Fetal and maternal hemodynamics in acute malaria during pregnancy

ObjectiveTo measure maternal and fetal hemodynamics during acute malaria in pregnancy.MethodsTime 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.ResultsMean 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 μL. 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.ConclusionAcute malaria induces maternal and fetal hemodynamic changes.