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MICROSCOPIC AND SUB-MICROSCOPIC PLASMODIUM FALCIPARUM INFECTION, BUT NOT INFLAMMATION CAUSED BY INFECTION, IS ASSOCIATED WITH LOW BIRTH WEIGHT

Pregnancy-associated malaria is one of the leading causes of low birth weight in malaria endemic areas. In this study, 145 parturient women residing in areas endemic for Plasmodium falciparum in Lambaréné, Gabon, were recruited into the study after delivery, and the association of maternal P. falciparum infection, inflammatory response, and birth weight was studied. At delivery, 10% (15) of the mothers (12 were positive in both peripheral and placental blood smears, 1 was positive in peripheral blood only, and 2 were positive in placenta blood only) were positive for P. falciparum by microscopy and 23% (30) by real-time polymerase chain reaction (PCR). The level of C-reactive protein (CRP) was significantly elevated in microscopically P. falciparum–positive pregnant women (34 mg/L; 95% CI: 3–458) but not in those with sub-microscopic infections (6 mg/L; 95% CI: 1–40) compared with those free of P. falciparum infection (7 mg/L; 95% CI: 1–43). In a multivariate analysis, the presence of microscopic (adjusted OR = 28.6, 95% CI = 4.8–169.0) or sub-microscopic (adjusted OR = 13.2, 95% CI = 2.4–73.0) P. falciparum infection in pregnant women and age of mothers < 21 years (adjusted OR = 9.7 CI = 1.0–89.7), but not CRP levels, were independent predictors for low birth weight. This finding may have important operational implications and emphasizes the need for appropriate diagnostic methods in studies evaluating the outcome of pregnancy-associated malaria.

Received February 22, 2006. Accepted for publication July 26, 2006.

Acknowledgments: We thank all pregnant women who participated in this study and the midwives at the General Hospital and the Albert Schweitzer Hospital in Lambaréné. We also thank Brigitte Migombet and Anselme Ndzengue for excellent technical assistance and Dr. Bertrand Lell and Eric Kendjo for critical comments on the statistics.

Financial support: This study was funded by the Netherlands Foundation for the Advancement of Tropical Research Grant W93-385 20077, and A.A.A. was financially supported by the UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR) ID A30863.

^* Address correspondence to Ayola Akim Adegnika, Department of Parasitology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA P4-37 Leiden, The Netherlands. E-mail: aadegnika{at}yahoo.fr

Authors’ addresses: Ayôla A Adegnika, Selidji T Agnandji, Sanders K. Chai, Lutz Ph. Breitling, Michael Ramharter, Saadou Issifou, Peter G. Kremsner, and Maria Yazdanbakhsh, Medical Research Unit, Albert Schweitzer Hospital, Lambaréné, BP: 13901 Libreville Gabon, Telephone: 00241 581099, Fax: 00241 581196, E-mail: aadegnika{at}yahoo.fr. Ayôla A Adegnika, Jaco J.Verweij, and Maria Yazdanbakhsh, Department of Parasitology, Leiden University Medical Center Albinusdreef 2 2333, ZA P4-37 Leiden, The Netherlands. Ayôla A. Adegnika, Selidji T Agnandji, Michael Ramharter, Saadou Issifou, and Peter G. Kremsner, Institute of Tropical Medicine, University of Tübingen, Wilhelmstrasse 27, 72074 Tübingen, Germany. Marijke Frolich, Department of Clinical Chemistry, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands. Lutz Ph. Breitling, Research Institute for Integrative and Comparative Biology, University of Leeds, Leeds LS2 9JT, UK.

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