Malaria and HIV Infections in Pregnancy: Maternal, Perinatal and Infant Health Issues

Abstract

In sub-Saharan Africa, several hundreds of pregnancies are exposed to both malaria and HIV infections annually. Consequences of these infections include maternal anemia, immunosuppression, preterm delivery, low birth weight, low Apgar score, and cord malaria. Unfortunately, these infections in relation to these adverse outcomes are not well characterized in Ghana. This study determined whether maternal malaria and HIV infections during pregnancy are associated with increased risk of these outcomes. The study enrolled 1154 (443 HIV-positive and 711 HIV-negati ve) women at their first antenatal visit, and prospectively collected data at delivery on 761 mother-infant pairs. Maternal and cord blood malaria parasitemia status were determined using a Rapid Immunochromatographic Test Kit. Hemoglobin concentrations were determined using an automated hematologic analyzer, and CD4+ count determined using the Becton Dickinson F ACScount system. This study demonstrates a significantly increased risk of LBW among HIV-positive women who had malaria at recruitment; odds ratio (OR) = 4.4, 95% Confidence Interval [CI] (2.3 - 8.4), at delivery; OR = 2.5, 95% CI (1.1 - 3.7), and at both time points; OR = 11.3, 95% CI (4.6 - 27.4). Women dually-infected with HIV and malaria'at both time points had a 4-fold risk of delivering preterm; OR = 3.96, 95% CI (1.8 - 8.5). Neonates with cord malaria were more likely to be born to women dually-infected with HIV and malaria at recruitment and at delivery; OR = 10.5, 95% CI (4.5 - 24.0). Maternal anemia and immunosuppression (as measured by reduced CD4+ count) were significantly associated with maternal infection with malaria and HIV (p < 0.05) in each case. These findings suggest that maternal infection with HIV and/or malaria is associated with increased risk of adverse maternal and perinatal outcomes. Routine screening of pregnant women for both malaria and HIV at antenatal visits, and successful treatment of malaria may reduce these adverse outcomes.