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Am. J. Trop. Med. Hyg., 73(4), 2005, pp. 694-697
Copyright © 2005 by The American Society of Tropical Medicine and Hygiene

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SHORT REPORT


ADVERSE PERINATAL OUTCOMES OF HIV-1–INFECTED WOMEN IN RELATION TO MALARIA PARASITEMIA IN MATERNAL AND UMBILICAL CORD BLOOD

EDUARDO VILLAMOR*, GERNARD MSAMANGA, SAID ABOUD, WILLY URASSA, DAVID J. HUNTER, AND WAFAIE W. FAWZI
Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts; Departments of Community Health and Microbiology and Immunology, Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania; Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts

 

ABSTRACT

Malaria infection during pregnancy increases the risk of adverse birth outcomes among HIV-infected women. The role of umbilical cord parasitemia is not well characterized. We examined the risk of adverse perinatal outcomes in relation to maternal or umbilical cord Plasmodium falciparum parasitemia among 275 HIV-infected women from Tanzania, who participated in a randomized trial of zinc supplementation during pregnancy. Maternal parasitemia (≥1/µL) at the first antenatal visit was associated with increased risk of low birth weight < 2,500 g (adjusted relative risk [ARR] = 2.66; P = 0.01) and preterm delivery < 37 weeks (ARR = 1.87; P = 0.06). Maternal parasitemia at delivery was associated with preterm delivery (ARR = 2.27; P = 0.008), intrauterine growth retardation (ARR = 1.92; P = 0.03), and neonatal death (ARR = 3.22; P = 0.07). Cord parasitemia was associated with a large and significant increase in the risk of neonatal death (ARR = 8.75; P = 0.003). Maternal parasitemia at the first antenatal visit was strongly related to parasitemia at delivery, and the latter was associated with cord blood parasitemia. CD4 cell counts, parity, or assignment to the zinc arm (25 mg daily) were not associated with parasitemia in maternal or cord blood at delivery. Successful treatment of HIV-infected women who present to the first prenatal visit with malaria parasitemia and avoidance of reinfection are likely to decrease the risk of adverse outcomes during pregnancy and the early postpartum period. Cord blood parasitemia is a strong predictor of neonatal death. The potential effect of zinc supplementation on clinical malaria outcomes deserves future investigation.

Received March 4, 2005. Accepted for publication June 8, 2005.

Acknowledgments: We are grateful to the women and children who participated in the study. The authors thank the field teams including nurses, physicians, midwives, supervisors, lab staff, and the administrative staff who made the study possible. The authors thank the authorities at Muhimbili University College of Health Sciences, Muhimbili National Hospital, the City of Dar es Salaam Regional Health Authority, and the Tanzanian National AIDS Control Program for their institutional support.

Financial support: This study was supported by the National Institute of Child Health and Human Development (NICHD R01 32257).

* Address correspondence to Eduardo Villamor, Department of Nutrition, Harvard School of Public Health, 665 Huntington Ave., Boston, MA 02115. E-mail: evillamo{at}hsph.harvard.edu.

Authors’ addresses: Eduardo Villamor, Department of Nutrition, Harvard School of Public Health, 665 Huntington Ave., Boston, MA 02115, E-mail: evillamo{at}hsph.harvard.edu. Gernard Msamanga, Department of Community Health, Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania, E-mail: gmsamanga{at}muchs.ac.tz. Said Aboud, Department of Microbiology and Immunology, Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania, E-mail: saboud{at}muchs.ac.tz. Willy Urassa, Department of Microbiology and Immunology, Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania, E-mail: wurassa{at}muchs.ac.tz. David J. Hunter, Department of Epidemiology, Harvard School of Public Health, 665 Huntington Ave., Boston, MA 02115, E-mail: nhdjh{at}channing.harvard.edu. Wafaie W. Fawzi, Department of Nutrition, Harvard School of Public Health, 665 Huntington Ave., Boston, MA 02115, E-mail: mina{at}hsph.harvard.edu.

Reprint requests: Eduardo Villamor, Department of Nutrition, Harvard School of Public Health, 665 Huntington Ave., SPH2, Boston, MA 02115. E-mail: evillamo{at}hsph.harvard.edu.






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