Risk Factors and Mechanisms of Preterm Delivery in Malawi

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Abstract
Problem: We examined risk factors and mechanisms of preterm delivery (PTD) in malaria-exposed pregnant women in Blantyre, Malawi. Method of study: The human immunodeficiency virus (HIV), malaria, syphilis, and anemia were assessed in a cross-sectional study of 572 pregnant women. In a nested case–control study, chorioamnionitis (CAM) was examined; tumor necrosis factor (TNF)-α, interleukin (IL)-6, IL-8, macrophage inflammatory protein (MIP)-1α, monocyte chemotactic protein (MCP)-1, transforming growth factor (TGF)-β, cortisol, and corticotropin-releasing hormone were measured in placental, maternal and/or cord blood. Results: HIV, infrequent antenatal clinic attendance, low-maternal weight, no intermittent preventive malaria therapy (IPT), and CAM were associated with PTD, while malaria was not. Of the 18 compartmental cytokine measurements, elevations in placental and/or cord IL-6 and IL-8 were associated with both CAM and PTD. In contrast, there was no overlap between the cytokines affected by malaria and those associated with PTD. Conclusions: The HIV and CAM were the major infections associated with PTD in this study. CAM, but not malaria, causes PTD via its effect on proinflammatory cytokines.