Reducing childhood mortality in poor countries - Importance and prevention of malaria in pregnancy


Shulman, CE; Dorman, EK; (2003) Reducing childhood mortality in poor countries - Importance and prevention of malaria in pregnancy. Transactions of the Royal Society of Tropical Medicine and Hygiene, 97 (1). pp. 30-5. ISSN 0035-9203 DOI: 10.1016/S0035-9203(03)90012-5

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Abstract

Malaria in pregnancy is one of the most important preventable causes of low birthweight deliveries worldwide. It is also a major cause of severe maternal anaemia contributing to maternal mortality. It is estimated that 40% of the world's pregnant women are exposed to malaria infection during pregnancy. The clinical features of Plasmodium falciparum malaria in pregnancy depend to a large extent on the immune status of the woman, which in turn is determined by her previous exposure to malaria. In pregnant women with little or no pre-existing immunity, such as women from non-endemic areas or travellers to malarious areas, infection is associated with high risks of severe disease with maternal and perinatal mortality. Women are at particular risk of cerebral malaria, hypoglycaemia, pulmonary oedema and severe haemolytic anaemia. Fetal and perinatal loss has been documented to be as high as 60-70% in non-immune women with malaria. Adults who are long-term residents of areas of moderate or high malaria transmission, including large parts of sub-Saharan Africa, usually have a high level of immunity to malaria. Infection is frequently asymptomatic and severe disease is uncommon. During pregnancy this immunity to malaria is altered. Infection is still frequently asymptomatic, so may go unsuspected and undetected, but is associated with placental parasitization. Malaria in pregnancy is a common cause of severe maternal anaemia and low birthweight babies, these complications being more common in primigravidae than multigravidae. Preventative strategies include regular chemoprophylaxis, intermittent preventative treatment with antimalarials and insecticide-treated bednets.

Item Type: Article
Keywords: malaria, Plasmodium falciparum, anaemia, prevention, chemotherapy, pregnancy, birthweight, antimalarials, insecticide-treated bednets, insecticide-treated bednets, chondroitin sulfate-a, birth-, weight, plasmodium-falciparum, placental malaria, controlled, trial, rural malawi, hemoglobin levels, anemia, women, Anemia, complications, Antimalarials, therapeutic use, Bedding and Linens, Endemic Diseases, Female, Fetal Growth Retardation, parasitology, HIV Infections, complications, Human, Infant, Low Birth Weight, Infant, Newborn, Insect Control, Labor, Premature, parasitology, Malaria, Falciparum, congenital, prevention & control, Maternal Mortality, Poverty Areas, Pregnancy, Pregnancy Complications, Infectious, virology, Pregnancy Complications, Parasitic, prevention & control, Prenatal Diagnosis, Travel
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology
PubMed ID: 12886801
Web of Science ID: 184231000011
URI: http://researchonline.lshtm.ac.uk/id/eprint/16110

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