Morphology of the Placenta in Women Infected with Malaria during Pregnancy

Abstract

Malaria in pregnancy may cause changes in placental morphology and result in alteration in maternal-fetal perfusion contributing to adverse pregnancy outcomes. It is not fully understood how malaria in pregnancy alters the terminal villus and how these relate to pregnancy outcome. We aimed determine placenta terminal villi morphology in patients with and without malaria in pregnancy. The study followed a retrospective cohort design in which 116 placentae, 58 from mothers who have had malaria in pregnancy and 58 from mothers without a history of malaria in pregnancy were assessed by histological examination. Statistical analyses were performed using SPSS to compare features of the placenta in the two groups. From the findings, the odds of having low placental weight was significantly higher for those with malaria compared to those without malaria (mean placental weights 478.27g ± 40.95 and 511.55g ± 35.58 respectively ; P=0.001, OR=4.424). Morphometric analyses showed significantly higher counts of syncytial knot (p-value <0.001, CI: 1.549 - 4.596) and delamination (p-value 0.01, CI: 0.715 - 4.667), fibrin deposition (p-value 0.009, CI: 0.029 - 0.188), smaller intervillous space area (p-value 0.036, CI: -0.013- -0.362) and (p-value 0.004, CI: 0.846 - 3.98) in placenta from mothers with malaria in pregnancy compared to the non-exposed group. The findings provide a morphological basis for understanding adverse pregnancy outcomes in women who have had malaria in pregnancy. Measures should be put in place aggressively to treat and hence reduce the severity of adverse feto-maternal outcomes of malaria infection in pregnant mothers.