CLINICAL ARTICLE Pregnancy outcomes in women with or without placental malaria infection S.N. Kassam a , S. Nesbitt b , L.P. Hunt c , N. Oster d , P. Soothill e , C. Sergi a,f, * a School of Biomedical Sciences, University of Bristol, Bristol, UK b Department of Paediatrics, Gertrude’s Garden Children’s Hospital, Nairobi, Kenya c Department of Clinical Sciences at South Bristol, University of Bristol, UK d Department of Parasitology, University of Heidelberg, Medical Faculty, Heidelberg, Germany e Department of Obstetrics and Gynecology, University of Bristol, Bristol, UK f Pediatric Pathology Unit, Institute of Pathology, Innsbruck Medical University, Austria Received 19 October 2005; received in revised form 14 February 2006; accepted 28 February 2006 Abstract Objective: To assess delivery outcomes in women with placental malaria who presented at public hospitals in Kisumu, a holoendemic region in western Kenya. Methods: A cross-sectional study using both histology and molecular biology was conducted with 90 consecutive pregnant women who presented at 3 hospitals during a 2-week period. Data collectors completed standardized questionnaires using each patient’s hospital record and physical examination results, and registered birth indices such as weight, head circumference, and weight—head ratio. Malaria infection of the placenta was assessed using a molecular biology approach (for genomic differences among parasite species) as well as histology techniques. Of the 5 histologic classes of placental infection, class 1 corresponds to active infection and class 4 to past infection; class 2 and 3 to active chronic infection; and class 5 to uninfected individuals. Plasmodium species typing was determined by polymerase chain reaction amplification of the parasite’s genome. Results: In newborns at term, low birth weight was directly associated with classes 2 and 4 of placental infection ( P = 0.053 and P = 0.003, respectively), and differences in birth weight remained significant between the 5 classes ( P b 0.001) even after adjusting for parity and mother’s age. Plasmodium falciparum was the only detected parasite. Conclusions: In Kisumu, infection with P. falciparum is an important cause of low birth weight and 0020-7292/$ - see front matter D 2006 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijgo.2006.02.021 * Corresponding author. Institute of Pathology, Medical University of Innsbruck, Muellerstrasse 44, A-6020 Innsbruck, Austria. Tel.: +43 512 507 3669; fax: +43 512 582 088. E-mail address: consolato.sergi@i-med.ac.at (C. Sergi). KEYWORDS Malaria; Pregnancy; Placenta; Histology; Genome International Journal of Gynecology and Obstetrics (2006) 93, 225—232 www.elsevier.com/locate/ijgo