1921
Volume 73, Issue 4
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

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 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; = 0.01) and preterm delivery < 37 weeks (ARR = 1.87; = 0.06). Maternal parasitemia at delivery was associated with preterm delivery (ARR = 2.27; = 0.008), intrauterine growth retardation (ARR = 1.92; = 0.03), and neonatal death (ARR = 3.22; = 0.07). Cord parasitemia was associated with a large and significant increase in the risk of neonatal death (ARR = 8.75; = 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.

Loading

Article metrics loading...

/content/journals/10.4269/ajtmh.2005.73.694
2005-10-01
2017-09-24
Loading full text...

Full text loading...

/deliver/fulltext/14761645/73/4/0730694.html?itemId=/content/journals/10.4269/ajtmh.2005.73.694&mimeType=html&fmt=ahah

References

  1. Moore JM, Ayisi J, Nahlen BL, Misore A, Lal AA, Udhayakumar V, 2000. Immunity to placental malaria. II. Placental antigen-specific cytokine responses are impaired in human immunodeficiency virus-infected women. J Infect Dis 182 : 960–964.
  2. Chaisavaneeyakorn S, Moore JM, Otieno J, Chaiyaroj SC, Perkins DJ, Shi YP, Nahlen BL, Lal AA, Udhayakumar V, 2002. Immunity to placental malaria. III. Impairment of interleukin(IL)-12, not IL-18, and interferon-inducible protein-10 responses in the placental intervillous blood of human immunodeficiency virus/malaria-coinfected women. J Infect Dis 185 : 127–131.
  3. Ayisi JG, van Eijk AM, ter Kuile FO, Kolczak MS, Otieno JA, Misore AO, Kager PA, Steketee RW, Nahlen BL, 2003. The effect of dual infection with HIV and malaria on pregnancy outcome in western Kenya. AIDS 17 : 585–594.
  4. Mount AM, Mwapasa V, Elliott SR, Beeson JG, Tadesse E, Lema VM, Molyneux ME, Meshnick SR, Rogerson SJ, 2004. Impairment of humoral immunity to Plasmodium falciparum malaria in pregnancy by HIV infection. Lancet 363 : 1860–1867.
  5. Steketee RW, Wirima JJ, Bloland PB, Chilima B, Mermin JH, Chitsulo L, Breman JG, 1996. Impairment of a pregnant woman’s acquired ability to limit Plasmodium falciparum by infection with human immunodeficiency virus type-1. Am J Trop Med Hyg 55 : 42–49.
  6. van Eijk AM, Ayisi JG, ter Kuile FO, Misore AO, Otieno JA, Rosen DH, Kager PA, Steketee RW, Nahlen BL, 2003. HIV increases the risk of malaria in women of all gravidities in Kisumu, Kenya. AIDS 17 : 595–603.
  7. 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.
  8. Ticconi C, Mapfumo M, Dorrucci M, Naha N, Tarira E, Pietropolli A, Rezza G, 2003. Effect of maternal HIV and malaria infection on pregnancy and perinatal outcome in Zimbabwe. J Acquir Immune Defic Syndr 34 : 289–294.
  9. 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 : S33–S41.
  10. Leroy V, Ladner J, Nyiraziraje M, De Clercq A, Bazubagira A, Van de Perre P, Karita E, Dabis F, 1998. Effect of HIV-1 infection on pregnancy outcome in women in Kigali, Rwanda, 1992–1994. Pregnancy and HIV Study Group. AIDS 12 : 643–650.
  11. Fawzi WW, Villamor E, Msamanga GI, Antelman G, Aboud S, Urassa W, Hunter D, 2005. Trial of zinc supplements in relation to pregnancy outcomes, hematologic indicators, and T cell counts among HIV-1-infected women in Tanzania. Am J Clin Nutr 81 : 161–167.
  12. Guay LA, Musoke P, Fleming T, Bagenda D, Allen M, Nakabiito C, Sherman J, Bakaki P, Ducar C, Deseyve M, Emel L, Mirochnick M, Fowler MG, Mofenson L, Miotti P, Dransfield K, Bray D, Mmiro F, Jackson JB, 1999. Intrapartum and neonatal single-dose nevirapine compared with zidovudine for prevention of mother-to-child transmission of HIV-1 in Kampala, Uganda: HIVNET 012 randomised trial. Lancet 354 : 795–802.
  13. World Health Organization, 1991. Basic Laboratory Methods in Medical Parasitology. Geneva: WHO.
  14. Fawzi WW, Msamanga G, Hunter D, Urassa E, Rengifo B, Mwakagile D, Hertzmark E, Coley J, Garland M, Kapiga S, Antelman G, Essex M, Spiegelman D, 2000. Randomized trial of vitamin supplements in relation to vertical transmission of HIV-1 in Tanzania. J Acquir Immune Defic Syndr 23 : 246–254.
  15. Brenner WE, Edelman DA, Hendricks CH, 1976. A standard of fetal growth for the United States of America. Am J Obstet Gynecol 126 : 555–564.
  16. Nyirjesy P, Kavasya T, Axelrod P, Fischer PR, 1993. Malaria during pregnancy: neonatal morbidity and mortality and the efficacy of chloroquine chemoprophylaxis. Clin Infect Dis 16 : 127–132.
  17. Redd SC, Wirima JJ, Steketee RW, Breman JG, Heymann DL, 1996. Transplacental transmission of Plasmodium falciparum in rural Malawi. Am J Trop Med Hyg 55 : 57–60.
  18. Kariuki SK, ter Kuile FO, Wannemuehler K, Terlouw DJ, Kolczak MS, Hawley WA, Phillips-Howard PA, Orago AS, Nahlen BL, Lal AA, Shi YP, 2003. Effects of permethrin-treated bed nets on immunity to malaria in western Kenya I. Antibody responses in pregnant women and cord blood in an area of intense malaria transmission. Am J Trop Med Hyg 68 : 61–67.
  19. Bloland PB, Wirima JJ, Steketee RW, Chilima B, Hightower A, Breman JG, 1995. Maternal HIV infection and infant mortality in Malawi: evidence for increased mortality due to placental malaria infection. AIDS 9 : 721–726.
  20. Premji Z, Makwaya C, Minjas JN, 1999. Current clinical efficacy of chloroquine for the treatment of Plasmodium falciparum infections in urban Dar es Salaam, United Republic of Tanzania. Bull World Health Organ 77 : 740–744.
  21. Wolfe EB, Parise ME, Haddix AC, Nahlen BL, Ayisi JG, Misore A, Steketee RW, 2001. Cost-effectiveness of sulfadoxine-pyrimethamine for the prevention of malaria-associated low birth weight. Am J Trop Med Hyg 64 : 178–186.
  22. Shankar AH, Prasad AS, 1998. Zinc and immune function: the biological basis of altered resistance to infection. Am J Clin Nutr 68 : 447S–463S.
  23. Shankar AH, Genton B, Baisor M, Paino J, Tamja S, Adiguma T, Wu L, Rare L, Bannon D, Tielsch JM, West KP Jr, Alpers MP, 2000. The influence of zinc supplementation on morbidity due to Plasmodium falciparum: a randomized trial in preschool children in Papua New Guinea. Am J Trop Med Hyg 62 : 663–669.
  24. Gibson RS, Huddle JM, 1998. Suboptimal zinc status in pregnant Malawian women: its association with low intakes of poorly available zinc, frequent reproductive cycling, and malaria. Am J Clin Nutr 67 : 702–709.
  25. Nacher M, McGready R, Stepniewska K, Cho T, Looareesuwan S, White NJ, Nosten F, 2003. Haematinic treatment of anaemia increases the risk of Plasmodium vivax malaria in pregnancy. Trans R Soc Trop Med Hyg 97 : 273–276.
  26. Fiske DN, McCoy HE 3rd, Kitchens CS, 1994. Zinc-induced si-deroblastic anemia: report of a case, review of the literature, and description of the hematologic syndrome. Am J Hematol 46 : 147–150.
http://instance.metastore.ingenta.com/content/journals/10.4269/ajtmh.2005.73.694
Loading
/content/journals/10.4269/ajtmh.2005.73.694
Loading

Data & Media loading...

  • Received : 04 Mar 2005
  • Accepted : 08 Jun 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