Nutritional Advice El Mondo

Plasmodium falciparum malaria in pregnancy increases stillbirth risk

Objectives:
2-6 million stillbirths occur annually worldwide. The association between malaria in pregnancy and stillbirth has yet to be comprehensively quantified. Therefore, this review article (meta-analysis) has been conducted.

Does malaria in pregnancy increases stillbirth risk?

Study design:
This review article included 59 studies (population-based cross-sectional, cohort or case-control studies and randomised controlled trials, identified before Feb 28, 2017) consisting of 141,415 women and 3,387 stillbirths.

Results and conclusions:
The investigators found plasmodium falciparum malaria detected at delivery in peripheral samples significantly increased the risk of stillbirth with 81% [OR = 1.81, 95% CI = 1.42-2.30, I2 = 26.1%, 34 estimates].

The investigators found plasmodium falciparum malaria detected at delivery in placental samples significantly increased the risk of stillbirth with 95% [OR = 1.95, 95% CI = 1.48-2.57, I2 = 33.6%, 31 estimates].

The investigators found plasmodium 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].

The investigators found plasmodium vivax malaria detected at delivery non-significantly increased the risk of stillbirth with 181% [OR = 2.81, 95% CI= 0.77-10.22, 3 estimates].

The investigators found plasmodium vivax malaria detected and treated during pregnancy non-significantly increased the risk of stillbirth with 9% [OR = 1.09, 95% CI= 0.76-1.57, 4 estimates].

The investigators found the association between plasmodium falciparum malaria in pregnancy and stillbirth was two times greater in areas of low-to-intermediate endemicity than in areas of high endemicity [OR = 1.96, 95% CI = 1.34-2.89]. 

The investigators concluded plasmodium falciparum malaria in pregnancy increases 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.
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 plasmodium falciparum malaria in pregnancy; the population attributable fraction decreases to 12%, assuming all women with malaria are treated during pregnancy.


Original title:
Quantification of the association between malaria in pregnancy and stillbirth: a systematic review and meta-analysis by Moore KA, Simpson JA, […], Fowkes FJI.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/28967610

Additional information of El Mondo:
Find more information/studies on food fortification/malnutrition right here.

Malaria is a life-threatening disease and is caused by Plasmodium parasites. The parasites are spread to people through the bites of infected female Anopheles mosquitoes, called "malaria vectors". There are 5 parasite species that cause malaria in humans and 2 of these species - Plasmodium falciparum and Plasmodium vivax - pose the greatest threat.

  1. Plasmodium falciparum is responsible for the majority of malaria deaths globally and is the most prevalent species in sub-Saharan Africa. The remaining species are not typically as life threatening as Plasmodium falciparum.
  2. Plasmodium vivax, is the second most significant species and is prevalent in Southeast Asia and Latin America. Plasmodium vivax and Plasmodium ovale have the added complication of a dormant liver stage, which can be reactivated in the absence of a mosquito bite, leading to clinical symptoms.
  3. Plasmodium ovale represents only a small percentage of infections.
  4. Plasmodium malariae represents only a small percentage of infections.
  5. A fifth species Plasmodium knowlesi - a species that infects primates - has led to human malaria, but the exact mode of transmission remains unclear.

The time from the initial malaria infection until symptoms appear - incubation period - typically ranges from:

  • 9 to 14 days for Plasmodium falciparum.
  • 12 to 18 days for Plasmodium vivax and Plasmodium ovale.
  • 18 to 40 days for Plasmodium malariae.
  • 11 to 12 days for Plasmodium knowlesi.

Malaria is preventable and curable.