Malaria, anaemia and pregnancy

Physicians at University College Hospital in Ibadan Nigeria selected 250 initially unmarried 17-25 year old women employed at the hospital as subjects of a prospective study of the relationship between malaria anemia and 1st pregnancy. 60 women later became pregnant. Physicians gave full physical examination to each of the 250 women which included urine analysis determination of liver and spleen size and a variety of hematologic tests such as packed cell volume (PCV) and blood film for malaria parasites. The frequency of malaria parasitemia and the density of infection were higher in pregnant women (4-12 times more frequent and 1775 parasites/cubic mm respectively) than the same women prior to pregnancy or in the nonpregnant women. Plasmodium falciparum caused infection in almost all cases with P. malariae being responsible for only 4 cases. The incidence of splenomegaly was much higher in the group of pregnant women (42%) than found in the same women before pregnancy. 38 women did not take antimalaria chemoprophylaxis until that point in pregnancy when treatment was necessary and 24 (63%) of them developed hemolytic anemia (PCV <28%). On the other hand none of the 19 women who received antimalarial drugs developed hemolytic anemia but 1 did develop megaloblastic anemia in the 18th week. The hemolytic anemia occurred between weeks 16-24. In some cases PCV fell before the appearance of detectable parasite densities and hemolysis continued for 2 weeks after chloroquine therapy effectively eliminated parasites. In a country where malaria is endemic administering antimalarial drugs prophylactically throughout pregnancy is the most important antenatal treatment.