Volume 68, Issue 1
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


Maternal anemia and low birth weight (LBW) may complicate malaria in pregnancy, and placental monocyte infiltrates have been associated with LBW, and anecdotally with anemia. We examined placental pathology from 357 Malawian women. Intervillous monocyte infiltrates were frequent in placental malaria and were not seen in uninfected placentas. Histology was grouped according to a 5-point scale. Dense monocyte infiltrates and presence of intramonocytic malaria pigment were associated with anemia and LBW. Of factors associated with LBW and/or anemia in univariate analysis, gravidity ( = 0.002), number of antenatal clinic (ANC) visits ( < 0.001), malaria pigment in fibrin ( = 0.03), and monocyte malaria pigment ( = 0.0001) remained associated with lower birth weight by multivariate analysis. Associated with maternal anemia were HIV infection ( < 0.0001), intervillous monocyte numbers ( < 0.0001), number of ANC visits ( = 0.002), and recent febrile symptoms ( = 0.0001). Pigment-containing placental monocytes are associated with anemia and LBW due to malaria, and may have a causative role in their development.


Article metrics loading...

Loading full text...

Full text loading...



  1. Steketee RW, Nahlen BL, Parise ME, Menendez C, 2001. The burden of malaria in pregnancy in malaria-endemic areas. Am J Trop Med Hyg 64 (Suppl): 28–35.
  2. Steketee RW, Wirima JJ, Hightower AW, Slutzker L, Heymann DL, Breman JG, 1996. The effect of malaria and malaria prevention in pregnancy on offspring birthweight, prematurity, and intrauterine growth retardation in rural Malawi. Am J Trop Med Hyg 55: 33–41.
  3. Walter PR, Garin Y, Blot P, 1982. Placental pathologic changes in malaria. A histologic and ultrastructural study. Am J Pathol 109: 330–342.
  4. Ordi J, Ismail MR, Ventura P, Kahigwa E, Hirt R, Cardesa A, Alonso P, Menendez C, 1998. Massive chronic intervillositis of the placenta associated with malarial infection. Am J Surg Path 22: 1006–1011.
  5. Menendez C, Ordi J, Ismail MR, Ventura PJ, Aponte JJ, Kahigwa E, Font F, Alonso PL, 2000. The impact of placental malaria on gestational age and birth weight. J Infect Dis 181: 1740–1745.
  6. Watkinson M, Rushton DI, 1983. Plasmodial pigmentation of placentae and outcome of pregnancy in West African mothers. B Med J 287: 251–254.
  7. Jilly P, 1969. Anaemia in parturient women, with special reference to malaria infection of the placenta. Ann Trop Med Parasitol 63: 109–116.
  8. Bulmer JN, Rasheed FN, Francis N, Morrison L, Greenwood BM, 1993. Placental malaria. I. Pathological classification. Histopathology 22: 211–218.
  9. Ismail MR, Ordi J, Menendez C, Ventura PJ, Aponte JJ, Kahigwa E, Hirt R, Cardesa A, Alonso PL, 2000. Placental pathology in malaria: a histological, immunohistochemical, and quantitative study. Hum Pathol 31: 85–93.
  10. Leopardi O, Naughten W, Salvia L, Colecchia M, Matteelli A, Zucchi A, Shein A, Muchi JA, Carosi G, Ghione M, 1996. Malaric placentas. A quantitative study and clinico-pathological correlations. Path Res Pract 192: 892–898.
  11. Rogerson SJ, Chaluluka E, Kanjala M, Mkundika P, Mhango CG, Molyneux ME, 2000. Intermittent sulphadoxine-pyrimethamine in pregnancy: effectiveness against malaria morbidity in Blantyre, Malawi, 1997–1999. Trans R Soc Trop Med Hyg 94: 549–553.
  12. Nahlen BL, 2000. Rolling back malaria in pregnancy. N Engl J Med 343: 651–652.
  13. Fried M, Muga RO, Misore AO, Duffy PE, 1998. Malaria elicits type 1 cytokines in the human placenta: IFN-γ and TNF-α associated with pregnancy outcomes. J Immunol 160: 2523–2530.
  14. Moorman AM, Sullivan AD, Rochford RA, Chensue SW, Bock PJ, Nyirenda T, Meshnick SR, 1999. Malaria and pregnancy: placental cytokine expression and its relationship to intrauterine growth retardation. J Infect Dis 180: 1987–1993.
  15. Menendez C, 1995. Malaria during pregnancy: a priority area of malaria research and control. Parasitol Today 11: 178–183.
  16. Rogerson SJ, van den Broek NR, Chaluluka E, Qonqwane C, Mhango CG, Molyneux ME, 2000. Malaria and anemia in antenatal women in Blantyre, Malawi: a twelve-month survey. Am J Trop Med Hyg 62: 335–340.
  17. Van Eijk AM, Ayisi JG, Ter Kuile FO, Misore A, Otieno JA, Kolczak MS, Kager PA, Steketee RW, Nahlen BL, 2001. Human immunodeficiency virus seropositivity and malaria as risk factors for third-trimester anemia in asymptomatic pregnant women in Western Kenya. Am J Trop Med Hyg 65: 623–630.
  18. Brabin B, 1991. An assessment of low birthweight risk in primi-parae as an indicator of malaria control in pregnancy. Int J Epidemiol 20: 276–283.
  19. Letamo G, Majelantle RG, 2001. Factors influencing low birth weight and prematurity in Botswana. J Biosoc Sci 33: 391–403.
  20. Goodman CA, Coleman PG, Mills AJ, 2001. The cost-effectiveness of antenatal malaria prevention in sub-Saharan Africa. Am J Trop Med Hyg 64 (Suppl): 45–56.
  21. van den Broek NR, White SA, Neilson JP, 1998. The relationship between asymptomatic human immunodeficiency virus infection and the prevalence and severity of anemia in pregnant Malawian women. Am J Trop Med Hyg 59: 1004–1007.
  22. van den Broek NR, Letsky EA, 2000. Etiology of anemia in pregnancy in south Malawi. Am J Clin Nutr 72: 247S–256S.
  23. Guidotti RJ, 2000. Anaemia in pregnancy in developing countries. Br J Obstet Gynaecol 107: 437–438.
  24. Clark IA, Chaudhri G, 1988. Tumour necrosis factor may contribute to the anaemia of malaria by causing dyserythropoiesis and erythrophagocytosis. Br J Haematol 70: 99–103.
  25. Fried M, Duffy PE, 1998. Maternal malaria and parasite adhesion. J Mol Med 76: 162–171.
  26. Nguyen PH, Day N, Pram TD, Ferguson DJ, White NJ, 1995. Intraleucocytic malaria pigment and prognosis in severe malaria. Trans R Soc Trop Med Hyg 89: 200–204.

Data & Media loading...

  • Received : 20 Apr 2002
  • Accepted : 14 Oct 2002

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error