Risk factors and mechanisms of preterm delivery in Malawi.

Abstract

PROBLEM:

We examined risk factors and mechanisms of preterm delivery (PTD) in malaria-exposed pregnant women in Blantyre, Malawi.

METHOD OF STUDY:

The human immunodeficiency virus (HIV), malaria, syphilis, and anemia were assessed in a cross-sectional study of 572 pregnant women. In a nested case-control study, chorioamnionitis (CAM) was examined; tumor necrosis factor (TNF)-alpha, interleukin (IL)-6, IL-8, macrophage inflammatory protein (MIP)-1alpha, monocyte chemotactic protein (MCP)-1, transforming growth factor (TGF)-beta, cortisol, and corticotropin-releasing hormone were measured in placental, maternal and/or cord blood.

RESULTS:

HIV, infrequent antenatal clinic attendance, low-maternal weight, no intermittent preventive malaria therapy (IPT), and CAM were associated with PTD, while malaria was not. Of the 18 compartmental cytokine measurements, elevations in placental and/or cord IL-6 and IL-8 were associated with both CAM and PTD. In contrast, there was no overlap between the cytokines affected by malaria and those associated with PTD.

CONCLUSIONS:

The HIV and CAM were the major infections associated with PTD in this study. CAM, but not malaria, causes PTD via its effect on proinflammatory cytokines.

• Authors: Elizabeth T Abrams, Danny A Milner Jr, Jesse Kwiek, Victor Mwapasa, Deborah D Kamwendo, Donglin Zeng, Eyob Tadesse, Valentino M Lema, Malcolm E Molyneux, Stephen J Rogerson, Steven R Meshnick
• Journal: American journal of reproductive immunology (New York, N.Y. : 1989) (Am J Reprod Immunol) Vol. 52 Issue 2 Pg. 174-83 (Aug 2004) ISSN: 1046-7408 [Print] Denmark
• PMID: 15274659 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, P.H.S.)

Chemical References

• Chemokines
• Cytokines

Topics

• Anemia (epidemiology)
• Case-Control Studies
• Chemokines (metabolism)
• Chorioamnionitis (epidemiology)
• Cytokines (metabolism)
• Female
• HIV Infections (epidemiology)
• Humans
• Malaria (epidemiology)
• Malawi
• Pregnancy
• Premature Birth (epidemiology, metabolism)
• Risk Factors