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A study coordinated by NDM researchers published in BMC Medicine explores the factors predicting higher mortality in pregnant women with severe malaria and describes how severe falciparum malaria in pregnancy affects foetal health and mortality.

© MORU 2023. Photographer: Gerhard Jørén

Severe malaria during pregnancy can lead to serious problems in vital organs, increasing the risk of both maternal and foetal death. However, if a pregnant woman has severe anaemia or a high level of parasites in her blood (hyperparasitaemia), these factors alone do not seem to strongly predict an adverse outcome. This difference in outcomes affects the reported mortality rates for severe malaria in pregnancy. To address these risks, it's important to encourage access to antenatal care, which can help overcome obstacles to promptly diagnosing and treating malaria and anaemia.

The study published in the BMC Medicine was coordinated by NDM’s Shoklo Malaria Research Unit (SMRU), Mahidol-Oxford Tropical Medicine Research Unit (MORU), and Oxford University Clinical Research Unit (OUCRU). The aim of this study was to understand the risks of severe falciparum malaria in pregnancy (defined by WHO criteria) in terms of maternal and foetal health and to find out what factors contribute to higher maternal deaths.

This study involved two cohorts of pregnant women with severe falciparum malaria: one community-based and the other hospital-based. The researchers studied the records of severe malaria during pregnancy at SMRU on the Thailand-Myanmar border where women were monitored until delivery. They also used data from severe malaria studies in hospitals across six Southeast Asian countries.

The study clearly demonstrated that severe falciparum malaria leading to serious organ dysfunction has a high risk of death occurring in 1 in 3 women. However, there were no deaths in pregnant women with severe anaemia and/or high levels of parasites in their blood only, even though 70% of women in this group had received carefully supervised oral treatment rather than intravenous therapy. The noticeable difference in death rates based on different WHO criteria for severe malaria likely explains the varying reported mortality rates related to malaria in pregnancy across different international studies. This prompts the question of whether these criteria should be tailored to diagnose severe malaria in pregnancy.

Anaemia and malaria are common in pregnant women in tropical areas. Hyperparasitaemia is more frequent in low-transmission areas. For both conditions, results were positive for mothers who were provided with oral artemisinin and blood transfusion (when required).

Efforts to control malaria along the Thailand-Myanmar border have greatly lowered malaria and mortality in pregnant women. However, declining immunity due to elimination work makes pregnant women vulnerable to disruptions from factors like war and pandemics. Preserving access to antenatal care is vital to lessen obstacles to early diagnosis and treatment of malaria and anaemia.

The full paper can be found here: https://rdcu.be/dklhO

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