Malaria in Pregnancy

Key points

• Worldwide, malaria is the cause of severe maternal and perinatal morbidity and mortality.
• The peak incidence of travel-associated cases in the UK occurs in the population aged 15-44.
• No systematic information exists about the number of women with malaria in the UK who are pregnant, the populations in the UK in which malaria in pregnancy occurs, how these pregnant women with malaria are treated or the consequences of the disease in these women and their infants.
• This study will describe the epidemiology of malaria in pregnancy in the UK and the outcomes for both women and their infants.

Surveillance Period

November 2008 - October 2011

Background

Worldwide, malaria is the cause of severe maternal and perinatal morbidity and mortality. It is estimated that the population attributable fraction of maternal deaths due to malaria in sub-Saharan Africa is up to 23% and of neonatal deaths 18%^[1]. Research in African and Asian populations shows that pregnant women are at higher risk both of acquiring disease and of suffering from more severe disease than non-pregnant women^[1]. Malaria can cause severe anaemia, and in semi-immune populations may be associated with few other symptoms prior to the onset of severe complications such as adult respiratory distress syndrome or death, due to the sequestration of malarial parasites within the placenta^[2]. In non-immune pregnant women, infection with falciparum malaria is more likely to lead to severe complications such as cerebral malaria than in the non-pregnant population. Infants are similarly severely affected; maternal malaria may lead to stillbirth and also preterm birth or intrauterine growth retardation, with a consequent increase in neonatal mortality.

The majority of information about malaria in pregnancy comes from populations in which malaria is endemic or epidemic. 1500-2000 travel-associated cases of malaria are reported in the UK annually, with the peak occurring in the population aged 15-44^[3]. However, no information exists about the number of women with malaria in the UK who are pregnant, the populations in the UK in which malaria in pregnancy occurs, how these pregnant women with malaria are treated or the consequences of the disease in these women and their infants. This information is important to develop and implement guidelines for both prevention and management. This descriptive study will describe the epidemiology of malaria in pregnancy in the UK and the outcomes for both women and their infants.

Objectives

• To use the UK Obstetric Surveillance System to describe the epidemiology of malaria in pregnancy in the UK.
• To assess the outcomes for mother and infant following confirmed malaria infection.
• To use this information to inform the development and implementation of guidelines for the prevention and management of malaria in pregnant women in the UK.

Research questions

• What is the incidence of malaria in pregnancy in the UK?
• Does the disease occur in women from specific ethnic groups?
• Does the disease occur in women who have travelled to specific regions outside the UK?
• How and when does the disease present? How is malaria in pregnancy managed in the UK?
• What are the outcomes of malaria in pregnancy for mother and infant?

Case definition

Any woman with:

EITHER a positive blood film for malaria parasites

OR confirmed placental malaria

at any time during pregnancy or immediately postpartum (before discharge from hospital after delivery).

Funding

Departmental sources.

Ethics approval

The study has been approved by the London MREC (study ref 08/H0718/60).

Investigators

• Marian Knight, Jennifer Kurinczuk, Peter Brocklehurst, National Perinatal Epidemiology Unit
• Richard Pebody, Jane Jones, Health Protection Agency
• Christopher Whitty, London School of Hygiene and Tropical Medicine
• Peter Chiodini, Hospital for Tropical Diseases

Download the Data Collection Form (DCF)

UKOSS Malaria in Pregnancy Form