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Volume 21, Number 5—May 2015
Research

Protective Antibodies against Placental Malaria and Poor Outcomes during Pregnancy, Benin

Nicaise Tuikue NdamComments to Author , Lise Denoeud-Ndam, Justin Doritchamou, Firmine Viwami, Ali Salanti, Morten A. Nielsen, Nadine Fievet, Achille Massougbodji, Adrian J.F. Luty, and Philippe Deloron
Author affiliations: Institut de Recherche pour le Développement, Paris, France (N. Tuikue Ndam, L. Denoeud-Ndam, J. Doritchamou, N. Fievet, A.J.F. Luty, P. Deloron); Pôle de Recherche et d’Enseignement Supérieur Sorbonne Paris Cité, Paris (N.Tuikue Ndam, N. Fievet, A.J.F. Luty, P. Deloron),; Université d’Abomey-Calavi, Cotonou, Benin (F. Viwami, A. Massougbodji, A.J.F. Luty); University of Copenhagen, Copenhagen, Denmark (A. Salanti, M.A. Nielsen)

Main Article

Table 3

Association of antibody levels at enrollment with pregnancy-associated malaria and pregnancy outcomes in 710 pregnant women, Benin*

Characteristic No malaria infections/mo
 Placental malaria
 Low birthweight
IRR (95% CI) p value OR (95% CI) p value OR (95% CI) p value
VSA, range log RMFI n = 709 0.288 n = 607 0.022† n = 692 0.721
Second quartile, 2.8–3.7 0.85 (0.55–1.31)† 0.58 (0.28–1.18) 1.25 (0.65–2.43)
Third quartile, 3.7–4.4 0.84 (0.54–1.30)† 0.43 (0.21–0.91)† 0.84 (0.41–1.75)
Higher quartile, >4.4 1.14 (0.75–1.74) 0.40 (0.19–0.85)† 1.05 (0.51–2.17)
VAR2CSA DBL1–DBL2, AU n = 709 0.223† n = 607 0.61 n = 692 0.003†
Second quartile, 4–26 0.79 (0.51–1.24)† 1.07 (0.49–2.36) 0.71 (0.39–1.30)
Third quartile, 26–54 0.74 (0.47–1.17)† 1.46 (0.69–3.05) 0.36 (0.17–0.74)†
Higher quartile, >54 1.01 (0.64–1.60) 0.95 (0.43–2.13) 0.33 (0.16–0.71)†
VAR2CSA DBL3, AU n = 706 0.0001† n = 604 0.011† n = 689 0.0236
Second quartile, 17–40 0.43 (0.27–0.70)† 0.45 (0.21–0.99)† 0.54 (0.28–1.05)
Third quartile, 0–70 0.45 (0.27–0.75)† 0.41 (0.19–0.90)† 0.29 (0.13–0.65)
Higher quartile, >70 0.80 (0.48–1.32) 0.40 (0.18–0.92)† 0.50 (0.24–1.07)
VAR2CSA DBL4, AU n = 703 0.122† n = 601 0.69 n = 686 0.352†
Second quartile, 11–21 0.69 (0.44–1.07)† 0.84 (0.40–1.78) 0.83 (0.44–1.57)
Third quartile, 21–40 0.71 (0.45–1.08)† 0.70 (0.32–1.53) 0.67 (0.34–1.32)†
Higher quartile, >40 0.88 (0.57–1.36) 1.07 (0.52–2.22) 0.63 (0.31–1.30)†
VAR2CSA DBL5, AU n = 705 0.019 n = 603 0.79 n = 688 0.675
Second quartile, 29–56 0.67 (0.43–1.04) 1.15 (0.54–2.44) 1.39 (0.70–2.75)
Third quartile, 59–84 0.82 (0.52–1.29) 0.98 (0.45–2.14) 1.25 (0.60–2.62)
Higher quartile, >84 1.30 (0.83–2.05) 1.31 (0.60–2.84) 1.54 (0.75–3.14)
VAR2CSA DBL6, AU n = 352 n = 306 n = 343 0.118
Second quartile, 32–52 0.94 (0.51–1.73) 0.96 0.56 (0.20–1.56) 0.21 0.25 (0.08–0.79)
Third quartile, 52–74 0.84 (0.44–1.60) 0.29 (0.09–0.93) 0.83 (0.36–1.96)
Higher quartile, >74 0.95 (0.50–1.83) 0.47 (0.17–1.36) 0.65 (0.26–1.60)
FV2, AU n = 698 n = 596 n = 681
Second quartile, 29–65 0.83 (0.53–1.29) 0.0005 1.39 (0.66–2.93) 0.34 0.80 (0.42–1.54) 0.55
Third quartile, 65–94 0.62 (0.39–0.99) 0.74 (0.32–1.69) 0.58 (0.28–1.21)
Higher quartile, >94 1.52 (0.97–2.39) 0.84 (0.37–1.93) 0.82 (0.39–1.71)
IBA, % inhibition n = 703 0.226† n = 602 0.65 n = 686 0.21†
Second quartile, 25–40 0.93 (0.59–1.45) 0.83 (0.39–1.76) 1.06 (0.57–1.97)
Third quartile, 40–60 1.30 (0.84–2.01)† 0.98 (0.46–2.09) 0.68 (0.34–1.37)†
Higher quartile, >60 1.21 (0.77–1.90)† 1.34 (0.64–2.82) 0.62 (0.30–1.29)†
AMA1, AU n = 706 0.463 n = 604 0.58 n = 689 0.155†
Second quartile, 23–61 0.98 (0.62–1.55) 0.78 (0.37–1.65) 0.71 (0.36–1.42)†
Third quartile, 61–131 0.76 (0.48–1.20) 0.58 (0.27–1.25) 0.68 (0.35–1.33)†
Higher quartile, >131 1.04 (0.65–1.65) 0.73 (0.35–1.50) 0.64 (0.32–1.27)†

*Antibodies were tested individually after adjustment for study site, rank of gestation, and malaria at enrollment. p values were obtained by using the Wald test. Bold indicates significant p values after the Holm-Bonferroni correction was used for multiple testing. Analysis of placental malaria was restricted to 607 women who reached delivery, had antibody measurements, and had a placental blood smear. Analysis of low birthweight was restricted to 692 women who reached delivery and had an evaluation of birthweight. IRR, incidence rate ratio; OR, odds ratio; VSA, variant surface antigen; RMFI, relative mean fluorescence intensity; VAR2CSA, variant surface antigen 2 chondroitin sulfate; DBL, Duffy binding-like antigen; AU, absorbance units; FV2, full-length ectodomain of variant surface antigen 2 chondroitin sulfate; IBA, inhibition of binding assay; AMA1, apical membrane antigen 1.
†When ORs for 2 contiguous quartiles were similar, p values were computed after grouping those quartiles.

Main Article

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