Plasma Plasminogen Activator Inhibitor-2 Antigen Levels Among Plasmodium Falciparum Malaria-Infected Pregnant Women in Northern Ghana

Background: Pregnancy is a hypercoagulable state due to the changes that occur in the fibrinolytic and coagulation system. These changes include an increase in procoagulants and hypofibrinolysis caused by increase in Plasminogen Activator Inhibitor-2 and Plasmodium falciparum (Pf) induced coagulation through the secretion of Plasmodium falciparum Erythrocyte membrane protein-1(PfEmp-1), exacerbating the situation in pregnant women. This study assessed plasma PAI-2 antigen levels in Plasmodium falciparum malaria-infected pregnant women.

Materials and Methods: This hospital-based cross-sectional study recruited 85 pregnant women, 55 (64.7%) positive for Pf malaria and 30 (35.3%) negatives for Pf malaria (control group). Venous blood was aseptically taken for thin and thick blood film malaria microscopy, complete blood count analyses and measurement of PAI-2 Ag levels using sandwich ELISA. Data were analysed with SPSS version 26.0 and p<0.05 was considered statistically significant.

Results: Haemoglobin, RBC, HCT, MCV, MCH, MCHC, Absolute lymphocyte count and PLT values were lower in the Pf malaria-infected pregnant women than in the control pregnant women group (p<0.05). Gestational age, gravidity, parity and inter-pregnancy intervals had no significant impact on the concentration of PAI-2 in the participants (p=0.425, p=0.953, p=0.174 and p=0.826) respectively. The PAI-2 levels were elevated in pregnant women with Pf malaria than in the control group of pregnant women (p<0.001). There was a significant correlation between malaria parasite density and PAI-2 Ag levels (r=0.812, p<0.001). The concentration of PAI-2 Ag was shown to increase with the progression of parasite density.

Conclusion: Plasma PAI-2 antigen levels in P. falciparum malaria-infected pregnant women is higher compared to pregnant women without malaria. PAI-2 Ag levels was shown to increase with the progression of malaria infection and increased parasite density. The pathogenesis of Pf malaria and pregnancy may contribute to the reduction in red blood cell parameters and platelets.

Keywords: PAI-2 Antigen, P.f Malaria, Pregnancy.