Malaria in the Post-Partum Period; a Prospective Cohort Study
Background: Several studies have shown a prolonged or increased susceptibility to malaria in the post-partum period. A matched cohort study was conducted to evaluate prospectively the susceptibility to malaria of post-partum women in an area where P.falciparum and P.vivax are prevalent. Methods: In...
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th-mahidol.310542018-10-19T12:28:56Z Malaria in the Post-Partum Period; a Prospective Cohort Study Machteld E. Boel Marcus J. Rijken Tjalling Leenstra Aung Pyae Phyo Mupawjay Pimanpanarak Naw Lily Keereecharoen Stephane Proux Natthapon Laochan Mallika Imwong Pratap Singhasivanon Nicholas J. White Rose McGready François H. Nosten Shoklo Malaria Research Unit Academic Medical Centre, University of Amsterdam Mahidol University Nuffield Department of Clinical Medicine Agricultural and Biological Sciences Biochemistry, Genetics and Molecular Biology Medicine Background: Several studies have shown a prolonged or increased susceptibility to malaria in the post-partum period. A matched cohort study was conducted to evaluate prospectively the susceptibility to malaria of post-partum women in an area where P.falciparum and P.vivax are prevalent. Methods: In an area of low seasonal malaria transmission on the Thai-Myanmar border pregnant women attending antenatal clinics were matched to a non-pregnant, non-post-partum control and followed up prospectively until 12 weeks after delivery. Results: Post-partum women (n = 744) experienced significantly less P.falciparum episodes than controls (hazard ratio (HR) 0.39 (95%CI 0.21-0.72) p = 0.003) but significantly more P.vivax (HR 1.34 (1.05-1.72) p = 0.018). The reduced risk of falciparum malaria was accounted for by reduced exposure, whereas a history of P.vivax infection during pregnancy was a strong risk factor for P.vivax in post-partum women (HR 13.98 (9.13-21.41), p<0.001). After controlling for effect modification by history of P.vivax, post-partum women were not more susceptible to P.vivax than controls (HR: 0.33 (0.21-0.51), p<0.001). Genotyping of pre-and post-partum infections (n⊕ = ⊕10) showed that each post-partum P.falciparum was a newly acquired infection. Conclusions: In this area of low seasonal malaria transmission post-partum women were less likely to develop falciparum malaria but more likely to develop vivax malaria than controls. This was explained by reduced risk of exposure and increased risk of relapse, respectively. There was no evidence for altered susceptibility to malaria in the post-partum period. The treatment of vivax malaria during and immediately after pregnancy needs to be improved. © 2013 Boel et al. 2018-10-19T04:31:22Z 2018-10-19T04:31:22Z 2013-03-13 Article PLoS ONE. Vol.8, No.3 (2013) 10.1371/journal.pone.0057890 19326203 2-s2.0-84874854224 https://repository.li.mahidol.ac.th/handle/123456789/31054 Mahidol University SCOPUS https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=84874854224&origin=inward |
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Agricultural and Biological Sciences Biochemistry, Genetics and Molecular Biology Medicine Machteld E. Boel Marcus J. Rijken Tjalling Leenstra Aung Pyae Phyo Mupawjay Pimanpanarak Naw Lily Keereecharoen Stephane Proux Natthapon Laochan Mallika Imwong Pratap Singhasivanon Nicholas J. White Rose McGready François H. Nosten Malaria in the Post-Partum Period; a Prospective Cohort Study |
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Background: Several studies have shown a prolonged or increased susceptibility to malaria in the post-partum period. A matched cohort study was conducted to evaluate prospectively the susceptibility to malaria of post-partum women in an area where P.falciparum and P.vivax are prevalent. Methods: In an area of low seasonal malaria transmission on the Thai-Myanmar border pregnant women attending antenatal clinics were matched to a non-pregnant, non-post-partum control and followed up prospectively until 12 weeks after delivery. Results: Post-partum women (n = 744) experienced significantly less P.falciparum episodes than controls (hazard ratio (HR) 0.39 (95%CI 0.21-0.72) p = 0.003) but significantly more P.vivax (HR 1.34 (1.05-1.72) p = 0.018). The reduced risk of falciparum malaria was accounted for by reduced exposure, whereas a history of P.vivax infection during pregnancy was a strong risk factor for P.vivax in post-partum women (HR 13.98 (9.13-21.41), p<0.001). After controlling for effect modification by history of P.vivax, post-partum women were not more susceptible to P.vivax than controls (HR: 0.33 (0.21-0.51), p<0.001). Genotyping of pre-and post-partum infections (n⊕ = ⊕10) showed that each post-partum P.falciparum was a newly acquired infection. Conclusions: In this area of low seasonal malaria transmission post-partum women were less likely to develop falciparum malaria but more likely to develop vivax malaria than controls. This was explained by reduced risk of exposure and increased risk of relapse, respectively. There was no evidence for altered susceptibility to malaria in the post-partum period. The treatment of vivax malaria during and immediately after pregnancy needs to be improved. © 2013 Boel et al. |
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Shoklo Malaria Research Unit |
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Shoklo Malaria Research Unit Machteld E. Boel Marcus J. Rijken Tjalling Leenstra Aung Pyae Phyo Mupawjay Pimanpanarak Naw Lily Keereecharoen Stephane Proux Natthapon Laochan Mallika Imwong Pratap Singhasivanon Nicholas J. White Rose McGready François H. Nosten |
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Article |
author |
Machteld E. Boel Marcus J. Rijken Tjalling Leenstra Aung Pyae Phyo Mupawjay Pimanpanarak Naw Lily Keereecharoen Stephane Proux Natthapon Laochan Mallika Imwong Pratap Singhasivanon Nicholas J. White Rose McGready François H. Nosten |
author_sort |
Machteld E. Boel |
title |
Malaria in the Post-Partum Period; a Prospective Cohort Study |
title_short |
Malaria in the Post-Partum Period; a Prospective Cohort Study |
title_full |
Malaria in the Post-Partum Period; a Prospective Cohort Study |
title_fullStr |
Malaria in the Post-Partum Period; a Prospective Cohort Study |
title_full_unstemmed |
Malaria in the Post-Partum Period; a Prospective Cohort Study |
title_sort |
malaria in the post-partum period; a prospective cohort study |
publishDate |
2018 |
url |
https://repository.li.mahidol.ac.th/handle/123456789/31054 |
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1763496092853338112 |