Association between gestational malaria, intrauterine growth restriction and low birth weight in the far-western Brazilian Amazon.

Author(s)

Jamille Gregório Dombrowski

• Document type: Doctoral Thesis
• Press: São Paulo.
• Institution: Universidade de São Paulo (USP). Instituto de Ciências Biomédicas (ICB/SDI)
• Defense date: 2018-02-01

Examining board members

Claudio Romero Farias Marinho; Marcia Furquim de Almeida; Estela Maris Andrade Forell Bevilacqua; Fábio Trindade Maranhão Costa; Flor Ernestina Martinez Espinosa

• Advisor: Claudio Romero Farias Marinho

Abstract

Malaria is a severe parasitic disease that, when occurs during pregnancy, it is one of the main cause of maternal-fetal mortality leading also to maternal anemia, abortion, preterm birth, intrauterine growth restriction and low birth weight. Infections by Plasmodium (P.) falciparum are known to be detrimentally involved in poor pregnancy outcomes, effects that were also described during P. vivax infections. Despite its significant prevalence and possible association to severe complications during pregnancy, the impact of malaria in pregnant women and their children are not clearly understood. Current study aims to evaluate the consequences of malaria in pregnancy and correspondent association with intrauterine growth restriction and low birth weight in an endemic area located in the furthest west region of the Brazilian Amazon. A retrospective and prospective study was performed, accounting with pregnant women living in the region of Vale do Alto Juruá (Acre, Brazil) in which the consequences and extension of malaria effects on the newborns was evaluated through the analysis of epidemiological data and biological material. In this study, we observed an increase in the number of preterm deliveries and low birth weight among children born from pregnant women infected with P. vivax when compared to non-infected pregnant women. Regarding P. falciparum infection during pregnancy, we have noticed that this is a risk factor for newborns with reduced head circumference, also increasing the probability of occurring cases of microcephaly and preterm birth. Besides, every deleterious effect was associated with placental malaria, which is mainly characterized by an increase in the syncytial nuclear aggregates and inflammatory infiltrates, as well as by an imbalance in placental angiogenic factors and a reduction in leptin levels. Several studies mainly developed in Africa, highlight the negative effects of P. falciparum malaria in the maternal-fetal context yet, little is known about malaria in pregnancy that occurs in the endemic areas of the America where infections caused by P. vivax are predominate. Our results suggest that infections promoted by this parasite species are far from being benign as it was depicted in our cohort, which has shown high incidence of placental lesions, low birth weight, abortion and preterm delivery. Moreover, the present study has shown that malaria in pregnancy caused by P. falciparum increased the probability of preterm delivery and reduction of head circumference in newborns, which is associated to placental malaria. Therefore, knowing the impact of infection in the placenta and fetal development may bring an important contribution to the understanding of malaria in pregnancy, allowing the development of specific action that can be implemented in the routine of antenatal cares. (AU)

• FAPESP's process: 12/04755-3 - Association of gestational malaria with intrauterine growth restriction and low birth weight in the far-western Brazilian Amazon
• Grantee: Jamille Gregório Dombrowski
• Support Opportunities: Scholarships in Brazil - Doctorate (Direct)