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PLACENTAL MONOCYTE INFILTRATES IN RESPONSE TO PLASMODIUM FALCIPARUM MALARIA INFECTION AND THEIR ASSOCIATION WITH ADVERSE PREGNANCY OUTCOMES

Maternal anemia and low birth weight (LBW) may complicate malaria in pregnancy, and placental monocyte infiltrates have been associated with LBW, and anecdotally with anemia. We examined placental pathology from 357 Malawian women. Intervillous monocyte infiltrates were frequent in placental malaria and were not seen in uninfected placentas. Histology was grouped according to a 5-point scale. Dense monocyte infiltrates and presence of intramonocytic malaria pigment were associated with anemia and LBW. Of factors associated with LBW and/or anemia in univariate analysis, gravidity (P = 0.002), number of antenatal clinic (ANC) visits (P < 0.001), malaria pigment in fibrin (P = 0.03), and monocyte malaria pigment (P = 0.0001) remained associated with lower birth weight by multivariate analysis. Associated with maternal anemia were HIV infection (P < 0.0001), intervillous monocyte numbers (P < 0.0001), number of ANC visits (P = 0.002), and recent febrile symptoms (P = 0.0001). Pigment-containing placental monocytes are associated with anemia and LBW due to malaria, and may have a causative role in their development.

Received April 20, 2002. Accepted for publication October 14, 2002.

Acknowledgments: We thank M. Kanjala, P. Mkundika, E. Chaluluka, L. Njiragoma, and R. Jere for assistance with sample collection, Ian Hastings for assistance with statistical analysis, and James Beeson and Steve Meshnick for comments on the manuscript.

Financial support: This work was supported by the Wellcome Trust, UK, through a Career Development Fellowship to SJR (046012) and a Research Leave Fellowship to MEM (042390).

Reprint requests: Dr. S. J. Rogerson, University of Melbourne, Department of Medicine (RMH/WH), Post Office, Royal Melbourne Hospital, Parkville VIC 3050, Australia, Telephone: +61-3-8344-6252, Fax: +61-3-9347-1863, E-mail: sroger{at}unimelb.edu.au

Authors’ addresses: Stephen Rogerson, Department of Medicine (RMH/WH), University of Melbourne, Post Office Royal Melbourne Hospital, Victoria 3050, Australia. Elena Pollina, Department of Histopathology, King’s College Hospital, Denmakr Hill, London SE5 9RS, UK. Abera Getachew, Department of Histopathology, College of Medicine, P.O. Box 360, Blantyre, Malawi. Eyob Tadesse and Valentino Lema, Department of Obstetrics and Gynecology, College of Medicine, P.O. Box 360, Blantyre, Malawi. Malcolm Molyneux, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, P.O. Box 30096, Blantyre 3, Malawi.

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