TITLE:
Association between Placenta Malaria Parasites and Preeclampsia/Eclampsia among Parturient Mothers in Alex Ekwueme Federal University Teaching Hospital Abakaliki
AUTHORS:
Ayodele A. Olaleye, Leonard O. Ajah, Boniface N. Ejikeme, Justus N. Eze, Virtus O. Obi, Adeniyi J. Adebayo, Ikenna C. Ebere, Alfred N. Adiele, Festus Iyare
KEYWORDS:
Placental Malaria, Preeclampsia/Eclampsia, Maternal, Perinatal, Morbidities and Mortality
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.13 No.3,
March
21,
2023
ABSTRACT: In
tropical countries, malaria and preeclampsia/eclampsia are common diseases of
pregnancy; and placenta have been implicated in the pathophysiology of both
disease processes. The two diseases have pathophysiologic similarities in the
placenta such as placenta ischaemia, endothelial dysfunction and production of
pro-inflammatory cytokine. Yet, there is paucity of studies on the association
of these two disease processes. Determining the association between the two
disease processes may help to unravel the pathogenesis of preeclampsia and also
help in its prevention and patient management. Objective: Determined the
association between placenta malaria parasitemia and preeclampsia/eclampsia
among parturients at Alex Ekwueme Federal University Teaching Hospital
Abakaliki. Materials and Methods: This was a case control study that was
conducted in the Labour wards of department of Obstetrics and Gynaecology, Alex
Ekwueme Federal University Teaching Hospital Abakaliki (AEFUTHA) and Mile 4
Missionary Hospital Abakaliki, a comprehensive health care centre in Abakaliki,
Ebonyi state. It was conducted over a period of 6 months between 1st October 2021 and 31st March, 2022. The cases in this study were
parturients that developed preeclampsia/eclampsia in the course of pregnancy,
while the controls were parturient without preeclampsia/eclampsia.
Interviewer-administered questionnaires were used to collect data on
socio-demographic characteristics, obstetrics and medical histories.
Histological examinations were conducted to isolate plasmodium falciparum parasites
from placenta samples obtained from the maternal surface of the placenta. The
data was processed using Epi Info software. Categorical variables were analyzed
using Mc Nemar X2 test, with a p-value of 0.05 considered
statistically significant. Logistic regression models were used to estimate the
odds ratios (OR) and 95% CI of the association between placenta malaria
parasites and preeclampsia/eclampsia was conducted. Relative risk with 95% CI
was used to determine both fetal and maternal outcomes. Results: The
prevalence of preeclampsia during the study period was 2.9%. Placenta malaria was
positive in twenty one (21) of the 67 cases of preeclampsia/eclampsia analyzed,
giving a prevalence of 31.3% and in eleven (11) out of 68 controls
(normotensive) patients analyzed, giving a prevalence of 16.2%. The presence of placenta
malaria significantly increased the odds of developing preeclampsia/eclampsia
among parturients (OR = 2.4, 95% CI = 1.0 - 5.4, P
value = 0.04). Presence of placenta malaria in mothers with
preeclampsia/eclampsia was associated with adverse pregnancy outcomes such as
cerebrovascular accident (RR = 19.2, 95% CI = 1.1 - 341.7, P value = 0.04), DIC (RR = 10.9, 95% CI = 1.4
- 88.0, P value = 0.02), abruptio placenta (RR = 2.4, 95% CI = 1.2 - 4.8, P
value = 0.01), pulmonary edema (RR = 2.7, 95% CI = 1.1 - 25.9, P value = 0.03),
IUGR (RR = 2.1, 95% CI = 1.1 - 4.5, P value = 0.03) and IUFD (RR = 3.8, 95% CI
= 1.3 - 11.7, P value = 0.02). Presence of placenta malaria also increased the
risk of NICU admission (RR = 2.6, 95% CI = 1.1 - 6.0, P value = 0.03), Low 1st minute APGAR score (RR = 2.7, 95% CI = 1.2 - 6.1, P value = 0.02) and Low 5th minute APGAR score (RR = 3.0, 95% CI = 1.0 - 8.6, P value = 0.04) among
neonates delivered by mothers with preeclampsia/eclampsia. However, presence of
placenta malaria did not significantly increase maternal and perinatal
mortalities. Conclusion: There is a higher prevalence of placenta
malaria among mothers with preeclampsia/eclampsia when compared with normotensive
controls and this was associated with increased risk of certain maternal and
perinatal morbidities. Placental malaria was not associated with increased risk
of either maternal or perinatal mortality.