Poster Presentation Lorne Infection and Immunity 2018

Associations between Red Blood Cell Polymorphisms and Maternal and Birth Outcomes in a Malaria Endemic Region of Papua New Guinea: a cohort study (#123)

Eliza E Davidson 1 2 , Ricardo R Ataide 1 , Herbert H Opi 1 , Elizabeth E Peach 1 , Michelle M Scoullar 1 , Chris C Morgan 1 , James J Beeson 1 3 4 , Freya F Fowkes 1 2
  1. Burnet Institute, Melbourne, VIC, Australia
  2. Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
  3. Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
  4. Department of Microbiology, Monash University, Melbourne, VIC, Australia

The enormous burden of malaria has resulted in strong evolutionary selection for genes that confer resistance to Plasmodium infection. The best studied examples are red blood cell (RBC) polymorphisms, which have demonstrated varying degrees of protection against malaria in children, in numerous studies. However, the effect of these RBC polymorphisms on Plasmodium species infection in pregnant women, who are most susceptible to malaria after young children, has not been well studied. Malaria in pregnancy is a global health problem with severe consequences for both the mother and the infant that include the adverse outcomes of: preterm birth, low birth weight and perinatal mortality for the infant and severe anaemia and death for the mother.

Here we investigate the interactions between RBC polymorphisms, malaria in pregnancy, and adverse maternal and birth outcomes. This study utilized 700 samples and corresponding epidemiological data from pregnant women living in a malaria endemic region of Papua New Guinea, where the prevalence RBC polymorphisms and poor maternal and birth outcomes are high. Pregnant women were genotyped for Complement Receptor 1 (CR1) deficiency, Southeast Asian ovalocytosis (SAO) and alpha-thalassemia polymorphisms, which were present at high frequencies (>90%, 5.6% and 17% respectively). Preliminary epidemiological analysis revealed low frequencies of malaria and the adverse birth outcomes low-birthweight and pre-term delivery, and no substantial associations with RBC polymorphisms. However, maternal anaemia was highly prevalent in the cohort, and haemoglobin levels were influenced by RBC polymorphisms. In particular, women with CR1 deficiency had significantly lower prevalence of severe anaemia than women with the high CR1 expression genotype, indicating a potential protective effect. An association between the maternal SAO genotype and significantly reduced infant haemoglobin levels was also observed. These preliminary findings highlight the need for further investigation into the mechanistic role of these RBC polymorphisms in anaemia, a key pregnancy risk factor in malaria endemic regions.