Placental malaria and pregnancy outcome in a peri urban area in Senegal

BACKGROUND: In areas of seasonal malaria transmission in Senegal, two previous studies have found that maternal direct obstetrics deaths and preeclampsia were more frequent during the rainy/malaria season. These observations suggest a possible link between malaria and maternal or fetal morbidity and mortality. In this study, we explore this link in a peri urban maternity in Senegal. METHODS: We carried out an exhaustive survey at "Maternite Roi-Baudouin" in Guediawaye, which is the main maternity of the suburb of Dakar, Senegal. From August 1998 to December 1999, we included all women attending the maternity for delivery. Placental malaria was diagnosed by the presence of parasites or malarial pigment in placental apposition. Delivery diagnosis was assessed by obstetricians or midwives. Sociodemographic data and information about chloroquine intake were recorded. Multivariate analysis was performed to compare prevalence of placental malaria between normal and poor deliveries outcomes. RESULTS: Eight thousand two hundred and seventy three women were included. There were 5597 (67.7%) normal deliveries, 1214 (14.6%) low birth weight babies (<2500 g) and 1462 (17.7%) deliveries with a maternal or fetal poor outcome. Placental malaria prevalence was 9.5% (785/8273). Placental malaria was associated with low birth weight (adjusted OR=2.06 (1.72-2.57)), preterm birth (adjusted OR=3.51 (1.84-6.68)) and perinatal mortality (adjusted OR=2.56 (1.65-3.97)). We did not find an association between placental malaria and occurrence of a maternal pathology (dystocia, preeclampsia, eclampsia, retroplacental haematoma). CONCLUSION: Although malaria at delivery is not associated with occurrence of a maternal obstetric pathology, it has detrimental effects for the fetus and newborns. Effective antimalarial strategies during the antenatal period are urgently needed.