MALARIA ON PREGNANCY AND ITS EFFECT.pptx

This intend sharing experience and knowledge

1. MALARIA IN PREGNANCY Dr NIYONSENGA Antoine SUPERVISOR:DR NIGATU

2. Malaria infection in pregnancy is a major cause of maternal death, maternal anemia, and adverse pregnancy outcome (spontaneous abortion, preterm delivery, growth restriction/low birth weight, stillbirth, congenital infection, neonatal mortality) in geographic areas where malaria infection occurs commonly in pregnant women.  Pregnancy increases the chances of developing malaria infection and severe disease when infected. Pregnant women are particularly vulnerable to  Plasmodium falciparum  infection because red cells infected with the parasite can sequester in the placenta, and thereby cause adverse fetal effects.  If anti-malarial drugs do not achieve therapeutic levels in the placenta, parasites sequestered there may be released intermittently into the peripheral blood and cause recurrent maternal infection.

3. EPIDEMIOLOGY Among women living in a geographic region, a higher prevalence of malaria has been observed among pregnant women than in nonpregnant women, younger pregnant women than older pregnant women, women in their first or second pregnancies than in more multigravid women, women with HIV infection than women without HIV infection, and women in the first and second trimesters than women in the third trimester. The increased prevalence of malaria in pregnant women has been attributed to multiple factors, including increased susceptibility to mosquito bites, immunologic and hormonal changes related to pregnancy, and the ability of infected erythrocytes to adhere to and sequester in the intervillous space.

4. MICROBIOLOGY Species of malaria in humans include  P. falciparum ,  P. vivax ,  P. ovale ,  P. malariae ,  and  P. knowlesi . The effect of malaria on pregnancy varies by species and correlates with the ability of infected erythrocytes to adhere to and sequester in the placenta. P. falciparum  invades red cells of all ages; it is associated with especially high levels of parasitemia, placental sequestration, and severe adverse maternal-fetal sequelae. P. vivax  is infrequently associated with placental sequestration and less commonly associated with severe adverse maternal and fetal outcomes P. knowlesi  is relatively rare in pregnancy, but severe disease in pregnant women has been described in Southeast Asia. No placental changes have been observed in association with  P. knowlesi   infection. P. ovale  and  P. malariae  are not typically associated with severe illness in pregnancy. No placental changes have been observed in association with  P. ovale or P. malariae  infection. Coinfection with multiple species is relatively uncommon and varies in prevalence with transmission intensity; it is most frequently observed with  P. falciparum  and  P. vivax . Sequential infection with the same or different species occurs more commonly than coinfection.

5. Miscarriage Preterm birth (<37 weeks of gestation) Low birth weight (LBW; <2500 g at birth) Fetal growth restriction Stillbirth (intrauterine fetal demise) Neonatal mortality Congenital malaria infection Maternal anemia Maternal mortality Hypertensive disease of pregnancy

6. FETAL EFFECTS Reduction in birth weight  — In pregnancies complicated by malaria, both fetal growth restriction and preterm birth. Neurodevelopment Vertical transmission   All species of malaria parasite can be transmitted in utero; congenital disease is most often associated with  P. falciparum  and  P. vivax . Semi-immune and nonimmune pregnant women have a much higher likelihood of transplacental malaria transmission(7 to 10 percent)

7. MATERNAL EFFECT Maternal anemia Maternal mortality Hypertensive disease of pregnancy Miscarriage