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The Malaria in Pregnancy (MiP) Library is a regularly updated, comprehensive bibliographic database of published and unpublished literature relating to malaria in pregnancy, including a trial registry of planned and ongoing trials. The MiP library is a product of the Malaria in Pregnancy Consortium and is available free of charge.

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Article highlights from the update in January 2015

Article highlights from the update in January 2015:

 

In January 2015, over 160 new entries were added to the MiP library. New entries include peer reviewed journal articles, PhD and MSc theses, and reports. Here we highlight a few articles that may be of particular interest:

A trial in Papua New Guinea in an area with both P. falciparum and P. vivax compared monthly intermittent preventive treatment with sulfadoxine-pyrimethamine (SP) in combination with azithromycin vs. one dose of SP in combination with one treatment course of chloroquine followed by monthly placebo treatment. A significant reduction in low birth weight was seen in the SP-azithromycin arm, although the overall LBW prevalence was still high (15.1%). Other reductions in adverse outcomes were observed (maternal parasitaemia, active placental malaria, carriage of gonorrhoea), with similar numbers of serious adverse events and adverse events in both treatment arms (Unger 2014).

The Cochrane database for Systematic reviews published an important update of the review of chemoprevention for malaria in pregnancy, which includes intermittent preventive treatment and preventive regimens for P. vivax. Only studies with placebo or no intervention controls were used; seventeen trials conducted between 1957 and 2008 were included. High quality evidence was found for an effect on maternal anaemia and parasitemia and placental malaria in paucigravidae, whereas the effect on birthweight was classified as moderate quality evidence (Radevo-Petrova 2014). Treatment of severe malaria in pregnancy finally got the attention it deserves in a review by (Kovacks 2014), which recommends intravenous artesunate for treatment of severe malaria in all trimesters. A review by Huynh et al examined the adverse effects of malaria infection before 20 weeks on pregnancy outcomes; the 6 included studies identified early malaria infection as a serious risk for anaemia and low birthweight (Huynh 2014).

A cohort study from Malawi examined the association between malaria in pregnancy and gametocytaemia and reported that gametocytaemia at enrolment (4.9%) was associated with placental malaria, but not with adverse maternal or foetal outcomes (Boudova 2014). Gametocytaemia was not affected by IPTp, which is an important observation for elimination strategies. In Papua New Guinea, the number of circulating pigmented neutrophils at enrolment had a negative correlation with birth weight, which may be a useful marker to detect high risk women (Chua 2014). A study from Brazil highlights the potential of using PCR and serology in a low endemic area for the detection of a hidden malaria burden (and species) in pregnant women (Hristov 2014).

The reduced risk of malaria in an infant’s first 6 months of life has commonly been attributed to the persistence of foetal haemoglobin (which is a different type of haemoglobin compared to later in life). Two studies examined this hypothesis. One in vitro study in Gabon found that erythrocytes containing foetal haemoglobin were equally permissive as maternal erythrocytes to P. falciparum growth in vitro whereas the addition of maternal and cord plasma led to reduced parasite growth (Sauerzopf 2014). Whereas a cohort study from Burkina Faso saw an association between foetal haemoglobin and delayed first episode of febrile malaria, and no association between antibody titres to MSP3, GLURP-R0 or GLURP_R2 and early protection against malaria (Kangoye 2014). More studies are needed to further test this hypothesis. Studies examining the long term effects of malaria in pregnancy on the development of infants are not common but very important; a 3 year follow up study in Kenya reported that malaria and other parasitic diseases in pregnancy were associated with impaired ability to develop IgG antibody responses to key protective antigens of Haemophilis influenza and diphtheria in infants (Malhotra 2015). Maternal malaria in pregnancy was however not associated with latent tuberculosis infection or cytokine response to crude culture filtrate proteins of Mycobacterium tuberculosis in five year olds who had received BCG immunisation at birth in Uganda (Lule 2014).

There are several articles relating to the immunology of malaria in pregnancy, either reviewing current knowledge for the development of vaccines (Chan 2014), (Ouattara 2014), or examining the gaps in knowledge, such as factors that influence cytoadherence of P. falciparum (Goel 2014), (Rieger 2015).

Please note that conference proceedings from the 63rd Annual meeting of the American Society of Tropical Medicine and Hygiene in New Orleans have been included where related to malaria in pregnancy and where a formal publication on the subject was not yet available.