Severe falciparum malaria in pregnancy in Southeast Asia: a multi-centre retrospective cohort study
Issued Date
2023-12-01
Resource Type
eISSN
17417015
Scopus ID
2-s2.0-85168664938
Pubmed ID
37620809
Journal Title
BMC Medicine
Volume
21
Issue
1
Rights Holder(s)
SCOPUS
Bibliographic Citation
BMC Medicine Vol.21 No.1 (2023)
Suggested Citation
Saito M., Phyo A.P., Chu C., Proux S., Rijken M.J., Beau C., Win H.H., Archasuksan L., Wiladphaingern J., Phu N.H., Hien T.T., Day N.P., Dondorp A.M., White N.J., Nosten F., McGready R. Severe falciparum malaria in pregnancy in Southeast Asia: a multi-centre retrospective cohort study. BMC Medicine Vol.21 No.1 (2023). doi:10.1186/s12916-023-02991-8 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/89160
Title
Severe falciparum malaria in pregnancy in Southeast Asia: a multi-centre retrospective cohort study
Other Contributor(s)
Abstract
Background: Severe malaria in pregnancy causes maternal mortality, morbidity, and adverse foetal outcomes. The factors contributing to adverse maternal and foetal outcomes are not well defined. We aimed to identify the factors predicting higher maternal mortality and to describe the foetal mortality and morbidity associated with severe falciparum malaria in pregnancy. Methods: A retrospective cohort study was conducted of severe falciparum malaria in pregnancy, as defined by the World Health Organization severe malaria criteria. The patients were managed prospectively by the Shoklo Malaria Research Unit (SMRU) on the Thailand-Myanmar border or were included in hospital-based clinical trials in six Southeast Asian countries. Fixed-effects multivariable penalised logistic regression was used for analysing maternal mortality. Results: We included 213 (123 SMRU and 90 hospital-based) episodes of severe falciparum malaria in pregnancy managed between 1980 and 2020. The mean maternal age was 25.7 (SD 6.8) years, and the mean gestational age was 25.6 (SD 8.9) weeks. The overall maternal mortality was 12.2% (26/213). Coma (adjusted odds ratio [aOR], 7.18, 95% CI 2.01–25.57, p = 0.0002), hypotension (aOR 11.21, 95%CI 1.27–98.92, p = 0.03) and respiratory failure (aOR 4.98, 95%CI 1.13–22.01, p = 0.03) were associated with maternal mortality. Pregnant women with one or more of these three criteria had a mortality of 29.1% (25/86) (95%CI 19.5 to 38.7%) whereas there were no deaths in 88 pregnant women with hyperparasitaemia (> 10% parasitised erythrocytes) only or severe anaemia (haematocrit < 20%) only. In the SMRU prospective cohort, in which the pregnant women were followed up until delivery, the risks of foetal loss (23.3% by Kaplan–Meier estimator, 25/117) and small-for-gestational-age (38.3%, 23/60) after severe malaria were high. Maternal death, foetal loss and preterm birth occurred commonly within a week of diagnosis of severe malaria. Conclusions: Vital organ dysfunction in pregnant women with severe malaria was associated with a very high maternal and foetal mortality whereas severe anaemia or hyperparasitaemia alone were not associated with poor prognosis, which may explain the variation of reported mortality from severe malaria in pregnancy. Access to antenatal care must be promoted to reduce barriers to early diagnosis and treatment of both malaria and anaemia.