Highly Effective Therapy for Maternal Malaria Associated With a Lower Risk of Vertical Transmission

Jeanne Rini Poespoprodjo; W FOBIA; Enny Kenangalem; A HASANUDDIN; P SUGIARTO; Emiliana Tjitra; Nicholas Anstey; Ric Price

doi:10.1093/infdis/jir558

Highly Effective Therapy for Maternal Malaria Associated With a Lower Risk of Vertical Transmission

Jeanne Rini Poespoprodjo, W FOBIA, Enny Kenangalem, A HASANUDDIN, P SUGIARTO, Emiliana Tjitra, Nicholas Anstey, Ric Price

Research output: Contribution to journal › Article › peer-review

Abstract

Background: The epidemiology of congenital malaria was investigated in a hospital-based malaria surveillance study in Papua, Indonesia.

Methods: From April 2005 to January 2010, 4878 delivering women and their newborns underwent prospective clinical review and malaria screening by peripheral blood microscopy.

Findings: Congenital malaria occurred in 8 per 1000 (38/4884) live births, with Plasmodium falciparum accounting for 76.3% (29) and P. vivax for 15.8% (6) of infections. Maternal malaria at delivery (adjusted odds ratio [AOR], 9.5; 95% confidence interval [CI], 4.2-21.5; P <. 001), age ? 16 years (AOR, 4; 95% CI, 1.4-12.1; P =. 011), and prior malaria during pregnancy (AOR, 2.2; 95% CI, 1.1-4.4, P =. 022) were independent risk factors for vertical transmission. Of 29 mothers and neonates with contemporaneous peripheral parasitemia, 17% (5) had discordant parasite species, suggesting possible antenatal malaria transmission. Newborns with malaria were at significantly greater risk of low birth weight (AOR, 2.8; 95% CI, 1.2-6.6; P =. 002). Following introduction of dihydroartemisinin-piperaquine for uncomplicated malaria in the second and third trimesters of pregnancy, congenital malaria incidence fell from 3.2% to 0.2% (odds ratio, 0.07; 95% CI,. 03-.15; P <. 001).

Conclusions: Congenital malaria is an important cause of neonatal morbidity in this region co-endemic for P. falciparum and P. vivax malaria. The introduction of artemisinin-combination therapy was associated with a significant risk reduction in the vertical transmission of malaria.

Original language	English
Pages (from-to)	1613-1619
Number of pages	7
Journal	Journal of Infectious Diseases
Volume	204
Issue number	10
DOIs	https://doi.org/10.1093/infdis/jir558
Publication status	Published - 2011

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@article{dacbf888ae4147ca9e229671bab32181,

title = "Highly Effective Therapy for Maternal Malaria Associated With a Lower Risk of Vertical Transmission",

abstract = "Background: The epidemiology of congenital malaria was investigated in a hospital-based malaria surveillance study in Papua, Indonesia. Methods: From April 2005 to January 2010, 4878 delivering women and their newborns underwent prospective clinical review and malaria screening by peripheral blood microscopy. Findings: Congenital malaria occurred in 8 per 1000 (38/4884) live births, with Plasmodium falciparum accounting for 76.3% (29) and P. vivax for 15.8% (6) of infections. Maternal malaria at delivery (adjusted odds ratio [AOR], 9.5; 95% confidence interval [CI], 4.2-21.5; P <. 001), age ? 16 years (AOR, 4; 95% CI, 1.4-12.1; P =. 011), and prior malaria during pregnancy (AOR, 2.2; 95% CI, 1.1-4.4, P =. 022) were independent risk factors for vertical transmission. Of 29 mothers and neonates with contemporaneous peripheral parasitemia, 17% (5) had discordant parasite species, suggesting possible antenatal malaria transmission. Newborns with malaria were at significantly greater risk of low birth weight (AOR, 2.8; 95% CI, 1.2-6.6; P =. 002). Following introduction of dihydroartemisinin-piperaquine for uncomplicated malaria in the second and third trimesters of pregnancy, congenital malaria incidence fell from 3.2% to 0.2% (odds ratio, 0.07; 95% CI,. 03-.15; P <. 001). Conclusions: Congenital malaria is an important cause of neonatal morbidity in this region co-endemic for P. falciparum and P. vivax malaria. The introduction of artemisinin-combination therapy was associated with a significant risk reduction in the vertical transmission of malaria. ",

keywords = "antimalarial agent, artesunate, dihydroartemisinin plus piperaquine, quinine derivative, adolescent, article, birth weight, congenital malaria, controlled study, delivery, drug efficacy, female, high risk pregnancy, human, incidence, live birth, major clinical study, malaria, malaria control, malaria falciparum, maternal disease, maternal malaria, microscopy, monotherapy, parasite, parasitemia, Plasmodium vivax malaria, pregnancy, priority journal, risk factor, screening, third trimester pregnancy, vertical transmission, Antimalarials, Artemisinins, Drug Combinations, Female, Humans, Indonesia, Infant, Newborn, Infectious Disease Transmission, Vertical, Malaria, Falciparum, Malaria, Vivax, Population Surveillance, Pregnancy, Prospective Studies, Quinolines, Risk Factors",

author = "Poespoprodjo, {Jeanne Rini} and W FOBIA and Enny Kenangalem and A HASANUDDIN and P SUGIARTO and Emiliana Tjitra and Nicholas Anstey and Ric Price",

year = "2011",

doi = "10.1093/infdis/jir558",

language = "English",

volume = "204",

pages = "1613--1619",

journal = "Journal of Infectious Diseases",

issn = "0022-1899",

publisher = "Oxford University Press",

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T1 - Highly Effective Therapy for Maternal Malaria Associated With a Lower Risk of Vertical Transmission

AU - Poespoprodjo, Jeanne Rini

AU - FOBIA, W

AU - Kenangalem, Enny

AU - HASANUDDIN, A

AU - SUGIARTO, P

AU - Tjitra, Emiliana

AU - Anstey, Nicholas

AU - Price, Ric

PY - 2011

Y1 - 2011

N2 - Background: The epidemiology of congenital malaria was investigated in a hospital-based malaria surveillance study in Papua, Indonesia. Methods: From April 2005 to January 2010, 4878 delivering women and their newborns underwent prospective clinical review and malaria screening by peripheral blood microscopy. Findings: Congenital malaria occurred in 8 per 1000 (38/4884) live births, with Plasmodium falciparum accounting for 76.3% (29) and P. vivax for 15.8% (6) of infections. Maternal malaria at delivery (adjusted odds ratio [AOR], 9.5; 95% confidence interval [CI], 4.2-21.5; P <. 001), age ? 16 years (AOR, 4; 95% CI, 1.4-12.1; P =. 011), and prior malaria during pregnancy (AOR, 2.2; 95% CI, 1.1-4.4, P =. 022) were independent risk factors for vertical transmission. Of 29 mothers and neonates with contemporaneous peripheral parasitemia, 17% (5) had discordant parasite species, suggesting possible antenatal malaria transmission. Newborns with malaria were at significantly greater risk of low birth weight (AOR, 2.8; 95% CI, 1.2-6.6; P =. 002). Following introduction of dihydroartemisinin-piperaquine for uncomplicated malaria in the second and third trimesters of pregnancy, congenital malaria incidence fell from 3.2% to 0.2% (odds ratio, 0.07; 95% CI,. 03-.15; P <. 001). Conclusions: Congenital malaria is an important cause of neonatal morbidity in this region co-endemic for P. falciparum and P. vivax malaria. The introduction of artemisinin-combination therapy was associated with a significant risk reduction in the vertical transmission of malaria.

AB - Background: The epidemiology of congenital malaria was investigated in a hospital-based malaria surveillance study in Papua, Indonesia. Methods: From April 2005 to January 2010, 4878 delivering women and their newborns underwent prospective clinical review and malaria screening by peripheral blood microscopy. Findings: Congenital malaria occurred in 8 per 1000 (38/4884) live births, with Plasmodium falciparum accounting for 76.3% (29) and P. vivax for 15.8% (6) of infections. Maternal malaria at delivery (adjusted odds ratio [AOR], 9.5; 95% confidence interval [CI], 4.2-21.5; P <. 001), age ? 16 years (AOR, 4; 95% CI, 1.4-12.1; P =. 011), and prior malaria during pregnancy (AOR, 2.2; 95% CI, 1.1-4.4, P =. 022) were independent risk factors for vertical transmission. Of 29 mothers and neonates with contemporaneous peripheral parasitemia, 17% (5) had discordant parasite species, suggesting possible antenatal malaria transmission. Newborns with malaria were at significantly greater risk of low birth weight (AOR, 2.8; 95% CI, 1.2-6.6; P =. 002). Following introduction of dihydroartemisinin-piperaquine for uncomplicated malaria in the second and third trimesters of pregnancy, congenital malaria incidence fell from 3.2% to 0.2% (odds ratio, 0.07; 95% CI,. 03-.15; P <. 001). Conclusions: Congenital malaria is an important cause of neonatal morbidity in this region co-endemic for P. falciparum and P. vivax malaria. The introduction of artemisinin-combination therapy was associated with a significant risk reduction in the vertical transmission of malaria.

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KW - article

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KW - controlled study

KW - delivery

KW - drug efficacy

KW - female

KW - high risk pregnancy

KW - human

KW - incidence

KW - live birth

KW - major clinical study

KW - malaria

KW - malaria control

KW - malaria falciparum

KW - maternal disease

KW - maternal malaria

KW - microscopy

KW - monotherapy

KW - parasite

KW - parasitemia

KW - Plasmodium vivax malaria

KW - pregnancy

KW - priority journal

KW - risk factor

KW - screening

KW - third trimester pregnancy

KW - vertical transmission

KW - Antimalarials

KW - Artemisinins

KW - Drug Combinations

KW - Female

KW - Humans

KW - Indonesia

KW - Infant, Newborn

KW - Infectious Disease Transmission, Vertical

KW - Malaria, Falciparum

KW - Malaria, Vivax

KW - Population Surveillance

KW - Pregnancy

KW - Prospective Studies

KW - Quinolines

KW - Risk Factors

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U2 - 10.1093/infdis/jir558

DO - 10.1093/infdis/jir558

M3 - Article

VL - 204

SP - 1613

EP - 1619

JO - Journal of Infectious Diseases

JF - Journal of Infectious Diseases

SN - 0022-1899

IS - 10

ER -

Highly Effective Therapy for Maternal Malaria Associated With a Lower Risk of Vertical Transmission

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