@article{fdi:010070326,
  title = {{R}esisting and tolerating {P}-falciparum in pregnancy under different malaria transmission intensities},
  author = {{T}uikue {N}dam, {N}icaise and {M}buba, {E}. and {G}onzalez, {R}. and {C}istero, {P}. and {K}ariuki, {S}. and {S}evene, {E}. and {R}uperez, {M}. and {F}onseca, {A}. {M}. and {V}ala, {A}. and {M}aculuve, {S}. and {J}imenez, {A}. and {Q}uinto, {L}. and {O}uma, {P}. and {R}amharter, {M}. and {A}ponte, {J}. {J}. and {N}hacolo, {A}. and {M}assougbodji, {A}. and {B}riand, {V}al{\'e}rie and {K}remsner, {P}. {G}. and {M}ombo-{N}goma, {G}. and {D}esai, {M}. and {M}acete, {E}. and {C}ot, {M}ichel and {M}enendez, {C}. and {M}ayor, {A}.},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground: {R}esistance and tolerance to {P}lasmodium falciparum can determine the progression of malaria disease. {H}owever, quantitative evidence of tolerance is still limited. {W}e investigated variations in the adverse impact of {P}. falciparum infections among {A}frican pregnant women under different intensities of malaria transmission. {M}ethods: {P}. falciparum at delivery was assessed by microscopy, quantitative {PCR} (q{PCR}) and placental histology in 946 {HIV}-uninfected and 768 {HIV}-infected pregnant women from {B}enin, {G}abon, {K}enya and {M}ozambique. {R}esistance was defined by the proportion of submicroscopic infections and the levels of anti-parasite antibodies quantified by {L}uminex, and tolerance by the relationship of pregnancy outcomes with parasite densities at delivery. {R}esults: {P}. falciparum prevalence by q{PCR} in peripheral and/or placental blood of {HIV}-uninfected {M}ozambican, {G}abonese and {B}eninese women at delivery was 6% (21/340), 11% (28/257) and 41% (143/349), respectively. {T}he proportion of peripheral submicroscopic infections was higher in {B}enin (83%) than in {M}ozambique (60%) and {G}abon (55%; {P} = 0.033). {P}ast or chronic placental {P}. falciparum infection was associated with an increased risk of preterm birth in {M}ozambican newborns ({OR} = 7.05, 95% {CI} 1.79 to 27.82). {M}icroscopic infections were associated with reductions in haemoglobin levels at delivery among {M}ozambican women (-1.17 g/d{L}, 95% {CI} -2.09 to -0.24) as well as with larger drops in haemoglobin levels from recruitment to delivery in {M}ozambican (-1.66 g/d{L}, 95% {CI} -2.68 to -0.64) and {G}abonese (-0.91 g/d{L}, 95% {CI} -1.79 to -0.02) women. {D}oubling q{PCR}-peripheral parasite densities in {M}ozambican women were associated with decreases in haemoglobin levels at delivery (-0.16 g/d{L}, 95% {CI} -0.29 to -0.02) and increases in the drop of haemoglobin levels (-0.29 g/d{L}, 95% {CI} -0.44 to -0.14). {B}eninese women had higher anti-parasite {I}g{G}s than {M}ozambican women ({P} < 0.001). {N}o difference was found in the proportion of submicroscopic infections nor in the adverse impact of {P}. falciparum infections in {HIV}-infected women from {K}enya ({P}. falciparum prevalence by q{PCR}: 9%, 32/351) and {M}ozambique (4%, 15/417). {C}onclusions: {T}he lowest levels of resistance and tolerance in pregnant women from areas of low malaria transmission were accompanied by the largest adverse impact of {P}. falciparum infections. {E}xposure-dependent mechanisms developed by pregnant women to resist the infection and minimise pathology can reduce malaria-related adverse outcomes. {D}istinguishing both types of defences is important to understand how reductions in transmission can affect malaria disease.},
  keywords = {{M}alaria ; {P}regnancy ; {I}mmunity ; {R}esistance ; {T}olerance},
  booktitle = {},
  journal = {{BMC} {M}edicine},
  volume = {15},
  numero = {},
  pages = {art. 130 [12 p.]},
  ISSN = {1741-7015},
  year = {2017},
  DOI = {10.1186/s12916-017-0893-6},
  URL = {https://www.documentation.ird.fr/hor/fdi:010070326},
}