Volume 73, Issue 6
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


Placental infection measured by placental smear at delivery is a standard indicator, widely used to characterize malaria infection in pregnant women. However, a single measure can hardly reflect the entire history of infection during pregnancy. To investigate the relation between this indicator and peripheral infection during pregnancy, we used data collected in a randomized trial of malaria prophylaxis in 928 pregnant women in Burkina Faso, 1987–1988, during which repeated measures of peripheral infection were taken. We analyzed placental infection using a logistic model, with two methods for handling missing data. Peripheral infection during two periods of pregnancy was significantly related to placental infection at delivery, before the fifth month: OR = 2.9 [1.3; 6.3]; after 7 months: OR = 4.9 [2.7; 8.8]). Therefore, an early peripheral infection may persist throughout gestation, and placental infection is a good indicator of the women’s parasitological status during pregnancy.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. Kortmann H, 1972. Malaria and Pregnancy. Utrecht: Drukkerij Elinwijk, 118.
  2. Fleming A, Ghatoura G, Harrison K, Briggs N, Dunn D, 1986. The prevention of anaemia in pregnancy in primigravidae in the guinea savanna of Nigeria. Ann Trop Med Parasitol 80 : 211–233. [Google Scholar]
  3. Brabin B, Ginny M, Sapau J, Galme K, Paino J, 1990. Consequences of maternal anaemia on outcome of pregnancy. Ann Trop Med Parasitol 84 : 11–24. [Google Scholar]
  4. Cot M, Deloron P, 2003. Malaria prevention strategies. Br Med Bull 67 : 137–148. [Google Scholar]
  5. McGregor IA, 1984. Epidemiology, malaria and pregnancy. Am J Trop Med Hyg 33 : 517–525. [Google Scholar]
  6. Meuris S, Bosango-Piko B, Eerens P, Vanbellinghen A, Dramaix M, Hennart P, 1993. Gestational malaria: assessment of its consequences on fetal growth. Am J Trop Med Hyg 48 : 603–609. [Google Scholar]
  7. Steketee RW, Wirima JJ, Hightower AW, Slutsker 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. [Google Scholar]
  8. Kramer MS, 1987. Determinants of low birth weight: methodological assessment and meta-analysis. Bull World Health Organ 65 : 663–737. [Google Scholar]
  9. Bloland P, Slutsker L, Steketee RW, Wirima JJ, Heymann DL, Breman JG, 1996. Rates and risk factors for mortality during the first two years of life in rural Malawi. Am J Trop Med Hyg 55 : 82–86. [Google Scholar]
  10. Bulmer JN, Rasheed FN, Morrison L, Francis N, Greenwood BM, 1993. Placental malaria. II. A semi-quantitative investigation of the pathological features. Histopathology 22 : 219–225. [Google Scholar]
  11. Rogerson SJ, Mkundika P, Kanjala MK, 2003. Diagnosis of Plasmodium falciparum malaria at delivery: comparison of blood film preparation methods and of blood films with histology. J Clin Microbiol 41 : 1370–1374. [Google Scholar]
  12. Steketee RW, Wirima JJ, Slutsker L, Heymann DL, Breman JG, 1996. The problem of malaria and malaria control in pregnancy in sub-Saharan Africa. Am J Trop Med Hyg 55 : 2–7. [Google Scholar]
  13. Watkinson M, Rushton DI, 1983. Plasmodial pigmentation of placenta and outcome of pregnancy in West African mothers. Br Med J (Clin Res Ed) 287 : 251–254. [Google Scholar]
  14. McGready R, Davison BB, Stepniewska K, Cho T, Shee H, Brockman A, Udomsangpetch R, Looareesuwan S, White NJ, Meshnick SR, Nosten F, 2004. The effects of Plasmodium falciparum and P. vivax infections on placental histopathology in an area of low malaria transmission. Am J Trop Med Hyg 70 : 398–407. [Google Scholar]
  15. Cot M, Roisin A, Barro D, Yada A, Verhave JP, Carnevale P, Breart G, 1992. Effect of chloroquine chemoprophylaxis during pregnancy on birth weight: results of a randomized trial. Am J Trop Med Hyg 46 : 21–27. [Google Scholar]
  16. Robert V, Carnevale P, Ouedraogo V, Petrarca V, Coluzzi M, 1988. Transmission of human malaria in a savanna village of southwest Burkina Faso. Ann Soc Belg Med Trop 68 : 107–121. [Google Scholar]
  17. Van Buuren S, Boshuizen H, Knook D, 1999. Multiple imputation of missing blood pressure covariates in survival analysis. Statistics Medicine 18 : 681–699. [Google Scholar]
  18. Chudleigh P, Pearce J, 1986. Obstetric Ultrasound: How, Why and When. London: Churchill Livingstone.
  19. Staalsoe T, Megnekou R, Fievet N, Ricke CH, Zornig HD, Leke R, Taylor DW, Deloron P, Hviid L, 2001. Acquisition and decay of antibodies to pregnancy-associated variant antigens on the surface of Plasmodium falciparum-infected erythrocytes that protect against placental parasitemia. J Infect Dis 184 : 618–626. [Google Scholar]
  20. Menendez C, 1995. Malaria during pregnancy: a priority area of malaria research and control. Parasitology Today 11 : 178–183. [Google Scholar]
  21. Steketee RW, Wirima JJ, Slutsker L, Breman JG, Heymann DL, 1996. Comparability of treatment groups and risk factors for parasitemia at the first antenatal clinic visit in a study of malaria treatment and prevention in pregnancy in rural Malawi. Am J Trop Med Hyg 55 : 17–23. [Google Scholar]
  22. Brabin BJ, 1983. An analysis of malaria in pregnancy in Africa. Bull World Health Organ 61 : 1005–1016. [Google Scholar]
  23. Taha Tel T, Gray RH, Mohamedani AA, 1993. Malaria and low birth weight in central Sudan. Am J Epidemiol 138 : 318–325. [Google Scholar]
  24. Greenland S, Finkle WD, 1995. A critical look at methods for handling missing covariates in epidemiologic regression analyses. Am J Epidemiol 142 : 1255–1264. [Google Scholar]
  25. Chavance M, Manfredi R, 2000. Modélisation d’observations in-complètes. Rev Epidém et Santé Publ 48 : 389–400. [Google Scholar]
  26. Schafer J, 1997. Analysis of Incomplete Multivariate Data. Chapman and Hall/CRC, Boca Ratan, USA.
  27. Faris PD, Ghali WA, Brant R, Norris CM, Galbraith PD, Knudtson ML, 2002. Multiple imputation versus data enhancement for dealing with missing data in observational health care outcome analyses. J Clin Epidemiol 55 : 184–191. [Google Scholar]
  28. Oudshorn K, van Buuren S, van Rijckevorsel J, 1999. Flexible multiple imputation by chained equations of the AVO-95 Survey. Available at http://www.jpsm.umd.edu/icsm/papers/oudshorn.htm. Accessed Aug 22, 2005.
  29. Greenwood BM, Greenwood AM, Snow RW, Byass P, Bennett S, Hatib-N’Jie AB, 1989. The effects of malaria chemoprophylaxis given by traditional birth attendants on the course and outcome of pregnancy. Trans R Soc Trop Med Hyg 83 : 589–594. [Google Scholar]
  30. Cot M, Le Hesran JY, Miailhes P, Esveld M, Etya’ale D, Breart G, 1995. Increase of birth weight following chloroquine chemoprophylaxis during the first pregnancy: results of a randomized trial in Cameroon. Am J Trop Med Hyg 53 : 581–585. [Google Scholar]
  31. Steketee RW, 1996. Malaria prevention in pregnancy: the effects of treatment and chemoprophylaxis on placental malaria infection, low birth weight, and fetal, infant, and child survival. Mangochi Malaria Research Project: United States Agency for International Development.
  32. Steketee RW, Wirima JJ, Slutsker L, Roberts JM, Khoromana CO, Heymann DL, Breman JG, 1996. Malaria parasite infection during pregnancy and at delivery in mother, placenta, and newborn: efficacy of chloroquine and mefloquine in rural Malawi. Am J Trop Med Hyg 55 : 24–32. [Google Scholar]
  33. Clark H, 1915. the diagnostic value of the placental blood film in aestivo-autumnal malaria. J Exp Med 23 : 427–445. [Google Scholar]
  34. Leke RF, Djokam RR, Mbu R, Leke RJ, Fogako J, Megnekou R, Metenou S, Sama G, Zhou Y, Cadigan T, Parra M, Taylor DW, 1999. Detection of the Plasmodium falciparum antigen histidine-rich protein 2 in blood of pregnant women: implications for diagnosing placental malaria. J Clin Microbiol 37 : 2992–2996. [Google Scholar]

Data & Media loading...

  • Received : 31 Jan 2005
  • Accepted : 26 May 2005

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