Malaria and pregnancy outcomes in an area of high HIV and glucose-6-phosphate dehydrogenase deficiency prevalence Public Deposited

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  • March 21, 2019
Creator
  • Nkhoma, Ella T.
    • Affiliation: Gillings School of Global Public Health, Department of Epidemiology
Abstract
  • HIV and G6PD deficiency are part of a milieu of population-level biological factors in which pregnancies occur in malaria-endemic areas. In this research we examine the effect of HIV infection and malaria parasitemia on pregnancy outcomes, the relationship between HIV infection and risk, frequency, and severity of maternal parasitemia, and the effect of G6PD deficiency on parasitemia risk and pregnancy outcomes. Between 2005 and 2006, we followed pregnant women attending two antenatal care clinics in southern Malawi from the second trimester of gestation until delivery. HIV was associated with increased risk of LBW (adjusted prevalence ratio, PRadj=3.08, 95% confidence interval, CI, = 1.40, 6.79). Placental parasitemia was associated with an elevated risk of LBW (PRadj=1.79, 95% CI = 0.83, 3.84), as was having [greater than or equal to]3 episodes of peripheral parasitemia during follow-up (PRadj=2.68, 95% CI = 1.06, 6.79). HIV was not associated with increased risk of parasitemia among primigravidae over follow-up (RR=1.0, 95% CI: 0.4, 2.8). Among multigravidae, the risk of parasitemia over follow-up among HIV-infected women was 2.2 times (95% CI: 1.5, 3.2) that of HIV-uninfected women. Further, the odds of having [greater than or equal to]3 episodes of parasitemia among HIV-infected multigravidae were 4.8 (95% CI: 2.1, 10.9) times that of HIV-uninfected multigravidae. Among both primigravidae and multigravidae, placental parasite density among HIV-infected women was on average 3.6 (95% CI: 1.8, 7.2) times as high as among HIV-uninfected women. G6PD A- primigravidae were as likely to have placental parasitemia as G6PD-normal primigravidae (PR=1.0, 95% confidence interval (CI): 0.7, 1.3). Among multigravid G6PD A- carriers, the prevalence of placental parasitemia was 0.9 (95% CI: 0.8, 1.0) times that of G6PD-normal women. Further, their placental parasite density was on average 0.22 times that of G6PD-normal multigravidae. Among primigravidae, G6PD A- carriers had 1.7 (95% CI: 1.0, 2.9) times the average risk of maternal anemia over follow-up when compared to G6PD-normal women. Across gravidities, G6PD deficiency was associated with an increased risk of low birth weight (PR=2.5, 95% CI: 1.2, 5.2). Understanding the contribution of these different coexistent factors should aid in the design of effective interventions to improve maternal and infant health in malaria-endemic areas.
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  • Meshnick, Steven R.
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