title: Malaria in pregnancy: a passive surveillance study of pregnant women in low transmission areas of Colombia, Latin America.
abstract: BACKGROUND
  Malaria causes a significant burden in highly endemic areas where children and pregnant women are more susceptible to severe disease and death, however, in low transmission settings malaria in pregnant women is less frequent. The aim of this study was to provide information of clinical profile, anti-parasite host immune responses and parasite genotyping of pregnant women with malaria in low endemic areas of Colombia.
  
  
  METHODS
  This was a descriptive study conducted through passive surveillance in 1328 individuals from three endemic areas of Córdoba, Nariño and Chocó departments between 2011 and 2013. Trained physicians confirmed the pregnancy status and recorded clinical and epidemiological information. Haematological parameters, as well as hepatic and renal function, anti-malarial antibodies and parasite genotypes were evaluated.
  
  
  RESULTS
  A total of 582 women presented with malaria infection, 34 of whom were pregnant (5.8 %), and most were infected by Plasmodium falciparum (n = 24). In 44 % (n = 15) of the women, the infection occurred during the first half of pregnancy. Although uncomplicated disease and parasitaemia ≤20,000 parasites/µL were common (n = 31), three women (8.8 %) infected by P. falciparum were classified as severe cases. Mild to moderate anaemia (68 %) and mild thrombocytopaenia (41 %) were the most frequent blood alterations and in four women acute renal failure was observed. Six women presented a second malaria episode during pregnancy mainly caused by P. vivax (n = 5), although no direct evidence of relapse was found by genotyping. Two out of the six women presenting a second malaria episode had severe malaria. A low prevalence of specific anti-parasite antibodies was found. Microsatellites indicated that all P. vivax infections involved multiple lineages whereas all but one P. falciparum infections harboured single genotypes.
  
  
  CONCLUSIONS
  Most malaria infected pregnant women displayed uncomplicated malaria, although a few of them with a second malaria episode presented an increased risk of severe malaria which appeared to be associated with malaria transmission intensity and not with levels of anti-parasite antibodies. The effects of severe malaria in both mother and fetus warrant future studies in low transmission settings.
authors: Caucaseco Scientific Research Center, Cali, Colombia. marlopez@inmuno.org.
authors: Mary
authors: M
authors: Lopez-Perez
authors: Institute for Genomics and Evolutionary Medicine (igem), Temple University, Philadelphia, PA, USA. tug00270@temple.edu.
authors: M Andreína
authors: MA
authors: Pacheco
authors: Caucaseco Scientific Research Center, Cali, Colombia. nburitica@inmuno.org.
authors: Lucía
authors: L
authors: Buriticá
authors: Institute for Genomics and Evolutionary Medicine (igem), Temple University, Philadelphia, PA, USA. Ananias.escalante@temple.edu.|Department of Biology, Temple University, Philadelphia, PA, USA. Ananias.escalante@temple.edu.
authors: Ananias A
authors: AA
authors: Escalante
authors: Caucaseco Scientific Research Center, Cali, Colombia. sherrera@inmuno.org.
authors: Sócrates
authors: S
authors: Herrera
authors: Caucaseco Scientific Research Center, Cali, Colombia. marevalo@inmuno.org.|Faculty of Health, Universidad del Valle, Cali, Colombia. marevalo@inmuno.org.
authors: Myriam
authors: M
authors: Arévalo-Herrera
mesh_terms: D003105:Colombia / Q000453:epidemiology; D005260:Female; D005838:Genotype; D006801:Humans; D008288:Malaria / Q000175:diagnosis / Q000453:epidemiology / Q000635:transmission*; D016778:Malaria, Falciparum / Q000175:diagnosis / Q000453:epidemiology / Q000635:transmission; D010963:Plasmodium falciparum / Q000502:physiology; D011159:Population Surveillance; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000175:diagnosis / Q000453:epidemiology