title: Placental tumor necrosis factor alpha but not gamma interferon is associated with placental malaria and low birth weight in Malawian women.
abstract: Malaria in pregnancy predisposes to maternal anemia and low birth weight (LBW). We examined the possible roles of the cytokines tumor necrosis factor alpha (TNF-alpha) and gamma interferon (IFN-gamma) in these adverse outcomes. We measured cytokine concentrations in placental, peripheral, and cord blood plasma in relation to malaria parasitemia and placental monocyte accumulation in 276 Malawian women. Maternal hemoglobin concentration, human immunodeficiency virus status, and infant birth weight were determined. Concentrations of TNF-alpha in placental blood were correlated with densities of Plasmodium falciparum-infected erythrocytes (P < 0.0001) and of intervillous monocyte infiltrates (P < 0.0001) on placental histology. Peripheral blood TNF-alpha concentrations were relatively low and were weakly associated with malaria. TNF-alpha concentrations were higher in placental blood, where they were strongly associated with malaria. Placental plasma TNF-alpha levels were higher in women who had LBW babies (P = 0.0027), women with febrile symptoms (P < 0.0001), and teenage mothers (P = 0.04) than in other women. The presence of TNF-alpha in cord blood was not associated with malaria infection. IFN-gamma levels were infrequently elevated, and elevated IFN-gamma levels were not associated with poor pregnancy outcomes. Placental production of TNF-alpha, but not of IFN-gamma, may be implicated in impaired fetal growth in Malawian women.
authors.affiliation: Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Department of Obstetrics and Gynaecology, College of Medicine, University of Malawi, Blantyre, Malawi. sroger@unimelb.edu.au
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Rogerson
authors.forename: Heidi C
authors.initials: HC
authors.lastname: Brown
authors.forename: Elena
authors.initials: E
authors.lastname: Pollina
authors.forename: Elizabeth T
authors.initials: ET
authors.lastname: Abrams
authors.forename: Eyob
authors.initials: E
authors.lastname: Tadesse
authors.forename: Valentino M
authors.initials: VM
authors.lastname: Lema
authors.forename: Malcolm E
authors.initials: ME
authors.lastname: Molyneux
mesh_terms: D017088:AIDS-Related Opportunistic Infections; D000293:Adolescent; D000328:Adult; D005260:Female; D005312:Fetal Blood / Q000276:immunology; D015658:HIV Infections / Q000150:complications; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007371:Interferon-gamma / Q000097:blood / Q000378:metabolism*; D016778:Malaria, Falciparum / Q000276:immunology*; D008295:Malawi; D018512:Parasitemia / Q000276:immunology; D010920:Placenta / Q000276:immunology* / Q000469:parasitology; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism*
chemical_list: D014409:Tumor Necrosis Factor-alpha; D007371:Interferon-gamma