Clinical outcomes of submicroscopic infections and correlates of protection of VAR2CSA antibodies in a longitudinal study of pregnant women in Colombia

Research output: Contribution to journalJournal articleResearchpeer-review

  • Kenneth Gavina
  • Sedami Gnidehou
  • Eliana Arango
  • Chloe Hamel-Martineau
  • Catherine Mitran
  • Olga Agudelo
  • Carolina Lopez
  • Aisha Karidio
  • Shanna Banman
  • Jaime Carmona-Fonseca
  • Salanti, Ali
  • Nicaise Tuikue Ndam
  • Michael Hawkes
  • Amanda Maestre
  • Stephanie K Yanow

Malaria in pregnancy can cause serious adverse outcomes for the mother and the fetus. However, little is known about the effects of submicroscopic infections (SMIs) in pregnancy, particularly in areas wherePlasmodium falciparumandPlasmodium vivaxcocirculate. A cohort of 187 pregnant women living in Puerto Libertador in northwest Colombia was followed longitudinally from recruitment to delivery. Malaria was diagnosed by microscopy, reverse transcription-quantitative PCR (RT-qPCR), and placental histopathology. Gestational age, hemoglobin concentration, VAR2CSA-specific IgG levels, and adhesion-blocking antibodies were measured during pregnancy. Statistical analyses were performed to evaluate the impact of SMIs on birth weight and other delivery outcomes. Twenty-five percent of women (45/180) were positive for SMIs during pregnancy. Forty-seven percent of infections (21/45) were caused byP. falciparum, 33% were caused byP. vivax, and 20% were caused by mixedPlasmodiumspp. Mixed infections ofP. falciparumandP. vivaxwere associated with lower gestational age at delivery (P= 0.0033), while other outcomes were normal. Over 60% of women had antibodies to VAR2CSA, and there was no difference in antibody levels between those with and without SMIs. The anti-adhesion function of these antibodies was associated with protection from SMI-related anemia at delivery (P= 0.0086). SMIs occur frequently during pregnancy, and while mixed infections of bothP. falciparumandP. vivaxwere not associated with a decrease in birth weight, they were associated with significant risk of preterm birth. We propose that the lack of adverse delivery outcomes is due to functional VAR2CSA antibodies that can protect pregnant women from SMI-related anemia.

Original languageEnglish
Article numbere00797-17
JournalInfection and Immunity
Volume86
Issue number4
ISSN0019-9567
DOIs
Publication statusPublished - Apr 2018

ID: 194042906