PLoS Neglected Tropical Diseases (Jun 2017)

Burden and impact of Plasmodium vivax in pregnancy: A multi-centre prospective observational study.

  • Azucena Bardají,
  • Flor Ernestina Martínez-Espinosa,
  • Myriam Arévalo-Herrera,
  • Norma Padilla,
  • Swati Kochar,
  • Maria Ome-Kaius,
  • Camila Bôtto-Menezes,
  • María Eugenia Castellanos,
  • Dhanpat Kumar Kochar,
  • Sanjay Kumar Kochar,
  • Inoni Betuela,
  • Ivo Mueller,
  • Stephen Rogerson,
  • Chetan Chitnis,
  • Dhiraj Hans,
  • Michela Menegon,
  • Carlo Severini,
  • Hernando Del Portillo,
  • Carlota Dobaño,
  • Alfredo Mayor,
  • Jaume Ordi,
  • Mireia Piqueras,
  • Sergi Sanz,
  • Mats Wahlgren,
  • Laurence Slutsker,
  • Meghna Desai,
  • Clara Menéndez,
  • PregVax Study Group

DOI
https://doi.org/10.1371/journal.pntd.0005606
Journal volume & issue
Vol. 11, no. 6
p. e0005606

Abstract

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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.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).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.