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Malaria in pregnancy in the Western Brazilian Amazon: associated factors and impact on maternal and fetal health.

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Author(s):
Anaclara Pincelli Cintra
Total Authors: 1
Document type: Master's Dissertation
Press: São Paulo.
Institution: Universidade de São Paulo (USP). Instituto de Ciências Biomédicas (ICB/SDI)
Defense date:
Examining board members:
Marcelo Urbano Ferreira; Daniel Youssef Bargieri; Flor Ernestina Martinez Espinosa; Alicia Matijasevich Manitto
Advisor: Marcelo Urbano Ferreira
Abstract

The main objectives of this observational study were to investigate the associations between malaria in pregnancy (MiP) and sociodemographic and biological variables of mothers and estimate its impact on birth weight and length and maternal hemoglobin in 1,180 women from Juruá Valley, the main malaria hotspot in Brazil. Antenatal malaria episodes, 74.6% of them due to Plasmodium vivax, were microscopically diagnosed in 8.0% of the women and were associated with an average reduction in birth weight z-scores of 0.36 (95% confidence interval [CI] -0.57 - -0.14 p = <0.01) and in birth length z-scores of 0.31 (CI 95%, - 0.54 - -0.08, p = 0.01), compared with malaria-free pregnancies. Affected mothers had a mean decrease in hemoglobin concentration at delivery of 0.34 g/100 mL (CI 95%, -0.62 - -0.05 p = 0.02). Although repeated antenatal vivax infections were associated with poorer birth outcomes, even a single vivax malaria episode was associated with a significant reduction in birth weight and length and maternal hemoglobin. Overall, 7.5% women had the parasites DNA found in peripheral blood at delivery. Most (83.1%) of these 89 perinatal infections were due to P. vivax and only 7.9% of them progressed to symptomatic disease after delivery. P. vivax and P. falciparum DNA was found in 0.6% and 0.3% of 637 cord blood samples examined, respectively, but only one newborn developed clinical neonatal malaria. Living in rural areas was the main factor associated with gestational malaria in the study population. Moreover, we found further evidence that health-care providers often fail to comply with the countrys malaria treatment guidelines for pregnant women in Brazil. We retrospectively found that Primaquine was prescribed for more than half of the antenatal P. vivax infections diagnosed during the study, not only in the first trimester (when the pregnancy status might be unknown) but also in infections correctly reported as MiP. Our results further challenge the notion that vivax malaria is relatively benign during pregnancy and call for better strategies for its prevention. (AU)

FAPESP's process: 16/06932-0 - Malaria in pregnancy: molecular diagnosis, prevalence and risk factors in the Juruá Valley, Brazilian Amazon
Grantee:Anaclara Pincelli Cintra
Support Opportunities: Scholarships in Brazil - Master