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Malaria In Pregnancy ‘more Complex Than Thought’ by kayzeez(m): 12:25pm On Sep 17, 2009
The deleterious effects of malaria in pregnancy is not fully appreciated by most women. Experts say one of the consequences of malaria in pregnancy is pre-eclampsia,another term for high blood pressure and protein loss in the urine, which carries high risks for both child and mother in the first pregnancy, reports Sade Oguntola.

In malaria-endemic regions, the burden of the disease is primarily borne by young children and pregnant women. Malaria affects millions of pregnant women each year, mostly young African women during their first pregnancy as a result of which they lose the semi-immunity normally found in adults.

Research shows that pregnant women attract twice the number of mosquitoes as non-pregnant women, which probably increases their risk of contracting malaria.

In these young mothers, the Plasmodium falciparum (a parasite that causes malaria) accumulates in the placenta, causing them to become short of blood. As a result, the children of infected mothers are often underdeveloped or babies with lower birth weights. Sometimes, children of such mothers with severe malaria even end up being born premature or die while still in the womb.

But, that is not all about the deleterious effects of malaria during pregnancy. One of the consequences of malaria has been shown in a new research to include pre-eclampsia (very high blood pressure and protein loss in the urine), which carries high risks for both mother and child for women in their first pregnancy.

Pre-eclampsia is thought to be more common in some parts of the world where there is severe malaria problem and it has often been speculated that there might be a connection. Malaria is more common in a first pregnancy and so is pre-eclampsia.

Dr. Kayode Afolabi, a consultant Obstetrician and Gynaecologist at the University College Hospital (UCH), Ibadan, Oyo State, described pre-eclampsia as a condition in pregnancy wherein the woman has high blood pressure coexisting with protein in urine. What is obvious to the human eyes is that they appear blown up. “Looking at them, their whole body is swollen, especially their face, hands and feet,” he declared.

Dr. Afolabi said so many things could predispose a woman to pre-eclampsia. “It is a disease that is common in women that are getting pregnant for the first time or those that are getting pregnant for a new husband, even though they have had previous pregnancies or deliveries in the past.”

In addition, he declared that “it is common among women who before pregnancy have had other medical problem like diabetes, hypertension or even kidney problems. Women who have multiple pregnancy are equally prone to developing the problem.”

Dr. Afolabi described malaria and pre-eclampsia as two common problems of pregnant women, stressing that “there is a possibility of malaria contributing to cases of pre-eclampsia in women, considering the fact that a pregnant woman who has malaria could have a high concentration of malaria parasites developing in the placenta. The placental is the cord attaching the unborn baby to the mother and this cord supply it with oxygen and nutrients from the mother.”

When a pregnant woman has a high concentration of malaria parasites developing in the placenta, she is said to have “placental malaria”. This is very harmful to the mother and to the unborn baby; it leads to low birth weight and, in Africa alone, is estimated to be responsible for the deaths of about 200,000 infants every year. A woman who is pregnant for the first time is most likely to suffer from placental malaria, and will have her placenta become highly infected and extremely inflamed.

Dr. Afolabi explained that in a situation where a woman has a high load of malaria parasites in the placenta, effectiveness of the placenta in oxygen and nutrient supply to the baby would be affected. “Due to the high load of malaria parasites in the placenta, there could be damage to the placenta in such a way that it could predispose the mother to pre-eclampsia,” he said.

Even though women with their first pregnancy have a higher risk of contracting malaria, Dr. Afolabi declared that malaria in pregnancy was a serious disease. “There is the tendency for people to see malaria as ordinary, but it is a serious disease in the sense that both the mother and the baby could be seriously affected if it is not properly and promptly treated. The risk to the mother includes low blood level(anemia) in pregnancy, which could become severe and necessitate blood transfusion.

“In the case of the unborn baby, malaria could lead to miscarriage, referred to in the medical parlance as spontaneous abortion, depending on the stage at which the malaria occurs. The baby may be born premature, with a low birth weight due to slow growth while in the womb.”

“This is why the use of malaria medications is always considered an important issue and emphasis placed on its prevention. Currently, we embark on the prevention of malaria in pregnancy with two to three doses of the prescribed antimalarial drug (sulfadoxine-pyrimethamine) during pregnancy. This is commenced after the first three months of pregnancy when it is certain that the medication would not cause any deformity in the developing child in the womb.”

Pre-eclampsia is a serious complication of pregnancy and affects one out of every 10 pregnant women in Nigeria according to Dr. Bukola Fawole, a consultant obstetrician and gynaecologist at the University College Hospital (UCH) Ibadan. The condition which is often silent; showing up unexpectedly during a routine blood pressure check and urine test, according to Dr. Fawole cannot be outrightly said to be due to malaria.

“Right now, we do not know if there is a direct connection between malaria parasites within the placenta leading to pre-eclampsia,” he declared. “What we know is that when there are malaria parasites in the placenta, it has its own problems. It leads to reduced growth of the baby and in very severe situations, the baby may end up dying right in the womb.”

The best option no doubt should include preventing pre-eclampsia. According to Dr. Fawole, there are no definitive preventive methods for pre-eclampsia. “A number of interventions have been suggested but none of them is known to work 100 per cent. Some suggested the use of aspirin in low doses and some suggested Vitamin C and Vitamin E. From our experience in practice, just as research has shown, none is particularly 100 per cent efficient. We know if some women take low doses of aspirin, they may not develop it, but despite this some women still develop pre-eclampsia.”

Researchers from the USA, UK and Tanzania, who investigated the possibility that malaria might lead to pre-eclampsia, found that for the first-time young mothers, having placental malaria increased the risk of hypertension about three-fold, suggesting that attempts to reduce the chance of such women getting malaria would have the additional benefit of lowering their chance of developing pre-eclampsia.

Pregnant women with pre-eclampsia are usually advised to take time off work, have bed rest, take medication, and sometimes even hospitalised to keep the blood pressure under control. Unfortunately, the only “cure” for the disease is delivery of the baby, but it is in the best interest of the babies to be kept in the womb as long as possible. Sometimes, it is in the best interest of the mother to deliver the baby before term. http///www.tribune.com.ng
Re: Malaria In Pregnancy ‘more Complex Than Thought’ by angela992: 8:37am On Feb 21, 2018
Prevelance of Malaria in Pregnancy among Antenatal Clinic Patient in Ebonyi State University Teaching Hospital

Prevalence of malaria in pregnant women is caused by four specie of plasmodium. Infection in pregnant women are associated with multiple complication including anemia, low birth weight, and still birth. This research work reviews the cause: prevention and roles of nurses and midwives in ensuring complete eradication of the menace associated with malaria parasite...


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