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 journalArticleResearchpeer-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 languageEnglish
Pages (from-to)1613-1619
Number of pages7
JournalJournal of Infectious Diseases
Volume204
Issue number10
DOIs
Publication statusPublished - 2011

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Malaria
Mothers
Odds Ratio
Confidence Intervals
Therapeutics
dihydroartemisinin
Newborn Infant
Plasmodium falciparum
Pregnancy
Indonesia
Parasitemia
Third Pregnancy Trimester
Low Birth Weight Infant
Second Pregnancy Trimester
Risk Reduction Behavior
Microscopy
Parasites
Epidemiology
Morbidity
Incidence

Cite this

Poespoprodjo, J. R., FOBIA, W., Kenangalem, E., HASANUDDIN, A., SUGIARTO, P., Tjitra, E., ... Price, R. (2011). Highly Effective Therapy for Maternal Malaria Associated With a Lower Risk of Vertical Transmission. Journal of Infectious Diseases, 204(10), 1613-1619. https://doi.org/10.1093/infdis/jir558
Poespoprodjo, Jeanne Rini ; FOBIA, W ; Kenangalem, Enny ; HASANUDDIN, A ; SUGIARTO, P ; Tjitra, Emiliana ; Anstey, Nicholas ; Price, Ric. / Highly Effective Therapy for Maternal Malaria Associated With a Lower Risk of Vertical Transmission. In: Journal of Infectious Diseases. 2011 ; Vol. 204, No. 10. pp. 1613-1619.
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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. ",
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Poespoprodjo, JR, FOBIA, W, Kenangalem, E, HASANUDDIN, A, SUGIARTO, P, Tjitra, E, Anstey, N & Price, R 2011, 'Highly Effective Therapy for Maternal Malaria Associated With a Lower Risk of Vertical Transmission', Journal of Infectious Diseases, vol. 204, no. 10, pp. 1613-1619. https://doi.org/10.1093/infdis/jir558

Highly Effective Therapy for Maternal Malaria Associated With a Lower Risk of Vertical Transmission. / Poespoprodjo, Jeanne Rini; FOBIA, W; Kenangalem, Enny; HASANUDDIN, A; SUGIARTO, P; Tjitra, Emiliana; Anstey, Nicholas; Price, Ric.

In: Journal of Infectious Diseases, Vol. 204, No. 10, 2011, p. 1613-1619.

Research output: Contribution to journalArticleResearchpeer-review

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AU - Kenangalem, Enny

AU - HASANUDDIN, A

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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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