The Hidden Burden of Plasmodium vivax Malaria in Pregnancy in the Amazon: An Observational Study in Northwestern Brazil

Autor(es):Mostrar menos -

Pincelli, Anaclara ^[1] ; Neves, Paulo A. R. ^[2] ; Lourenco, Barbara H. ^{[2, 3]} ; Corder, Rodrigo M. ^[1] ; Malta, Maira B. ^[2] ; Sampaio-Silva, Juliana ^[2] ; de Souza, Rodrigo M. ^[4] ; Cardoso, Marly A. ^[2] ; Castro, Marcia C. ^[5] ; Ferreira, Marcelo U. ^[1] ; Grp, MINA Brazil Working

Afiliação do(s) autor(es)

^[1] Univ Sao Paulo, Inst Biomed Sci, Dept Parasitol, Ave Prof Lineu Prestes 1374, Cidade Univ, BR-05508900 Sao Paulo - Brazil

^[2] Univ Sao Paulo, Sch Publ Hlth, Dept Nutr, Sao Paulo - Brazil

^[3] Univ Fed Sao Paulo, Dept Prevent Med, Escola Paulista Med, Sao Paulo - Brazil

^[4] Univ Fed Acre, Multidisciplinary Ctr, Campus Floresta, Cruzeiro Do Sul - Brazil

^[5] Harvard TH Chan Sch Publ Hlth, Dept Global Hlth & Populat, Boston, MA - USA

• Tipo de documento: Artigo Científico
• Fonte: American Journal of Tropical Medicine and Hygiene; v. 99, n. 1, p. 73-83, 2018.
• Citações Web of Science: 5

Resumo

We measured the prevalence of malaria in pregnancy and estimated its impact on birth weight and length and maternal hemoglobin in 1,180 women from Jurua Valley, the main malaria hotspot in Brazil. Antenatal malaria episodes, 74.6% of them due to Plasmodium vivax, were microscopically diagnosed in 8.0% of the women and were associated with an average reduction in birth weight z-scores of 0.35 (95% confidence interval {[}CI] = 0.14-0.57) and in birth length z-scores of 0.31 (95% CI = 0.08-0.54), compared with malaria-free pregnancies. Affected mothers had a mean decrease in hemoglobin concentration at delivery of 0.33 g/100 mL (95% CI = 0.05-0.62 g/100 mL); 51.6% were anemic. The timing and frequency of antenatal infections influenced pregnancy outcomes and first-or second-trimester infections were not associated with decreased birth weight and length and maternal hemoglobin at delivery. Although repeated antenatal vivax infections were associated with poorer birth outcomes, even a single vivax malaria episode was associated with a significant reduction in birth weight and length and maternal hemoglobin. Overall, 7.5% women had the parasite's DNA found in peripheral blood at delivery. Most (83.1%) of these 89 perinatal infections were due to P. vivax and only 7.9% of them progressed to symptomatic disease after delivery. Plasmodium vivax and Plasmodium falciparum DNA was found in 0.6% and 0.3% of 637 cord blood samples examined, respectively, but only one newborn developed clinical neonatal malaria. Our results further challenge the notion that vivax malaria is relatively benign during pregnancy and call for better strategies for its prevention. (AU)

• Processo FAPESP: 16/00270-6 - Estudo MINA - Materno-Infantil no Acre: coorte de nascimentos da Amazônia Ocidental Brasileira
• Beneficiário: Marly Augusto Cardoso
• Modalidade de apoio: Auxílio à Pesquisa - Temático