Prevalence of Placental Malaria Relative to Placental Cytokines and Birth Anthropometry Among Sub-Sahara Black African Women in their First or Second Pregnancy

Abstract

Introduction: Pregnancy is a complex condition during which pathological complications such as iron deficiency anemia, infections, under- or over-nutrition and excessive production of cytokines may occur to jeopardize the well-being of the fetus. Objective: The objective of this study was to evaluate the interactions between placental or peripheral  malaria (PlacMal or PerMal), Tumor Necrosis Factor-α (TNF-α), Interferon-γ (IFN-γ), Iron deficiency anemia (IDA), Platelets (Plt) and immature granulocytes (IG) in the placenta and neonatal birthweight, birth length and birth head circumference among study subjects in their 1^st or 2^nd pregnancy in Nigeria. Materials and Method: This was part of a prospective and exploratory study carried out among women in their 1^st and 2^nd pregnancy at Ikorodu General Hospital and its annex, Ita-Elewa Primary Health Care Center at Ikorodu, Lagos, Nigeria. Complete data from 78 women in their 1^st or 2^nd pregnancy who were assessed for TNF-α and IFN-γ, and whose socio-demographic characteristics, ante-natal history, birth anthropometry, placental hemogram and malaria parasitemia were recorded and analyzed. Data analysis was conducted using  NCSS and STATA softwares. Results: Study participants in their 2^nd pregnancy were significantly older (t-test=4.51, P-value=0.00004) and heavier (t-test=2.44, P-value=0.02) than those in their 1^st pregnancy. While the means of TNF-α<20 pg/ml in subjects with (9.4±1.5) and without (20.3±24.1) PlacMal were notably different (t-test=3.74, P-value=0.0004), the means in subjects with (20.3±14.8) and without PerMal (19.8±25.4) were insignificant.  At normal TNF of <20 pg/ml, mean birth length of neonates from 1^st pregnancy (50.6±1.8 cm) was notable higher (t-test=2.98, P-value=0.005) than that those 2^nd pregnancy (47.8±5.1 cm). Overall birthweight was significantly higher (3.2±0.5) when Hgb was ≥9.5 and TNF-α was <20 pg/ml than when Hgb was ≥9.5 and TNF-α was ≥20 pg/ml. Overall birth length (52.0±0.0) was notably longer (t-test=3.79, P-value=0.004) when IG was >0.456 and Hgb was <9.5 compared to when IG >0.456 and Hgb was ≥9.5. The mean platelets count (x10⁹/L) of subjects with (27.7±14.2) and without (79.6±89.4) PlacMal were significantly different (t-test=3.94, P-value=0.002) but those of subjects with (69.2±50.5) and without (79.6±95.3) PerMal were not. Multivariate regression analysis indicates a positive, statistically significant relationship between birthweight and age group (coeff. = 0.22, SE=0.06, t-test = 3.78, P-value = 0.003). Conclusion: Placental TNF-α, IFN-γ, Platelet count, and IG may have a distinct or combined role to play the the development of gestation process and neonatal anthropometry. More studies are needed to support and substantiate these findings.