Case Report: Birth Outcome and Neurodevelopment in Placental Malaria Discordant Twins

Am J Trop Med Hyg. 2019 Mar;100(3):552-555. doi: 10.4269/ajtmh.18-0659.

Abstract

Maternal infection during pregnancy can have lasting effects on neurodevelopment, but the impact of malaria in pregnancy on child neurodevelopment is unknown. We present a case of a 24-year-old gravida three woman enrolled at 14 weeks 6 days of gestation in a clinical trial evaluating malaria prevention strategies in pregnancy. She had two blood samples test positive for Plasmodium falciparum using loop-mediated isothermal amplification before 20 weeks of gestation. At 31 weeks 4 days of gestation, the woman presented with preterm premature rupture of membranes, and the twins were delivered by cesarean section. Twin A was 1,920 g and Twin B was 1,320 g. Both placentas tested negative for malaria by microscopy, but the placenta of Twin B had evidence of past malaria by histology. The twins' development was assessed using the Bayley Scales of Infant and Toddler Development-Third Edition. At 1 year chronologic age, Twin B had lower scores across all domains (composite scores: cognitive, Twin A [100], Twin B [70]; motor, Twin A [88], Twin B [73]; language, Twin A [109], Twin B [86]). This effect persisted at 2 years chronologic age (composite scores: cognitive, Twin A [80], Twin B [60]; motor, Twin A [76], Twin B [67]; language, Twin A [77], Twin B [59]). Infant health was similar over the first 2 years of life. We report differences in neurodevelopmental outcomes in placental malaria-discordant dizygotic twins. Additional research is needed to evaluate the impact of placental malaria on neurodevelopmental complications. Trial registration number: ClinicalTrials.gov number, NCT02163447. Registered: June 2014, https://clinicaltrials.gov/ct2/show/NCT02163447.

Publication types

  • Case Reports

MeSH terms

  • Antimalarials / administration & dosage
  • Antimalarials / pharmacology
  • Artemisinins / administration & dosage
  • Artemisinins / pharmacology
  • Developmental Disabilities / etiology*
  • Diseases in Twins*
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Malaria / complications*
  • Malaria / prevention & control
  • Placenta / parasitology*
  • Pregnancy
  • Pregnancy Complications, Parasitic / pathology*
  • Pregnancy Outcome
  • Premature Birth
  • Quinolines / administration & dosage
  • Quinolines / pharmacology

Substances

  • Antimalarials
  • Artemisinins
  • Quinolines
  • dihydroartemisinin
  • piperaquine

Associated data

  • ClinicalTrials.gov/NCT02163447