Burden and impact of Plasmodium vivax in pregnancy: A multi-centre prospective observational study

作者：Bardaj Azucena^*; Martinez Espinosa Flor Ernestina; Arevalo Herrera Myriam; Padilla Norma; Kochar Swati; Ome Kaius Maria; Botto Menezes Camila; Castellanos Maria Eugenia; Kochar Dhanpat Kumar; Kochar Sanjay Kumar; Betuela Inoni; Mueller Ivo; Rogerson Stephen; Chitnis Chetan; Hans Dhiraj; Menegon Michela; Severini Carlo; del Portillo Hernando; Dobano Carlota; Mayor Alfredo; Ordi Jaume; Piqueras Mireia; Sanz Sergi; Wahlgren Mats; Slutsker Laurence; Desai Meghna

来源：PLoS Neglected Tropical Diseases, 2017, 11(6): e0005606.

DOI：10.1371/journal.pntd.0005606

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.

• 出版日期2017-6
• 单位河北医科大学