Effects of Plasmodium vivax malaria in pregnancy.

BACKGROUND: Plasmodium vivax is more common than P. falciparum as a cause of malaria in many parts of the tropics outside Africa. P. falciparum infection has harmful effects in pregnancy, but the effects of P. vivax have not been characterised. We investigated the effects of P. vivax infection during pregnancy. METHODS: Since 1986, pregnant Karen women living in camps for displaced people on the western border of Thailand have been encouraged to attend antenatal clinics. Karen women were screened for malaria and anaemia at each week of pregnancy until delivery, and pregnancy outcome recorded. We compared the effects of P. vivax infection on anaemia and pregnancy outcome with those of P. falciparum and no malaria infection in the first pregnancy recorded at the antenatal clinics. FINDINGS: There were 634 first episodes of pure P. vivax malaria in 9956 women. P. vivax malaria was more common in primigravidae than in multigravidae and was associated with mild anaemia and an increased risk of low birthweight (odds ratio 1.64 [95% CI 1.29-2.08], p<0.001). The birthweight was a mean of 107 g (95% CI 61-154) lower in women with P. vivax infection than in uninfected women. By contrast with P. falciparum malaria, the decrease in birthweight was greater in multigravidae. P. vivax malaria was not associated with miscarriage, stillbirth, or with a shortened duration of pregnancy. INTERPRETATION: P. vivax malaria during pregnancy is associated with maternal anaemia and low birthweight. The effects of P. vivax infection are less striking than those of P. falciparum infection, but antimalarial prophylaxis against P. vivax in pregnancy may be justified.

PIP: This article presents the results of a study on the effects of Plasmodium vivax infection during pregnancy. Pregnant Karen women living in open camps to the north and south of Thailand were the subjects of the study. In each camp, the subjects attended weekly antenatal clinics for physical examination and blood screening by microscopy for malaria parasites; the outcome was recorded. The investigators compared the effects of P. vivax infection on anemia and pregnancy outcome women with those of P. falciparum and no malaria infection in the first pregnancy recorded at the clinics. Results showed that P. vivax malaria was more common in primigravidas than in multigravidas and was associated with mild maternal anemia and significantly decreased birth weight by comparison with babies born to women with no evidence of malaria during pregnancy. By contrast with P. falciparum malaria, the decrease in birth weight was greater in multigravidas. The mean birth weight was 107 g lower in women with P. vivax infection than in uninfected women. Infection with P. vivax during pregnancy was not associated with shorter gestation or with an increased rate of miscarriage or stillbirth. The findings suggest that studies of P. vivax, P. malariae, and P. ovale malaria in pregnancy should be encouraged and that chemoprophylaxis against P. vivax malaria in pregnancy may be justified.

Quinine and mefloquine in the treatment of multidrug-resistant Plasmodium falciparum malaria in pregnancy.

Between 1991 and 1996, 372 pregnant women with uncomplicated, multidrug-resistant Plasmodium falciparum malaria, living on the western border of Thailand, were treated with either mefloquine (N = 194), quinine (N = 93) or both drugs (N = 85). Antimalarial treatment was generally well tolerated; the most common side-effects were dizziness (42%) and tinnitus (35%) following quinine, and anorexia (23%) and dizziness (36%) following mefloquine. In the patients treated for primary infections with melfloquine, 6% failed to clear their parasitaemia by day 7 and 28% failed by day 42. The corresponding figures for quinine were 4% and 23%, respectively. The failure rates in the 117 women treated for recrudescent infections were higher, the increase being significant for quinine (38%; P = 0.03) but not for mefloquine (37%). The percentage of pregnant women who had patent gametocytaemia on presentation ranged from 4%-19%. Over 50% of the patients were anaemic (haematocrit < 30%) on presentation and 52% of those not anaemic on enrolment developed anaemia during follow-up. Mefloquine and quinine, the only antimalarials generally available for the treatment of highly drug-resistant P. falciparum in pregnancy, give unsatisfactory treatment responses when used as single agents. New, safe and effective regimens are needed for the treatment of pregnant women with multidrug-resistant falciparum malaria.