Risk Factors and Mechanisms of Preterm Delivery in Malawi
Article first published online: 26 JUL 2004
American Journal of Reproductive Immunology
Volume 52, Issue 2, pages 174–183, August 2004
How to Cite
Abrams, E. T., Milner, D. A., Kwiek, J., Mwapasa, V., Kamwendo, D. D., Zeng, D., Tadesse, E., Lema, V. M., Molyneux, M. E., Rogerson, S. J. and Meshnick, S. R. (2004), Risk Factors and Mechanisms of Preterm Delivery in Malawi. American Journal of Reproductive Immunology, 52: 174–183. doi: 10.1111/j.1600-0897.2004.00186.x
- Issue published online: 26 JUL 2004
- Article first published online: 26 JUL 2004
- Submitted October 23, 2003; revised April 29, 2004; accepted May 3, 2004.
- human immunodeficiency virus;
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)-α, interleukin (IL)-6, IL-8, macrophage inflammatory protein (MIP)-1α, monocyte chemotactic protein (MCP)-1, transforming growth factor (TGF)-β, 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.