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Cited by 81Malaria Research and ControlPregnancy and preeclampsia studiesHemoglobinopathies and Related Disorders

Detection and clinical manifestation of placental malaria in southern Ghana

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Mockenhaupt, Frank P, Bedu-Addo, George, von Gaertner, Christiane, Boyé, Renate, Fricke, Katrin, Hannibal, Iris, Karakaya, Filiz, Schaller, Marieke +5 more·2006·Malaria Journal
DOI 10.1186/1475-2875-5-119PMC PMC1716171
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Abstract

BACKGROUND: Plasmodium falciparum can be detected by microscopy, histidine-rich-protein-2 (HRP2) capture test or PCR but the respective clinical relevance of the thereby diagnosed infections in pregnant women is not well established. METHODS: In a cross-sectional, year-round study among 839 delivering women in Agogo, Ghana, P. falciparum was screened for in both, peripheral and placental blood samples, and associations with maternal anaemia, low birth weight (LBW) and preterm delivery (PD) were analysed. RESULTS: In peripheral blood, P. falciparum was observed in 19%, 34%, and 53% by microscopy, HRP2 test, and PCR, respectively. For placental samples, these figures were 35%, 41%, and 59%. Irrespective of diagnostic tool, P. falciparum infection increased the risk of anaemia. Positive peripheral blood results of microscopy and PCR were not associated with LBW or PD. In contrast, the HRP2 test performed well in identifying women at increased risk of poor pregnancy outcome, particularly in case of a negative peripheral blood film. Adjusting for age, parity, and antenatal visits, placental HRP2 was the only marker of infection associated with LBW (adjusted odds ratio (aOR), 1.5 (95%CI, 1.0-2.2)) and, at borderline statistical significance, PD (aOR, 1.4 (1.0-2.1)) in addition to anaemia (aOR, 2.3 (1.7-3.2)). Likewise, HRP2 in peripheral blood of seemingly aparasitaemic women was associated with PD (aOR, 1.7 (1.0-2.7)) and anaemia (aOR, 2.1 (1.4-3.2)). CONCLUSION: Peripheral blood film microscopy not only underestimates placental malaria. In this highly endemic setting, it also fails to identify malaria as a cause of foetal impairment. Sub-microscopic infections detected by a HRP2 test in seemingly aparasitaemic women increase the risks of anaemia and PD. These findings indicate that the burden of malaria in pregnancy may be even larger than thought and accentuate the need for effective anti-malarial interventions in pregnancy.

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  • Parasites detected by microscopy, HRP2-RDT or PCR in maternal peripheral or placental blood were associated with mild maternal anemia (hemoglobin <11 g/dl).

    “Parasites detected by microscopy, HRP2-RDT or PCR in maternal peripheral blood or placental blood were associated with mild maternal anemia (hemoglobin <11 g/dl) [16,53].”

    From Diagnosing malaria in pregnancy: An update (2012) · cites this paper as [53]

  • Previous studies conducted at the time of birth have shown that RDT detecting P. falciparum HRP2 are more sensitive than blood smears, and appear to be reliable predictors of adverse outcomes of malaria in pregnancy.

    “Previous studies conducted at the time of birth have shown that RDT detecting P. falciparum HRP2 are more sensitive than blood smears, and appear to be reliable predictors of adverse outcomes of malaria in pregnancy [30-32].”

    From Reliability of rapid diagnostic test for diagnosing peripheral and placental malaria in an area of unstable malaria transmission in Eastern Sudan (2013) · cites this paper as [30]

  • Positive placental blood PCR was associated with an increased rate of low birthweight in one study but not in several others.

    “Positive placental blood PCR was associated with an increased rate of LBW in one study [15] but not several others [10,16,53].”

    From Diagnosing malaria in pregnancy: An update (2012) · cites this paper as [53]

  • HRP2 or pLDH detected in placental blood has been associated with increased rates of low birthweight in some studies but not in Mozambique.

    “HRP2 or pLDH detected in placental blood has been associated with increased rates of LBW in some studies [10,15,53] but not in Mozambique [16].”

    From Diagnosing malaria in pregnancy: An update (2012) · cites this paper as [53]

  • The association of maternal anemia to submicroscopic infection is inconsistent, with some studies finding a relationship and other studies not.

    “However, the association of maternal anemia to submicroscopic infection (defined by PCR, qPCR or HRP2 methods) is inconsistent, with some studies finding a relationship [16,47,53] while other studies did not [38,40,47].”

    From Diagnosing malaria in pregnancy: An update (2012) · cites this paper as [53]

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Authors
Mockenhaupt, F. P., Bedu-Addo, G., von Gaertner, C., Boyé, R., Fricke, K., Hannibal, I., Karakaya, F., Schaller, M., Ulmen, U., Acquah, P. A., Dietz, E., Eggelte, T. A., & Bienzle, U.
Affiliations
  • Charité – Universitätsmedizin Berlin (DE)
  • Amsterdam UMC Location University of Amsterdam (NL)
Corresponding author
Mockenhaupt, Frank P
ORCID
Venue
Malaria Journal
Publisher
Springer Science and Business Media LLC
Published
2006-12
Volume
5
Issue
1
Pages
119-119
ISSN
1475-2875 (ISSN-L)
DOI
10.1186/1475-2875-5-119
PMC
PMC1716171
OpenAlex
W2119330550
Cited by
81
References
48
Citations by year
2026: 1 · 2025: 1 · 2023: 2 · 2022: 2 · 2021: 2 · 2020: 4 · 2019: 3 · 2018: 3 · 2017: 5 · 2016: 1 · 2015: 9 · 2014: 4 · 2013: 3 · 2012: 8
FWCI
6.35
Type
journal article
Language
en
Open access
Licence
Locations
  • Malaria Journal (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
  • Lund University Publications (Lund University) (submittedVersion)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Malaria Research and Control
  • Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
  • Health Sciences › Medicine › Genetics › Hemoglobinopathies and Related Disorders
Keywords
placental malaria, Plasmodium falciparum, malaria in pregnancy, submicroscopic malaria infection, anemia in pregnancy, low birth weight, preterm birth, pregnancy outcomes, southern Ghana
MeSH terms
Animals, Antigens, Protozoan, Antimalarials, Female, Ghana, Humans, Microscopy, Polarization, Placenta Diseases, Plasmodium falciparum, Pregnancy, Pyrimethamine, Pregnancy Complications, Parasitic, Protozoan Proteins, Polymerase Chain Reaction, Malaria, Falciparum

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