ELIZABETH T. ABRAMS, while a student at the University of Michigan in Ann Arbor, Michigan, was awarded a grant in September 2001 to aid research on variability in birth outcomes following malaria during pregnancy, under the supervision of Dr. A. Roberto Frisancho. Malaria infections during pregnancy are associated with a number of poor birth outcomes, including intrauterine growth retardation, preterm delivery, and fetal death. Previous researchers had identified malaria-induced immune responses and birth outcomes, but the immune response to malaria could not fully account for the variation in birth outcomes. Abrams focused on a second potential determinant of poor birth outcomes: maternal and fetal iron status. She examined umbilical-cord hemoglobin levels in 33 malaria-infected and 57 uninfected women delivering in Blantyre, Malawi, in relation to maternal hemoglobin levels, malaria status, neonatal inflammation, and birth outcome. Although, as expected, maternal hemoglobin levels were significantly decreased by malaria infection during pregnancy, there was no reduction in cord levels, nor was there any significant relationship between the two. Nevertheless, cord ferritin levels were elevated in the neonates of malaria-infected mothers in relation to increased parasitemia, suggesting fetal immune activation to maternal malaria. Increased cord ferritin was associated with significantly decreased birth weight and gestational length, although maternal and cord hemoglobin levels and malaria status had no effect on birth outcome. The markers of fetal hypoxia that were examined, including erythropoietin, cortisol, and corticotrophin-releasing hormone, were not altered in malaria-infected versus uninfected women. In sum, in this population, cord hemoglobin levels were buffered from the effects of maternal malaria. However, elevated cord ferritin levels suggested fetal immune activation to malaria, which appeared to influence birth outcomes.
Abrams, Elizabeth T., and Julienne N. Rutherford. 2011. Framing Postpartum Hemorrhage as a Consequence of Human Placental Biology: An Evolutionary and Comparative Perspective. American Anthropologist 113(3):417-430.
Abrams, Elizabeth T. and Elizabeth M. Miller. 2011. The Roles of the Immune System in Women's Reproduction: Evolutionary Constraints and Life History Trade-Offs. Yearbook of Physical Anthropology 54:134-154.
Abrams, Elizabeth T., et al 2005. Malaria during Pregnancy and Fetal Haematological Status in Blantyre, Malawi. Malaria Journal 4(39):1-8.