Dynamics of persistent submicroscopic and microscopic Plasmodium falciparum in pregnant women under IPTp: a study cohort in Benin
Sayeh Jafari-Guemouri, Robinson Dégbègni, Laura Courtois, Manfred Accrombessi, Achille Massougbodji, Xavier C Ding, Nicaise Tuikue Ndam, Atika Mama, Nadine Fievet, Véronique Sarrasin-Hubert, Gilles Cotrell, Valérie BriandAbstract
Background
Malaria infections in pregnancy are a major cause of maternal morbidity and neonatal mortality in sub-Saharan Africa. A high proportion of these infections are submicroscopic, which are usually asymptomatic and therefore untreated during pregnancy. Intermittent Preventive Treatment with sulfadoxine-pyrimethamine (IPTp-SP) aims to prevent and treat all potential infections whether or not submicroscopic. However, the resistance of parasites to SP is steadily increasing. The dynamic of microscopic and submicroscopic infections in a cohort of Beninese women throughout their pregnancy and its relation with IPTp-SP has been assessed.
Methods
As a sub-sample of the RECIPAL project, 130 women with at least two infections detected by Polymerase Chain Reaction (PCR) during their pregnancy were included. Infections were categorized as new (isolated) or persistent based on msp-2 genotyping, where persistent infections had identical genotypes in all studied time points. Submicroscopic infections were defined as PCR-positive and thick blood smear-negative. The persistence of infections according to IPTp-SP uptake was assessed.
Results
73,1% of women (95 women out of 130) had exclusively persistent infections throughout their pregnancy, while only 7,7% (10 out of 130) of them had exclusively new infections. During pregnancy, the median time spent with 1 persistent infection was 7.2 weeks. A considerable proportion of these persistent infections 64,3% (72 out of 113) was only submicroscopic. Approximately, 20% of these persistent infections occurred despite the use of IPTp-SP.
Conclusion
Using new antimalarial combinations could contribute to limit the persistence of submicroscopic infections and their probable negative effects on the mother and the fetus.