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Zahavi I, Fons M, Meir M, Volevich M, Guasch E, Nunnally M, Einav S. Anesthetic approach to pregnant patients with malaria: a narrative review of the literature. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2024; 4:48. [PMID: 39060922 PMCID: PMC11282754 DOI: 10.1186/s44158-024-00185-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Accepted: 07/22/2024] [Indexed: 07/28/2024]
Abstract
INTRODUCTION Anesthesiologists play an important role in the management of labor and delivery during acute malaria infection. The peripartum anesthesia considerations for such cases remain unclear. FINDINGS Important peripartum considerations include the severity of thrombocytopenia and coagulopathy, hemodynamic status and cardiac disease, and the likelihood of central nervous system (CNS) involvement. Several antimalarial drugs may interact with perioperative medications, causing hypoglycemia, methemoglobinemia, or QT prolongation. Labor should usually not be induced. Patient volume status should be optimized pre-induction, but fluids should be administered with caution given the risk of cerebral edema. In case of CNS involvement intracranial pressure should be maintained. Case reports describe the successful use of neuraxial anesthesia but this approach requires further confirmation of safety. Despite the risks accompanying airway management in pregnancy, in some cases, general anesthesia was preferred due to the chance of CNS infection and disease complications. Tight postoperative assessments of neurological and bleeding status are indicated regardless of the mode of delivery. CONCLUSIONS Despite the prevalence of malaria, the perioperative risk and preferred mode of anesthesia for pregnant patients with acute malaria remain under-researched and outcome data are limited.
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Affiliation(s)
- Itay Zahavi
- The Bruce and Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | - Meir Fons
- The Faculty of Medicine of the Hebrew University, Jerusalem, Israel
| | - Michal Meir
- The Bruce and Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- The Pediatric Infectious Disease Unit, Ruth Rappaport Children's Hospital, Rambam Health Care Campus and Bruce and Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Mark Volevich
- The Bruce and Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Emilia Guasch
- Anaesthesia and Reanimation Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Mark Nunnally
- Departments of Anesthesia, Perioperative Care and Pain Medicine, Neurology, Surgery and Medicine, New York University, New York City, NY, USA
| | - Sharon Einav
- The Hebrew University Faculty of Medicine, Jerusalem, Israel
- Maccabi Healthcare Services, Sharon Region, Israel
- Medint Medical Intelligence Ltd, Tel-Aviv, Israel
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Beitze DE, Kavira Malengera C, Barhwamire Kabesha T, Frank J, Scherbaum V. Disparities in health and nutrition between semi-urban and rural mothers and birth outcomes of their newborns in Bukavu, DR Congo: a baseline assessment. Prim Health Care Res Dev 2023; 24:e61. [PMID: 37870120 PMCID: PMC10594532 DOI: 10.1017/s1463423623000518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 03/29/2023] [Accepted: 08/28/2023] [Indexed: 10/24/2023] Open
Abstract
AIM This research aimed to evaluate health and nutritional practices of mothers during pregnancy and birth outcomes of their newborns in Bukavu, Democratic Republic of the Congo (DRC), comparing semi-urban and rural areas. BACKGROUND Health and nutrition during pregnancy are crucial for adequate development of the fetus. Health care plays an important role but is often poor in rural areas of developing countries. METHODS A baseline survey of a nutritional follow-up study was conducted in two semi-urban and one rural hospital in the vicinity of Bukavu, DRC. In total, 471 mother-child pairs were recruited after delivery. Data collection included socio-demographic parameters, nutrition and health measures during pregnancy, and anthropometric parameters. Semi-urban and rural study locations were compared and predictors of birth weight evaluated. FINDINGS Semi-urban and rural mothers differed significantly in nutrition and health practices during pregnancy, as well as birth outcomes. In the rural area, there was a higher rate of newborns with low birth weight (10.7%) and lower rates of antimalarial medication (80.8%), deworming (24.6%), consumption of nutritional supplements (81.5%), and being informed about nutrition by medical staff (32.8%) during pregnancy as well as practicing family planning (3.1%) than in the semi-urban areas (2.7%, 88.6%, 88.3%; 89.3%, 46.5%, and 17.1%, respectively). Birth weight was positively predicted by increasing maternal MUAC, age, and gestational age and negatively by rural location, being primipara, being a farmer, and female newborn sex. CONCLUSION The findings highlight the importance of strengthening antenatal care activities especially in rural areas in order to ameliorate both maternal and infantile health and ensure appropriate development.
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Affiliation(s)
| | - Céline Kavira Malengera
- School of Public Health, Faculty of Medicine, Université de Goma, Goma, DR Congo
- School of Medicine and Public Health, Université Evangélique en Afrique, Bukavu, DR Congo
- Département de Nutrition, Centre de Recherche en Sciences Naturelles/Lwiro, D.S. Bukavu, DR Congo
| | - Theophile Barhwamire Kabesha
- School of Medicine and Public Health, Université Evangélique en Afrique, Bukavu, DR Congo
- Faculty of Medicine, Official University of Bukavu, Bukavu, DR Congo
| | - Jan Frank
- Institute of Nutritional Sciences, University of Hohenheim, Stuttgart, Germany
- Food Security Center, University of Hohenheim, Stuttgart, Germany
| | - Veronika Scherbaum
- Institute of Nutritional Sciences, University of Hohenheim, Stuttgart, Germany
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Eltayeb R, Rayis DA, Sharif ME, Ahmed ABA, Elhardello O, Adam I. The prevalence of serum magnesium and iron deficiency anaemia among Sudanese women in early pregnancy: a cross-sectional study. Trans R Soc Trop Med Hyg 2020; 113:31-35. [PMID: 30325455 DOI: 10.1093/trstmh/try109] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 09/07/2018] [Indexed: 11/14/2022] Open
Abstract
Background Anaemia during pregnancy is associated with adverse maternal and child health. Investigations of anaemia and its predictors among pregnant women are needed for preventive measures. Methods A cross-sectional study was conducted to investigate the prevalence and determinants of anaemia in early pregnancy in Khartoum, Sudan. Clinical characteristics were gathered using a questionnaire. Serum ferritin, magnesium and high-sensitivity C-reactive protein (hs-CRP) were measured using different laboratory methods. Results Of the 180 women in the study, 65.0% had anaemia (haemoglobin [Hb] <11 g/dl), 0.6% had severe anaemia (Hb <7 g/dl), 38.9% had iron deficiency (serum ferritin <15 μg/l), 30.6% had iron deficiency anaemia (<11 g/dl and serum ferritin <15 μg/l) and 57.2% had magnesium deficiency (<1.80 mg/dl). There was no significant difference in the age, parity, gestational age, body mass index (BMI) and hs-CRP between anaemic and non-anaemic pregnant women. Anaemic pregnant women had significantly lower levels of serum ferritin and serum magnesium. While age, parity, gestational age, BMI and hs-CRP were not associated with anaemia, low serum ferritin (odds ratio [OR] 0.97 [95% confidence interval {CI} 0.96 to 0.99]) and low serum magnesium (OR 0.91 [95% CI 0.84 to 0.99]) were associated with anaemia. There were significant positive correlations between Hb and serum ferritin (r=0.382, p<0.001) and serum magnesium (r=0.192, p=0.010). Conclusion The role of magnesium as a possible contributing factor to anaemia in pregnancy has important implications for prevention and treatment of these women.
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Affiliation(s)
- Reem Eltayeb
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Duria A Rayis
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Manal E Sharif
- Faculty of Medicine, Al-Neelain University, Khartoum, Sudan
| | - Abdel Bagi A Ahmed
- Department of Obstetrics and Gynecology, College of Medicine, King Khalid University, Abha, Kingdom of Saudi Arabia
| | | | - Ishag Adam
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
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Bahizire E, Dramaix M, Bigirinama R, Balegamire S, Balungu Y, Meuris S, D'Alessandro U, Donnen P. Prevention against malaria before the first antenatal visit and absence of anaemia at the first visit were protective from low birth weight: results from a South Kivu cohort, Democratic Republic of the Congo. Trans R Soc Trop Med Hyg 2019; 112:383-392. [PMID: 30053261 DOI: 10.1093/trstmh/try066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Accepted: 06/15/2018] [Indexed: 11/12/2022] Open
Abstract
Background There is little information on the causes of low birth weight (LBW, <2500 g) in South Kivu. The authors determined the prevalence of LBW among full-term newborns, and its relationship with malaria and anaemia at the first antenatal visit (ANV1) in the rural health zone of Miti-Murhesa, in the eastern Democratic Republic of the Congo. Methods Four-hundred-and-seventy-eight pregnant women in the second trimester attending their first antenatal clinic were recruited between November 2010 and July 2011, and followed-up until delivery. Besides information on use of preventive measures and malaria morbidity, anthropometric measures and a blood sample were collected. Results Women's mean age (SD) at enrolment, was 26 (6.5) years (n=434); prevalence of malaria was 9.5% (43/453) and that of anaemia 32.2% (141/439). The latter was significantly more frequent in malaria-infected women and in those who had not been dewormed. At delivery, prevalence of LBW was 6.5% (23/355) and was independently associated with not sleeping under insecticide-treated bed net (p=0.030), mother's height <150 cm (p=0.001) and anaemia at the ANV1 (p=0.006). Conclusion In South Kivu, malaria and anaemia are important risk factors for LBW, and should be prevented among all women of reproductive age.
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Affiliation(s)
- Esto Bahizire
- Center of Research in Epidemiology, Biostatistics and Clinical Research, Université Libre de Bruxelles, Route de Lennik, 808, CP 594, Brussels, Belgium.,Department of Medical Microbiology, University of Nairobi, KNH CAMPUS, Nairobi-00202, Kenya.,Centre de Recherche en Sciences Naturelles de Lwiro, 343 Av. PE Lumumba, Bukavu
| | - Michèle Dramaix
- Center of Research in Epidemiology, Biostatistics and Clinical Research, Université Libre de Bruxelles, Route de Lennik, 808, CP 594, Brussels, Belgium
| | - Rosine Bigirinama
- Department of Paediatrics, Université Catholique de Bukavu, 2 Av. Michombero, Bukavu, Democratic Republic of the Congo
| | - Safari Balegamire
- Centre de Recherche en Sciences Naturelles de Lwiro, 343 Av. PE Lumumba, Bukavu.,Department of Community Health, Université de Montréal, 7101 Av du Parc, Montréal (Quebec) H3N 1X9, Canada
| | - Yves Balungu
- Department of Gynaecology and Obstetrics, Université Catholique de Bukavu, 2 Av. Michombero, Bukavu, Democratic Republic of the Congo
| | - Sylvain Meuris
- Laboratory of experimental hormonology, Université Libre de Bruxelles, Route de Lennik, 808, CP 594, 1070 Brussels, Belgium
| | - Umberto D'Alessandro
- Medical Research Council Unit The Gambia, Fajara, Atlantic Boulevard, Fajara, Banjul, The Gambia.,London School of Hygiene and Tropical Medicine, Keppel Street London WC1E 7HT, United Kingdom
| | - Philippe Donnen
- Center of Research in Health Policy and Systems-International Health, Université Libre de Bruxelles, Route de Lennik, 808, CP 594, Brussels, Belgium
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Abstract
Maternal systemic inflammation during pregnancy may restrict embryo−fetal growth, but the extent of this effect remains poorly established in undernourished populations. In a cohort of 653 maternal−newborn dyads participating in a multi-armed, micronutrient supplementation trial in southern Nepal, we investigated associations between maternal inflammation, assessed by serum α1-acid glycoprotein and C-reactive protein, in the first and third trimesters of pregnancy, and newborn weight, length and head and chest circumferences. Median (IQR) maternal concentrations in α1-acid glycoprotein and C-reactive protein in the first and third trimesters were 0.65 (0.53–0.76) and 0.40 (0.33–0.50) g/l, and 0.56 (0.25–1.54) and 1.07 (0.43–2.32) mg/l, respectively. α1-acid glycoprotein was inversely associated with birth size: weight, length, head circumference and chest circumference were lower by 116 g (P = 2.3 × 10−6), and 0.45 (P = 3.1 × 10−5), 0.18 (P = 0.0191) and 0.48 (P = 1.7 × 10−7) cm, respectively, per 50% increase in α1-acid glycoprotein averaged across both trimesters. Adjustment for maternal age, parity, gestational age, nutritional and socio-economic status and daily micronutrient supplementation failed to alter any association. Serum C-reactive protein concentration was largely unassociated with newborn size. In rural Nepal, birth size was inversely associated with low-grade, chronic inflammation during pregnancy as indicated by serum α1-acid glycoprotein.
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Bahizire E, D'Alessandro U, Dramaix M, Dauby N, Bahizire F, Mubagwa K, Donnen P. Malaria and Iron Load at the First Antenatal Visit in the Rural South Kivu, Democratic Republic of the Congo: Is Iron Supplementation Safe or Could It Be Harmful? Am J Trop Med Hyg 2018; 98:520-523. [PMID: 29313480 DOI: 10.4269/ajtmh.17-0585] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
We investigated the relationship between malaria infection and iron status in 531 pregnant women in South Kivu, Democratic Republic of the Congo. Sociodemographic data, information on morbidity, and clinical data were collected. A blood sample was collected at the first antenatal visit to diagnose malaria and measure serum ferritin (SF), soluble transferrin receptor, C-reactive protein, and α1-acid-glycoprotein. Malaria prevalence was 7.5%. Median (interquartile range) SF (adjusted for inflammation) was significantly higher in malaria-infected (82.9 μg/L [56.3-130.4]) than in non-infected (39.8 μg/L [23.6-60.8]) women (P < 0.001). Similarly, estimated mean body iron store was higher in malaria-infected women (P < 0.001). Malaria was significantly and independently associated with high levels of SF. Efforts to improve malaria prevention while correcting iron deficiency and anemia during pregnancy are warranted.
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Affiliation(s)
- Esto Bahizire
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya.,Center of Research in Epidemiology, Biostatistics and Clinical Research, Université Libre de Bruxelles, Brussels, Belgium.,Centre de Recherche en Sciences Naturelles de Lwiro, Bukavu, DR Congo
| | - Umberto D'Alessandro
- London School of Hygiene and Tropical Medicine, London, United Kingdom.,Medical Research Council Unit The Gambia, Fajara, The Gambia
| | - Michèle Dramaix
- Center of Research in Epidemiology, Biostatistics and Clinical Research, Université Libre de Bruxelles, Brussels, Belgium
| | - Nicolas Dauby
- Department of Infectious Diseases, Centre Hospitalier Universitaire Saint-Pierre, Brussels, Belgium
| | - Fabrice Bahizire
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
| | - Kanigula Mubagwa
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Philippe Donnen
- Center of Research in Health Policy and Systems-International Health, Université Libre de Bruxelles, Brussels, Belgium
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