Placental malaria among HIV-infected and uninfected women receiving anti-folates in a high transmission area of Uganda

Newman, Patrick M; Wanzira, Humphrey; Tumwine, Gabriel; Arinaitwe, Emmanuel; Waldman, Sarah; Achan, Jane; Havlir, Diane; Rosenthal, Philip J; Dorsey, Grant; Clark, Tamara D; Cohan, Deborah

doi:10.1186/1475-2875-8-254

Cited by 42Malaria Research and ControlHIV/AIDS Research and InterventionsGlobal Maternal and Child Health

Placental malaria among HIV-infected and uninfected women receiving anti-folates in a high transmission area of Uganda

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Newman, Patrick M, Wanzira, Humphrey, Tumwine, Gabriel, Arinaitwe, Emmanuel, Waldman, Sarah, Achan, Jane, Havlir, Diane, Rosenthal, Philip J +3 more·2009·Malaria Journal

DOI 10.1186/1475-2875-8-254PMC PMC2781026

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Abstract

Background: HIV infection increases the risk of placental malaria, which is associated with poor maternal and infant outcomes. Recommendations in Uganda are for HIV-infected pregnant women to receive daily trimethoprim-sulphamethoxazole (TS) and HIV-uninfected women to receive intermittent sulphadoxine-pyrimethamine (SP). TS decreases the risk of malaria in HIV-infected adults and children but has not been evaluated among pregnant women. Methods: This was a cross sectional study comparing the prevalence of placental malaria between HIV-infected women prescribed TS and HIV-uninfected women prescribed intermittent preventive therapy with sulphadoxine-pyrimethamine (IPT-SP) in a high malaria transmission area in Uganda. Placental blood was evaluated for malaria using smear and PCR. Results: Placentas were obtained from 150 HIV-infected women on TS and 336 HIV-uninfected women on IPT-SP. The proportion of HIV-infected and HIV-uninfected women with placental malaria was 19% vs. 26% for those positive by PCR and 6% vs. 9% for those positive by smear, respectively. Among all infants, smear+ placental malaria was most predictive of low birth weight (LBW). Primigravidae were at higher risk than multigravidae of having placental malaria among HIV-uninfected, but not HIV-infected, women. Adjusting for gravidity, age, and season at the time of delivery, HIV-infected women on TS were not at increased risk for placental malaria compared to HIV-uninfected women on IPT-SP, regardless of the definition used. Conclusion: Prevalence of placental malaria was similar in HIV-infected women on TS and HIV-uninfected women on IPT-SP. Nonetheless, while nearly all of the women in this study were prescribed anti-folates, the overall risk of placental malaria and LBW was unacceptably high. The population attributable risk of placental malaria on LBW was substantial, suggesting that future interventions that further diminish the risk of placental malaria may have a considerable impact on the burden of LBW in this population.

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Submicroscopic placental infection was associated with reduced birthweight in several studies.
“Submicroscopic placental infection was associated with reduced birthweight in several studies [15,44,45].”
From Diagnosing malaria in pregnancy: An update (2012) · cites this paper as [45]
Two studies reported that pregnancy malaria detected by blood smear microscopy or by PCR only (submicroscopic infection) was associated with increased low birthweight deliveries.
“Two studies reported that PM detected by either BS microscopy or by PCR only (submicroscopic infection) was associated with increased LBW deliveries [44,45].”
From Diagnosing malaria in pregnancy: An update (2012) · cites this paper as [45]

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Additional file 1 of Malaria prevalence in HIV-positive children, pregnant women, and adults: a systematic review and meta-analysis
Mirzohreh, S.-T., Safarpour, H., Pagheh, A. S., Bangoura, B., Barac, A., & Ahmadpour, E. (2022) · Figshare · doi:10.6084/m9.figshare.21117515
Additional file 4 of Malaria prevalence in HIV-positive children, pregnant women, and adults: a systematic review and meta-analysis
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Additional file 5 of Malaria prevalence in HIV-positive children, pregnant women, and adults: a systematic review and meta-analysis
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Additional file 3 of Malaria prevalence in HIV-positive children, pregnant women, and adults: a systematic review and meta-analysis
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PREVALENCE AND PREDICTORS OF PLACENTAL MALARIA IN HIV-POSITIVE WOMEN IN ENUGU, SOUTH-EASTERN NIGERIA
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Authors: Newman, P. M., Wanzira, H., Tumwine, G., Arinaitwe, E., Waldman, S., Achan, J., Havlir, D., Rosenthal, P. J., Dorsey, G., Clark, T. D., & Cohan, D.
Affiliations: University of California, San Francisco (US)
Infectious Diseases Research Collaboration (UG)
Makerere University (UG)
San Francisco General Hospital (US)
Corresponding author: Cohan, Deborah
ORCID: Newman, Patrick M
Wanzira, Humphrey
Tumwine, Gabriel
Arinaitwe, Emmanuel
Waldman, Sarah
Achan, Jane
Havlir, Diane
Rosenthal, Philip J
Dorsey, Grant
Clark, Tamara D
Cohan, Deborah
Venue: Malaria Journal
Publisher: Springer Science and Business Media LLC
Published: 2009-11-14
Volume: 8
Issue: 1
Pages: 254-254
ISSN: 1475-2875 (ISSN-L)
DOI: 10.1186/1475-2875-8-254
PMC: PMC2781026
OpenAlex: W2144417430
Cited by: 42
References: 37
Citations by year: 2025: 1 · 2024: 1 · 2022: 6 · 2021: 1 · 2020: 1 · 2019: 2 · 2018: 1 · 2016: 3 · 2015: 4 · 2014: 5 · 2013: 6 · 2012: 5
FWCI: 3.68
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
Locations: Malaria Journal (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
eScholarship (California Digital Library) (submittedVersion)
Greater South Information System
Funders: Doris Duke Charitable Foundation
National Institutes of Health (RR024131)
University of California, San Francisco (UL1RR024131)
National Center for Research Resources (UL1RR024131)
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Malaria Research and Control
Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
Keywords: placental malaria, HIV in pregnancy, trimethoprim-sulfamethoxazole, intermittent preventive treatment, sulfadoxine-pyrimethamine, low birth weight, primigravida, malaria transmission, population attributable risk, placental blood
MeSH terms: Adult, Antimalarials, Cross-Sectional Studies, Drug Combinations, Female, Folic Acid, Humans, Pregnancy, Pyrimethamine, Risk Factors, Sulfadoxine, Uganda, HIV-1, Pregnancy Complications, Parasitic, HIV Infections, Trimethoprim, Sulfamethoxazole Drug Combination, Prevalence, Malaria, Falciparum, AIDS-Related Opportunistic Infections, Infectious Disease Transmission, Vertical, Young Adult

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Placental malaria among HIV-infected and uninfected women receiving anti-folates in a high transmission area of Uganda

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