institut de Recherche pour le Développement, UMR 216, Mère et enfant face aux infections tropicales, Paris, France
- PRES Sorbonne Paris Cité, Université Paris Descartes, Faculté de Pharmacie, Paris, France
- * E-mail:
| | - Bich-Tram Huynh
- Institut de Recherche pour le Développement, UMR 216, Mère et enfant face aux infections tropicales, Paris, France
- PRES Sorbonne Paris Cité, Université Paris Descartes, Faculté de Pharmacie, Paris, France
| | - Samad Ibitokou
- PRES Sorbonne Paris Cité, Université Paris Descartes, Faculté de Pharmacie, Paris, France
| | - Gbetognon Hounguevou
- PRES Sorbonne Paris Cité, Université Paris Descartes, Faculté de Pharmacie, Paris, France
| | - Jacqueline Affedjou
- PRES Sorbonne Paris Cité, Université Paris Descartes, Faculté de Pharmacie, Paris, France
| | - Jean-Claude Sagbo
- PRES Sorbonne Paris Cité, Université Paris Descartes, Faculté de Pharmacie, Paris, France
| | - Parfait Houngbegnon
- PRES Sorbonne Paris Cité, Université Paris Descartes, Faculté de Pharmacie, Paris, France
| | - Blaise Guezo-Mévo
- PRES Sorbonne Paris Cité, Université Paris Descartes, Faculté de Pharmacie, Paris, France
| | - Achille Massougbodji
- PRES Sorbonne Paris Cité, Université Paris Descartes, Faculté de Pharmacie, Paris, France
| | - Adrian J. F. Luty
- Institut de Recherche pour le Développement, UMR 216, Mère et enfant face aux infections tropicales, Paris, France
- PRES Sorbonne Paris Cité, Université Paris Descartes, Faculté de Pharmacie, Paris, France
| | - Michel Cot
- Institut de Recherche pour le Développement, UMR 216, Mère et enfant face aux infections tropicales, Paris, France
- PRES Sorbonne Paris Cité, Université Paris Descartes, Faculté de Pharmacie, Paris, France
| | - Philippe Deloron
- Institut de Recherche pour le Développement, UMR 216, Mère et enfant face aux infections tropicales, Paris, France
- PRES Sorbonne Paris Cité, Université Paris Descartes, Faculté de Pharmacie, Paris, France
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Kantele A, Siikamäki H, Hannila-Handelberg T, Laitinen K, Rombo L. Plasmodium falciparum--malaria in pregnant African immigrants often goes unrecognized. J Travel Med 2012; 19:380-2. [PMID: 23379709 DOI: 10.1111/j.1708-8305.2012.00651.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We report four cases of asymptomatic Plasmodium falciparum malaria in pregnant African women. They had immigrated to Finland 3 to 13 months earlier. The disease was revealed only by anemia. The diagnosis relied on blood smear which showed a parasitemia <0.2% in three cases. Medical personnel should be informed about the possibility of afebrile forms of malaria in pregnant women even months after immigration. Very low levels of parasitemia may call for a more sensitive diagnostic approach such as polymerase chain reaction.
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Affiliation(s)
- Anu Kantele
- Division of Infectious Diseases, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland.
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19
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Boström S, Ibitokou S, Oesterholt M, Schmiegelow C, Persson JO, Minja D, Lusingu J, Lemnge M, Fievet N, Deloron P, Luty AJF, Troye-Blomberg M. Biomarkers of Plasmodium falciparum infection during pregnancy in women living in northeastern Tanzania. PLoS One 2012; 7:e48763. [PMID: 23155405 PMCID: PMC3498253 DOI: 10.1371/journal.pone.0048763] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 10/05/2012] [Indexed: 11/24/2022] Open
Abstract
In pregnant women, Plasmodium falciparum infections are an important cause of maternal morbidity as well as fetal and neonatal mortality. Erythrocytes infected by these malaria-causing parasites accumulate through adhesive interactions in placental intervillous spaces, thus evading detection in peripheral blood smears. Sequestered infected erythrocytes induce inflammation, offering the possibility of detecting inflammatory mediators in peripheral blood that could act as biomarkers of placental infection. In a longitudinal, prospective study in Tanzania, we quantified a range of different cytokines, chemokines and angiogenic factors in peripheral plasma samples, taken on multiple sequential occasions during pregnancy up to and including delivery, from P. falciparum-infected women and matched uninfected controls. The results show that during healthy, uninfected pregnancies the levels of most of the panel of molecules we measured were largely unchanged except at delivery. In women with P. falciparum, however, both comparative and longitudinal assessments consistently showed that the levels of IL-10 and IP-10 increased significantly whilst that of RANTES decreased significantly, regardless of gestational age at the time the infection was detected. ROC curve analysis indicated that a combination of increased IL-10 and IP-10 levels and decreased RANTES levels might be predictive of P. falciparum infections. In conclusion, our data suggest that host biomarkers in peripheral blood may represent useful diagnostic markers of P. falciparum infection during pregnancy, but placental histology results would need to be included to verify these findings.
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Affiliation(s)
- Stéphanie Boström
- Department of Immunology, Wenner-Gren Institute, Stockholm University, Stockholm, Sweden.
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Huynh BT, Fievet N, Briand V, Borgella S, Massougbodji A, Deloron P, Cot M. Consequences of gestational malaria on birth weight: finding the best timeframe for intermittent preventive treatment administration. PLoS One 2012; 7:e35342. [PMID: 22514730 PMCID: PMC3325930 DOI: 10.1371/journal.pone.0035342] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Accepted: 03/15/2012] [Indexed: 11/18/2022] Open
Abstract
To investigate the consequences of intermittent preventive treatment (IPTp) timing on birth weight, we pooled data from two studies conducted in Benin between 2005 and 2010: a prospective cohort of 1037 pregnant women and a randomised trial comparing sulfadoxine-pyrimethamine (SP) to mefloquine in 1601 women. A total of 1439 women (752 in the cohort and 687 in the SP arm of the randomised trial) who delivered live singletons were analysed. We showed that an early intake of the first SP dose (4 months of gestation) was associated with a lower risk of LBW compared to a late intake (6–7 months of gestation) (aOR = 0.5 p = 0.01). We also found a borderline increased risk of placental infection when the first SP dose was administered early in pregnancy (aOR = 1.7 p = 0.1). This study is the first to investigate the timing of SP administration during pregnancy. We clearly demonstrated that women who had an early intake of the first SP dose were less at risk of LBW compared to those who had a late intake. Pregnant women should be encouraged to attend antenatal visits early to get their first SP dose and a third dose of SP could be recommended to cover the whole duration of pregnancy and to avoid late infections of the placenta.
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Affiliation(s)
- Bich-Tram Huynh
- UMR216, Institut de Recherche pour le Développement, Paris, France.
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21
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Bigey P, Gnidehou S, Doritchamou J, Quiviger M, Viwami F, Couturier A, Salanti A, Nielsen MA, Scherman D, Deloron P, Tuikue Ndam N. The NTS-DBL2X region of VAR2CSA induces cross-reactive antibodies that inhibit adhesion of several Plasmodium falciparum isolates to chondroitin sulfate A. J Infect Dis 2011; 204:1125-33. [PMID: 21881129 DOI: 10.1093/infdis/jir499] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Binding to chondroitin sulfate A by VAR2CSA, a parasite protein expressed on infected erythrocytes, allows placental sequestration of Plasmodium falciparum-infected erythrocytes. This leads to severe consequences such as maternal anemia, stillbirths, and intrauterine growth retardation. The latter has been clearly associated to increased morbidity and mortality of the infants. Acquired anti-VAR2CSA antibodies have been associated with improved pregnancy outcomes, suggesting a vaccine could prevent the syndrome. However, identifying functionally important regions in the large VAR2CSA protein is difficult. METHODS Using genetic immunization, we raised polyclonal antisera against overlapping segments of VAR2CSA in mice and rabbits. The adhesion-inhibition capacities of induced antisera and of specific antibodies purified from plasma of malaria-exposed pregnant women were assessed on laboratory-adapted parasite lines and field isolates expressing VAR2CSA. Competition enzyme-linked immunosorbent assay (ELISA) was employed to analyze functional resemblance between antibodies induced in animals and those naturally acquired by immune multigravidae. RESULTS Antibodies targeting the N-terminal sequence (NTS) up to DBL2X (NTS-DBL2X) efficiently blocked parasite adhesion to chondroitin sulfate A in a manner similar to that of antibodies raised against the entire VAR2CSA extracellular domain. Interestingly, naturally acquired antibodies and those induced by vaccination against NTS-DBL2X target overlapping strain-transcendent anti-adhesion epitopes. CONCLUSIONS This study highlights an important step achieved toward development of a protective vaccine against placental malaria.
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Affiliation(s)
- Pascal Bigey
- Unité de Pharmacologie Chimique et Génétique, Université Paris Descartes, ENSCP Chimie ParisTech, CNRS UMR8151, Inserm U 1022, France
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