Erin Fletcher Bio 1615 Friday @ 1 11.11.

13

Malaria and Pregnancy

Introduction: Malaria is an infectious disease that comes from infected mosquitos. Once the mosquito bites the disease gets into the blood stream and directly affects the circulatory system. The symptoms of having malaria is babies being born with a lower than average birth weight, premature delivery, and maternal anemia, which is when a pregnant woman does not have enough red blood cells and has a hard time getting oxygen. This is why the prevention of malaria is very important. In order to prevent it though, you need to know more about it and why it is so common. In order to do this researchers are going to perform an effective and safe test on the blood of maternal, placental, and umbilical cords.

Materials and Methods: There was a study on this from September 2005 to January 2006 in Libreville, Gabon. Gabon is located on the west coast of Africa about halfway down the continent. They chose the largest hospital in Libreville to collect the data from. They took blood samples from the peripheral, placenta, and umbilical cord. From there they tested for malaria in 3 different ways. They either performed microscopy, histidinrich protein-2 (HRP-2) detection, or polymerase chain reaction (PCR). For microscopy, two very good microscopists examined the blood samples very thoroughly. For HRP-2 they used a test called the Binax Now Malaria dipstick test. For PCR they did a genotype of the surface of protein 2. If any of these tests came back positive you were considered infected. From those results they categorized how severe it was into four sections. Early meant you only showed parasites, late was both parasites and pigment, resolved was only haemozoin, which is the scrapping left from a parasite digesting your blood, and none was neither parasites nor pigment showing.

Results: In the study they chose 203 women to observe. In all cases younger aged women ( < 20) had a higher chance of early delivery, compared to older women. In maternal malaria, 77% of the women who were pregnant were infected versus those who had already had a child. One of the bigger symptoms

was the baby being born a few weeks early (25%). However, low birth weight (13%) and fever at delivery (5%) were not very common. Maternal anemia (53%) was also very common in this category. When looking at placental malaria, HPMI (history of possible malaria infection) was the only reason for these first time mothers to be at risk. Not far behind maternal malaria, this one showed maternal anemia at 51%. This one was different from maternal malaria however because how far along the baby was did not affect the distribution of results from the 3 different tests. The total result of this experiment ended with 53.6% of women had placental malaria. Only 18.2% of babies had cord-blood infection and was detected by PCR. The HPMI in all cases was all about the same, averaging at about 21%. Newborns with the cord infection had a reduced birth weight in first time mothers only.

Discussion: The researchers found that the best method for estimating the number of parasites in the blood was by using microscopic detection. Placental and maternal anemia and malaria were common in many of these women in Libreville. The next step is to find treatments to prevent this from continuing to happen. Knowing the birth weight in a child is a good control to experiment which methods work best for prevention. When a mother is pregnant, the parasites of malaria like to cluster in the placenta, therefore making it a good spot to work on finding cures because the results are shown in the newborn baby. They have found that even with strategies to prevent malaria, it doesnt change how likely a woman is to get it. They did find that a medicine (IPTp/SP) that helps women whove been pregnant before, but the dose needs to be drastically increased in order to have the same effect on women pregnant for the first time.

Conclusion: After this study, the recommendations for preventing malaria is using a bug net around your bed, infused with insecticide to keep mosquitoes away. Another recommendation is to take a few doses

of sulfadoxine-pyrimethamine (IPTp/SP) while being pregnant to help keep malaria away. Making frequent visits to a maternity doctor while being pregnant can help prevent your baby from being born prematurely, or bring born with a low birth weight.

URL: http://www.ajtmh.org/content/82/2/202.full