Malaria in pregnancy in an area of stable and intense transmission: is it asymptomatic?

OBJECTIVE To report a study of the signs and symptoms of malarial infection during pregnancy in an area of stable and intense transmission. METHODS As part of a clinical trial, to assess the efficacy and safety of four antimalarial drug regimens in pregnant women, we collected clinical and laboratory data from 900 parasitaemic pregnant women and 223 non-parasitaemic pregnant women who attended an antenatal clinic at a district hospital in Ghana. Frequencies of signs and symptoms were calculated and their association with the level of parasitaemia was assessed using multivariate logistic regression. RESULTS History of fever (7.8%vs. 44.4%; P < 0.0001), headache (12.5%vs. 43.9%; P < 0.0001), vomiting (0 vs. 11.5%; P = 0.01), malaise (1.6%vs. 31.6%; P < 0.0001) dizziness (0%vs. 23%; P < 0.0001) and fatigue (0%vs. 22.5%; P < 0.0001) was substantially higher in parasitaemic primigravidae than in aparasitaemic primigravid women. Similar differences in the distribution of the symptoms and signs were observed between parasitaemic and aparasitaemic multigravid women. The proportion of women with elevated concentrations of aspartate aminotransferase, alanine aminotransferase and total bilirubin and its fractions was also higher in parasitaemic than in non-parasitaemic women. CONCLUSION In areas of stable malarial transmission, malaria in pregnancy is often symptomatic. Although the symptoms are mostly non-specific, careful recording of history may be useful to identify women who need a confirmatory test and an effective antimalarial treatment.