Skip directly to search Skip directly to A to Z list Skip directly to page options Skip directly to site content

Volume 19, Number 9—September 2013

Research

Plasmodium falciparum Mutant Haplotype Infection during Pregnancy Associated with Reduced Birthweight, Tanzania

Daniel T. R. MinjaComments to Author , Christentze Schmiegelow, Bruno Mmbando, Stéphanie Boström, Mayke Oesterholt, Pamela Magistrado, Caroline Pehrson, Davis John, Ali Salanti, Adrian J.F. Luty1, Martha Lemnge, Thor Theander, John Lusingu, and Michael Alifrangis
Author affiliations: National Institute for Medical Research, Tanga Centre, Tanzania (D.T.R. Minja, B. Mmbando, P. Magistrado, M. Lemnge, J. Lusingu); University of Copenhagen, Copenhagen, Denmark (D.T.R. Minja, C. Schmiegelow, P. Magistrado, C. Pehrson, A. Salanti, T. Theander, J. Lusingu, M. Alifrangis); Wenner-Gren Institute, Stockholm, Sweden (S. Boström); Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands (M. Oesterholt, A.J.F. Luty); Kilimanjaro Christian Medical Centre, Moshi, Tanzania (D. John)

Main Article

Table 2

Demographic and biological characteristics for 49 pregnant women infected with Plasmodium falciparum sextuple or less mutant haplotypes, Korogwe District, Tanga Region, Tanzania, September 2008–October 2010*

Characteristic P. falciparum mutant allelic haplotype
p value‡
Less than sextuple
Sextuple
No.† Median† Range or % No.† Median† Range or %
Maternal age, y
26.0
22.5
17.0–35.0

23.0
21.0
17.0–32.0

0.38
Gravidity 26 23 0.81
Primi-/secundigravidae 20 77% 17 74%
Multigravidae (3–8 pregnancies)
6

23%

6.0

26%


Gestational age, wk
At study inclusion 26.0 17.6 6.8–23.8 23.0 16.3 8.3–22.3 0.54
At delivery
26.0
39.7
32–43.1

22.0
40.0
35.1–42.6

0.82
Owned bed net
26
19
73%

23
11
48%

0.07
MUAC
At study inclusion, cm 26 26 20–32 23 24 22.0–37.0 0.07
At delivery, cm
23.0
25.5
21.4–31.6

20.0
25.0
21.2–30.0

0.22
Child’s birthweight, g§ 19 3,148 ± 434¶ 17 2,822 ± 436¶ 0.03
Children with birthweight <2,500 g
19
1
5%

17
2
12%

0.82
z-score at delivery
18.0
−0.11 ± 1.27¶


17.0
−0.88 ± 1.07¶


0.06
SGA at delivery
19
2
11%

17
6
35%

0.11
Weight of placenta, g
17
645
381–780

15.0
492
307–800

0.16
Hemoglobin level, g/dL
At delivery# 16.0 11.2 ± 1.8¶ 13.0 11.1 ± 1.8¶ 0.80
At time of infection
25.0
10.0 ± 1.4¶


22.0
10.3 ± 1.8¶


0.56
Fever at time of infection
25
1
4%

23
2
8.7%

0.60**
Parasitemia, IE/μL††
17
2,565
42–10,1208

18
1,895
40–390,749

0.64
>1 infection‡‡
26
1
4%

23
7
30%

0.02
>2 doses of IPTp 26 24 92% 23 21 91% 0.90

*MUAC, mid upper arm circumference; SGA, small gestational age; IE, infected erythrocytes; IPTp, intermittent preventive treatment during pregnancy.
†Data are no. or median no. unless otherwise indicated in column one or by ¶.
‡Unless otherwise indicated, all medians were compared by using the Mann Whitney Rank sum test, means were compared by using the Student t-test, and proportions were compared by using the χ2 test. Bold font indicates statistical significance (p<0.05).
§Among the 49 study participants, 1 had preeclampsia, 2 delivered twins, and 1 delivered a newborn with severe malformation. The birthweight of 39 newborns (including 1 pair of twins and the child born with severe malformation) was measured within 24 h of birth. Only the 36 singleton newborns without malformation were included in the analyses.
¶Data are mean ± SD.
#Hemoglobin levels were measured for many women after delivery; however, only levels measured before delivery were included in the analyses. Low hemoglobin after delivery might be due to ante- and postpartum bleeding rather than antenatal events (e.g., malaria infection).
**Fisher exact test.
††Parasitemia is only stated for 17 nonsextuple and 18 sextuple infections because some infections were rapid diagnostic test–positive but blood smear–negative. Sequence-specific oligonucleotide probe ELISA on filter paper was, however, still possible despite the very low level of parasitemia.
‡‡No. infections is based on all infections detected in the woman by using a rapid diagnostic test and/or blood smear, regardless of whether sequence-specific oligonucleotide probe ELISA was conducted.

Main Article

1Current affiliation: Mère et Enfant Face aux Infections Tropicales, Paris, France.

TOP