Relationships Between Measures of Malaria at Delivery and Adverse Birth Outcomes in a High-Transmission Area of Uganda. (2nd April 2020)

• Record Type: Journal Article
• Authors: Ategeka, John; Kakuru, Abel; Kajubi, Richard; Wasswa, Razack; Ochokoru, Harriet; Arinaitwe, Emmanuel; Yeka, Adoke; Jagannathan, Prasanna; Kamya, Moses R; Muehlenbachs, Atis; Chico, R Matthew; Dorsey, Grant
• Is Part Of: Journal of infectious diseases. Volume 222:Number 5(2020)
• Page Start: 863
• Page End: 870
• Publication Date: 2020-04-02
• Subjects: low birth weight -- malaria in pregnancy -- placental malaria -- preterm birth -- small for gestational age; Communicable diseases -- Periodicals; Diseases -- Causes and theories of causation -- Periodicals; Medicine -- Periodicals; Communicable Diseases -- Periodicals; Electronic journals; 616.9
• DOI: 10.1093/infdis/jiaa156
• Languages: English
• ISSNs: 0022-1899

Abstract

Abstract: Background: Clinical trials of interventions for preventing malaria in pregnancy often use measures of malaria at delivery as their primary outcome. Although the objective of these interventions is to improve birth outcomes, data on associations between different measures of malaria at delivery and adverse birth outcomes are limited. Methods: Data came from 637 Ugandan women enrolled in a randomized controlled trial of intermittent preventive treatment of malaria in pregnancy. Malaria at delivery was detected using peripheral and placental blood microscopy, placental blood loop-mediated isothermal amplification (LAMP), and placental histopathology. Multivariate analyses were used to estimate associations between measures of malaria at delivery and risks of low birth weight (LBW), small for gestational age (SGA), and preterm birth (PTB). Results: Detection of malaria parasites by microscopy or LAMP was not associated with adverse birth outcomes. Presence of malaria pigment detected by histopathology in ≥30% of high-powered fields was strongly associated with LBW (adjusted risk ratio [aRR] = 3.42, P = .02) and SGA (aRR = 4.24, P < .001) but not PTB (aRR = 0.88, P = .87). Conclusions: A semiquantitative classification system based on histopathologically detected malaria pigment provided the best surrogate measure of adverse birth outcomes in a high-transmission setting and should be considered for use in malaria in pregnancy intervention studies. Abstract : In a high-transmission setting, semiquantitative classification of malaria pigment by histopathology was the best surrogate measure of adverse birth outcomes. Detection of malaria parasites by microscopy or loop-mediated isothermal amplification of DNA was not associated with any adverse birth outcomes.