title: Imported malaria in pregnancy in Madrid.
abstract: BACKGROUND
  Malaria in pregnancy is associated with maternal and foetal morbidity and mortality in endemic areas, but information on imported cases to non-endemic areas is scarce.The aim of this study was to describe the clinical and epidemiological characteristics of malaria in pregnancy in two general hospitals in Madrid, Spain.
  
  
  METHODS
  Retrospective descriptive study of laboratory-confirmed malaria in pregnant women at the Fuenlabrada University Hospital and the Príncipe de Asturias University Hospital, in Madrid, over a six- and 11-year period, respectively. Relevant epidemiological, clinical and laboratory data was obtained from medical records.
  
  
  RESULTS
  There were 19 pregnant women among 346 malaria cases (5.4%). The average age was 27 years. The gestational age (trimester) was: 53% 3rd, 31% 1st, 16% 2nd. All but one were multigravidae. Three were HIV positive. All were sub-Saharan immigrants: two were recently arrived immigrants and seventeen (89%) had visited friends and relatives. None had taken prophylaxis nor seeked pre-travel advice.
  
  
  METHODS
  16 symptomatic patients (fever in fourteen, asthenia in two), three asymptomatic. Median delay in diagnosis: 7.5 days. Laboratory tests: anaemia (cut off Hb level 11 g/dl) 78.9% (mild 31.6%, moderate 31.6%, severe 15.8%) thrombocytopaenia 73.7%, hypoglycaemia 10.5%. All cases were due to Plasmodium falciparum, one case of hyperparasitaemia. Quinine + clindamycin prescribed in 84%.
  
  
  RESULTS
  no severe maternal complications or deaths, two abortions, fifteen term pregnancies, no low-birth-weight newborns, two patients were lost to follow-up.
  
  
  CONCLUSIONS
  Though cases of malaria in pregnancy are uncommon, a most at risk group is clearly defined: young sub-Saharan mothers visiting friends and relatives without pre-travel counselling and recently-arrived immigrants. The most common adverse maternal and foetal effects were anaemia and stillbirth. Given that presentation can be asymptomatic, malaria should always be considered in patients with unexplained anaemia arriving from endemic areas. These findings could help Maternal Health programme planners and implementers to target preventive interventions in the immigrant population and should create awareness among clinicians.
authors.affiliation: Internal Medicine Department, University Hospital Fuenlabrada, Madrid, Spain. carolina.jimenezna@gmail.com
authors.forename: Beatriz C
authors.initials: BC
authors.lastname: Jiménez
authors.forename: Pedro
authors.initials: P
authors.lastname: Cuadros-Tito
authors.forename: Jose M
authors.initials: JM
authors.lastname: Ruiz-Giardin
authors.forename: Gerardo
authors.initials: G
authors.lastname: Rojo-Marcos
authors.forename: Juan
authors.initials: J
authors.lastname: Cuadros-González
authors.forename: Eduardo
authors.initials: E
authors.lastname: Canalejo
authors.forename: Noemi
authors.initials: N
authors.lastname: Cabello
authors.forename: Juan V
authors.initials: JV
authors.lastname: San Martín
authors.forename: Ana M
authors.initials: AM
authors.lastname: Barrios
authors.forename: Juan
authors.initials: J
authors.lastname: Hinojosa
authors.forename: Laura
authors.initials: L
authors.lastname: Molina
mesh_terms: D000328:Adult; D000740:Anemia / Q000453:epidemiology / Q000209:etiology; D004641:Emigration and Immigration; D005260:Female; D006801:Humans; D016778:Malaria, Falciparum / Q000150:complications / Q000453:epidemiology* / Q000469:parasitology / Q000473:pathology; D010963:Plasmodium falciparum / Q000302:isolation & purification*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology* / Q000469:parasitology / Q000473:pathology; D011803:Quinine; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D050497:Stillbirth / Q000453:epidemiology; D014195:Travel
chemical_list: D011803:Quinine