title: Submicroscopic Plasmodium falciparum Infections Are Associated With Maternal Anemia, Premature Births, and Low Birth Weight.
abstract: BACKGROUND
  Molecular, as opposed to microscopic, detection measures the real prevalence of Plasmodium falciparum infections. Such occult infections are common during pregnancy but their impact on pregnancy outcomes is unclear. We performed a longitudinal study to describe that impact.
  
  
  METHODS
  In a cohort of 1037 Beninese pregnant women, we used ultrasound to accurately estimate gestational ages. Infection with P. falciparum, hemoglobin concentration, use of intermittent preventive treatment during pregnancy (IPTp) for malaria, and other parameters were recorded during pregnancy. Using multivariate analyses, we evaluated the impact of submicroscopic infections on maternal anemia, premature birth, and low birth weight.
  
  
  RESULTS
  At inclusion, polymerase chain reaction (PCR) and microscopy detected infection in 40% and 16% of women, respectively. The proportion infected declined markedly after 2 doses of IPTp but rebounded to 34% (by PCR) at delivery. Submicroscopic infections during pregnancy were associated with lower mean hemoglobin irrespective of gravidity, and with increased anemia risk in primigravidae (odds ratio [OR], 2.23; 95% confidence interval [CI], .98-5.07). Prospectively, submicroscopic infections at inclusion were associated with significantly increased risks of low birth weight in primigravidae (OR, 6.09; 95% CI, 1.16-31.95) and premature births in multigravidae (OR, 2.25; 95% CI, 1.13-4.46).
  
  
  CONCLUSIONS
  In this detailed longitudinal study, we document the deleterious impact of submicroscopic P. falciparum parasitemia during pregnancy on multiple pregnancy outcomes. Parasitemia occurs frequently during pregnancy, but routine microscopic and rapid diagnostic tests fail to detect the vast majority of episodes. Our findings imply caution in any revision of the current strategies for prevention of pregnancy-associated malaria.
authors.affiliation: PRES Sorbonne Paris Cité, Faculté de Pharmacie, Université Paris Descartes Institut de Recherche pour le Développement, UMR216-MERIT.
authors.forename: Gilles
authors.initials: G
authors.lastname: Cottrell
authors.affiliation: Institut de Recherche pour le Développement, UMR216-MERIT Université Pierre et Marie Curie, Paris, France;
authors.forename: Azizath
authors.initials: A
authors.lastname: Moussiliou
authors.affiliation: PRES Sorbonne Paris Cité, Faculté de Pharmacie, Université Paris Descartes Institut de Recherche pour le Développement, UMR216-MERIT.
authors.forename: Adrian J F
authors.initials: AJ
authors.lastname: Luty
authors.affiliation: PRES Sorbonne Paris Cité, Faculté de Pharmacie, Université Paris Descartes Institut de Recherche pour le Développement, UMR216-MERIT.
authors.forename: Michel
authors.initials: M
authors.lastname: Cot
authors.affiliation: PRES Sorbonne Paris Cité, Faculté de Pharmacie, Université Paris Descartes Institut de Recherche pour le Développement, UMR216-MERIT.
authors.forename: Nadine
authors.initials: N
authors.lastname: Fievet
authors.affiliation: Centre d'Etude et de Recherche sur le paludisme associé à la Grossesse et à l'Enfance, Université d'Abomey-Calavi, Cotonou, Benin.
authors.forename: Achille
authors.initials: A
authors.lastname: Massougbodji
authors.affiliation: PRES Sorbonne Paris Cité, Faculté de Pharmacie, Université Paris Descartes Institut de Recherche pour le Développement, UMR216-MERIT.
authors.forename: Philippe
authors.initials: P
authors.lastname: Deloron
authors.affiliation: PRES Sorbonne Paris Cité, Faculté de Pharmacie, Université Paris Descartes Institut de Recherche pour le Développement, UMR216-MERIT.
authors.forename: Nicaise
authors.initials: N
authors.lastname: Tuikue Ndam
mesh_terms: D000293:Adolescent; D000328:Adult; D000740:Anemia / Q000453:epidemiology / Q000209:etiology*; D001541:Benin / Q000453:epidemiology; D015331:Cohort Studies; D003955:Diagnostic Tests, Routine / Q000379:methods*; D005260:Female; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D008137:Longitudinal Studies; D016778:Malaria, Falciparum / Q000150:complications* / Q000453:epidemiology; D008853:Microscopy; D016133:Polymerase Chain Reaction; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious; D047928:Premature Birth; D011446:Prospective Studies; D055815:Young Adult
keywords: PCR; Plasmodium falciparum; malaria; pregnancy; submicroscopic