Impact of Plasmodium falciparum malaria infection on serum cortisol, adrenocorticotropic hormone, pregnancy associated plasma protein-A and alpha-fetoprotein in pregnant women at Nnewi

Abstract

The present study assessed the maternal cortisol, Adrenocorticotropic hormone (ACTH), Pregnancy associated plasma protein-A (PAPP-A) and alpha-fetoprotein (AFP) concentrations in malaria infected pregnant women. A total of 76 (40 apparently healthy pregnant and 36 malaria-infected pregnant) women aged 18-40 years were prospectively recruited. Early morning blood samples (5 ml) were collected from each subject at 1st and 2nd trimesters. 1 ml of whole blood was used for the diagnosis of P. falciparum malaria using malaria Plasmodium falciparum Rapid Test Device (RTD) and Giemsa stained thick blood smears for microscopic detection of P. falciparum parasites while the remaining 4 ml was centrifuged, separated and serum used for estimation of cortisol, ACTH, AFP and PAPP-A using ELISA-based method. The mean cortisol (125.80 ±30.80 ng/ml) and AFP (1.9 ±0.7 MoM) concentrations in malaria-infected pregnant women were significantly (p<0.05) higher than those of normal pregnant women (86.70 ±3.30 and 1.5 ±0.7 respectively). Malaria-infected pregnant women had higher percentage of low birth weight babies (27.8%), preeclampsia (11.1%), premature rupture of membrane (11.1%), preterm delivery (30.6%), miscarriages (27.8%) and low APGAR score at one minute (2.8%). This shows the possible impact of malaria infection on pregnancy and birth outcomes. The increased cortisol concentration in malaria infected pregnant women shows that malaria infection in pregnancy increases the stress pregnant women are exposed to but the placental defect associated with increased placental permeability to AFP is not related to the effect of the stress (cortisol) and thus does not influence birth outcomes.

Keywords: Plasmodium falciparum, pregnancy, cortisol, maternal serum markers, pregnancy outcome.