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Title: Burden and impact of Plasmodium vivax in pregnancy: A multi-centre prospective observational study
Author: Bardají, Azucena
Martínez Espinosa, Flor E.
Arévalo-Herrera, Myriam
Padilla, Norma
Kochar, Swati
Ome-Kaius, Maria
Botto Menezes, Camila
Castellanos, Maria Eugenia
Kochar, Dhanpat K.
Kochar, Sanjay K.
Betuela, Inoni
Mueller, Ivo
Rogerson, Stephen John
Chitnis, Chetan E.
Hans, Dhiraj
Menegon, Michela
Severini, Carlo
Portillo Obando, Hernando A. del
Dobaño, Carlota, 1969-
Mayor Aparicio, Alfredo Gabriel
Ordi i Majà, Jaume
Piqueras, Mireia
Sanz, Sergi
Wahlgren, Mats
Slutsker, Laurence
Desai, Meghna
Menéndez, Clara
PregVax Study Group
Keywords: Plasmodium vivax
Plasmodium vivax
Issue Date: 12-Jun-2017
Publisher: Public Library of Science (PLoS)
Abstract: BACKGROUND: Despite that over 90 million pregnancies are at risk of Plasmodium vivax infection annually, little is known about the epidemiology and impact of the infection in pregnancy. METHODOLOGY AND PRINCIPAL FINDINGS: We undertook a health facility-based prospective observational study in pregnant women from Guatemala (GT), Colombia (CO), Brazil (BR), India (IN) and Papua New Guinea PNG). Malaria and anemia were determined during pregnancy and fetal outcomes assessed at delivery. A total of 9388 women were enrolled at antennal care (ANC), of whom 53% (4957) were followed until delivery. Prevalence of P. vivax monoinfection in maternal blood at delivery was 0.4% (20/4461) by microscopy [GT 0.1%, CO 0.5%, BR 0.1%, IN 0.2%, PNG 1.2%] and 7% (104/1488) by PCR. P. falciparum monoinfection was found in 0.5% (22/4463) of women by microscopy [GT 0%, CO 0.5%, BR 0%, IN 0%, PNG 2%]. P. vivax infection was observed in 0.4% (14/3725) of placentas examined by microscopy and in 3.7% (19/508) by PCR. P. vivax in newborn blood was detected in 0.02% (1/4302) of samples examined by microscopy [in cord blood; 0.05% (2/4040) by microscopy, and 2.6% (13/497) by PCR]. Clinical P. vivax infection was associated with increased risk of maternal anemia (Odds Ratio-OR, 5.48, [95% CI 1.83-16.41]; p = 0.009), while submicroscopic vivax infection was not associated with increased risk of moderate-severe anemia (Hb<8g/dL) (OR, 1.16, [95% CI 0.52-2.59]; p = 0.717), or low birth weight (<2500g) (OR, 0.52, [95% CI, 0.23-1.16]; p = 0.110). CONCLUSIONS: In this multicenter study, the prevalence of P. vivax infection in pregnancy by microscopy was overall low across all endemic study sites; however, molecular methods revealed a significant number of submicroscopic infections. Clinical vivax infection in pregnancy was associated with maternal anemia, which may be deleterious for infant's health. These results may help to guide maternal health programs in settings where vivax malaria is endemic; they also highlight the need of addressing a vulnerable population such as pregnant women while embracing malaria elimination in endemic countries.
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It is part of: PLoS Neglected Tropical Diseases, 2017, vol. 11, num. 6, p. e0005606
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ISSN: 1935-2727
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