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Malaria infection during pregnancy: determining the time points of highest vulnerability - A project under STOPPAM (Strategies TO Prevent Pregnancy Associated Malaria)

Project period: 2008-2011

Project Team: 

• Christentze Schmiegelow, MD/PhD student, Centre for Medical Parasitology (CMP), Institute of International Health, Immunology and Microbiology (ISIM), University of Copenhagen and Department for Infectious Diseases, Rigshospitalet, Denmark
• Professor Thor Theander, CMP, ISIM, University of Copenhagen and Department for Infections Diseases, Rigshospitalet, Denmark
• Birgitte Bruun Nielsen, MD, PhD, Department of Obstetrics and Gynaecology, Aarhus University Hospital, Skejby, Denmark
• Vibeke Rasch MD, PhD, DMSc, Department of Obstetrics and Gynaecology, Odense University Hospital and ISIM, University of Copenhagen

Partner Institutions:

• National Institute for Medical Research, Tanga Region, Tanzania
• Department of Medical Microbiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
• Department of Immunology, Wenner-Gren Institute, University of Stockholm, Sweden
• Institut de Recherche pour le Développement (IRD), Paris, France
• Research Unit 010 (UR010), Mother and Child Health in the Tropics, Development Research Institute (IRD), Cotonou, Benin
• ALMA consulting group, France

Project description:

"Malaria infection during pregnancy - determining the time-points of highest vulnerability" is a PhD project and a specific subcomponent under the STOPPAM - Strategies TO Prevent Pregnancy Associated Malaria - project conducted in Tanzania and Benin. STOPPAM is a collaboration between CMP and the partner institutions mentioned above. The objective of STOPPAM is to map pregnancy-associated malaria (PAM) from a clinical, pathological, immunological and parasitological perspective. The knowledge gained will facilitate the development of a vaccine against PAM and optimisation of the prevention strategies currently existing.

The subcomponent "Malaria infection during pregnancy - determining the time-points of highest vulnerability" is specifically focusing on the clinical consequences of PAM.

Background: Malaria in pregnancy caused by Plasmodium falciparum has detrimental effects on both mother and offspring. It is a major cause of abortion, stillbirth, low birth weight and preterm delivery and increases the risk of maternal anaemia which contributes to maternal mortality. Recent studies have shown a possible link between PAM and the development of hypertensive disorders (pregnancy-induced hypertension and preeclampsia); disorders that, as PAM, are leading causes of maternal and foetal/infant mortality and morbidity in developing countries.

Currently PAM is tackled through treatment of identified cases and prevention strategies comprising of intermittent prophylactic treatment (IPTp) and bednets. Even though PAM is often asymptomatic, consequences of the infection are seen later in pregnancy and upon delivery. Increasing resistance to the drugs used for prevention strategies is also an ever-present challenge. The current strategies to prevent the consequences of PAM are therefore insufficient.

To overcome PAM, optimisation of the current prevention strategies and a vaccine are needed. This is only possible if the pathogenesis of PAM is better understood and the time-points of highest vulnerability to the infection are identified.

Aim: To contribute to a better understanding of PAM from a clinical point-of-view. The overall objective of the PhD study is to measure birth outcome, monitor maternal health (including the development of hypertensive disorders) and assess intrauterine growth by ultrasound investigations and relate these findings to knowledge about parasite exposure during the pregnancy.

Methodology: A cohort of 1000 pregnant women residing in Korogwe District, North-East Tanzania is followed from their first antenatal booking until delivery. They are screened for malaria infection, anaemia, hypertensive disorders and signs of foetal/infant compromise at regular visits in the Reproductive and Child Health clinic as well as upon delivery. To identify foetal compromise and to further characterise the origin of low birth weight ultrasound investigations will be performed regularly during the pregnancy. This will enable us to identify the occurrence and timing of intra-uterine growth retardation in respect to parasite exposure.

Upon delivery, birth anthropometry will be measured, the mother's health will be assessed with special focus on malaria infection and hypertensive disorders and placental specimens will be collected to further characterise the exposure to malaria and signs of inflammatory reactions.

Funding: European Union Framework 7 and University of Copenhagen.