Fetal and maternal hemodynamics in acute malaria during pregnancy

Objective: To measure maternal and fetal hemodynamics during acute malaria in pregnancy. Methods: Time courses of maternal heart rate (MHR), maternal blood pressure (BP), and fetal heart rate (FHR) were performed until 56 days after initiation of anti-malarial treatment with artemether-lumefantrine. Women with malaria were hospitalized for at least 3 days until recovery. Results: Mean baseline characteristics of pregnant women with malaria (n =38) versus pregnant women without malaria (n = 39) were as follows: gestational age (28.8 vs 24.6 weeks: P = 0.006); maximum FHR (165.3 vs 158.3 beats per minute [bpm]; P = 0.054); minimum FHR (137.6 vs 128.7 bpm; P = 0.016); mean BP (74.7 vs 80.9 mm Hg; P = 0.001); pulse pressure (40.3 vs 42.1 mm Hg; P = 0.300): and MHR (107.4 vs 81.3 bpm; P < 0.001). The geometric mean parasite count was 13 795 per mu L. Complete time courses were collected from a subgroup of participants. For women with malaria, maternal body temperature and BP normalized within 24 hours and after 72 hours, respectively. The MHR among pregnant women without malaria showed a physiologic increase during pregnancy of approximately 7 bpm between days 0 and 56. The mean FHR among women with malaria normalized after 72 hours. Conclusion: Acute malaria induces maternal and fetal hemodynamic changes. (c) 2012 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.