Malaria-Associated Maternal Illness
Malaria-Associated Maternal Illness: Plasmodium falciparum adds to expectant mothers’ woes
In the United States, malaria is a disease of the past, a force eliminated in 1949 by widespread DDT application, removal of mosquito breeding grounds, and spraying of insecticide. Both preventable and curable, malaria is still responsible for an estimated 627,000 deaths in 2012 alone (World Health Organization (WHO), 2014), of which approximately 10,000 are pregnant women. (Dellicour et al. 2010) While this infectious disease may be a distant memory in America, malaria continues to plague other regions of the world: Sub-Saharan Africa, Central America, South America, the Middle East and Southeast Asia.
In addition to a high malaria prevalence, some of these regions struggle with high maternal mortality rates, worsened by the risk of contracting malaria. In fact, pregnant women are more vulnerable to malaria and suffering severe complications.
Malaria is caused by parasitic protozoa (Plasmodium falciparum, P. vivax, P. ovale. P. malariae) and is transmitted to humans through bites of infected mosquitos. Infection by P. falciparum is mostly responsible for malaria-associated maternal illness and low birth weight. (WHO, 2014) Because rates of transmission vary, the intensity of symptoms and complications also vary accordingly. In high-transmission settings, levels of acquired immunity are much higher as a result of repeated infections over time. In low-transmission settings, however, there is little immunity to malaria. These differing levels of immunity contribute to the variation of malaria-associated maternal illness.
In high-transmission settings in which mothers have some level of immunity, infection by P. falciparum is usually asymptomatic, but the parasites can contribute to maternal anemia, which can lead to low birth weight, a risk factor for infant mortality (WHO, 2013). In malaria-endemic countries, P. falciparum contributes to 8-14% of low birth weight cases. (Centers for Disease Control and Prevention, 2014) Further, the effects of malaria are more pronounced for women in their first pregnancy.
When malaria transmission is low, levels of immunity are also low, and the effects of infection are more severe. Malaria in pregnancy is associated with an increased risk of severe malaria and anemia. It may also lead to spontaneous abortion, stillbirth, premature birth, and low birth weight. Whereas in high-transmission settings women in their first pregnancy were impacted more acutely, malaria affects women in low transmission settings equally. (WHO, 2013)
In order to protect expectant mothers from the harmful effects of malaria, the WHO recommends methods to prevent malaria, effective treatment during pregnancy and iron supplements to combat anemia. Efforts to eliminate malaria are ongoing – the Global Malaria Action Plan outlines how countries can collaborate to control malaria and one day eliminate it altogether.
Mick Hoy. 2009. Marlaria areas. [Map/Photograph]. Retrieved from https://flic.kr/p/66LBNz.*
NIAID. 2011. Mosquito that causes malaria. [Photograph.] Retrieved from https://flic.kr/p/adeXVQ.*
1. Centers for Disease Control and Prevention. (2014). Malaria Facts. Retrieved from: http://www.cdc.gov/malaria/about/facts.html
2. Dellicour S, Tatem AJ, Guerra CA, Snow RW, ter Kuile FO. (2010). Quantifying the Number of Pregnancies at Risk of Malaria in 2007: A Demographic Study.PLoS Med 7(1): e1000221. doi: 10.1371/journal.pmed.1000221
3. World Health Organization. (2014). Fact Sheet: Malaria. Retrieved from: http://www.who.int/mediacentre/factsheets/fs094/en/
4. World Health Organization. (2013). Malaria in Pregnant Women. Retrieved from: http://www.who.int/malaria/areas/high_risk_groups/pregnancy/en/
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