Association of Malaria Infection During Pregnancy With Head Circumference of Newborns in the Brazilian Amazon

Jamille Gregório Dombrowski,Sabrina Epiphanio,Marielton Dos Passos Cunha,Rodrigo Medeiros De Souza,Estela Bevilacqua,Julio Da Motta Singer,Oscar Murillo,Erika Paula Machado Peixoto,Cláudio Romero Farias Marinho,Paolo Marinho De Andrade Zanotto,Douglas De Sousa Costa,Flávia Afonso Lima,Lígia Antunes Gonçalves,Carla Letícia Bandeira,Susana Campino,Marcos Augusto Grigolin Grisotto,Taane Gregory Clark,Antonio Carlos Pedroso De Lima

doi:10.1001/jamanetworkopen.2019.3300

Abstract

Malaria during pregnancy is associated with adverse events for the fetus and newborn, but the association of malaria during pregnancy with the head circumference of the newborn is unclear. To investigate the association of malaria during pregnancy with fetal head growth. Two cohort studies were conducted at the general maternity hospital of Cruzeiro do Sul (Acre, Brazil) in the Amazonian region. One cohort study prospectively enrolled noninfected and malaria-infected pregnant women who were followed up until delivery, between January 2013 and April 2015. The other cohort study was assembled retrospectively using clinical and malaria data from all deliveries that occurred between January 2012 and December 2013. Data analyses were conducted from January to August 2017 and revised in November 2018. Clinical data from pregnant women and anthropometric measures of their newborns were evaluated. A total of 600 pregnant women were enrolled through volunteer sampling (prospective cohort study), and 4697 pregnant women were selected by population-based sampling (retrospective cohort study). After application of exclusion criteria, data from 251 (prospective cohort study) and 232 (retrospective cohort study) malaria-infected and 158 (prospective cohort study) and 3650 (retrospective cohort study) noninfected women were evaluated. Malaria during pregnancy. The primary end point was the incidence of altered head circumference in newborns delivered from malaria-infected mothers compared with that from noninfected mothers. Secondary end points included measures of placental pathology relative to newborn head circumference. In total, 4291 maternal-child pairs were analyzed. Among 409 newborns in the prospective cohort study, the mothers of 251 newborns had malaria during pregnancy, infected with Plasmodium vivax, Plasmodium falciparum, or both. Among 3882 newborns in the retrospective cohort study, 232 were born from mothers that had malaria during pregnancy. The prevalence of newborns with a small head (19 [30.7%] in the prospective cohort study and 30 [36.6%] in the retrospective cohort study) and the prevalence of microcephaly among newborns (5 [8.1%] in the prospective cohort study and 6 [7.3%] in the retrospective cohort study) were higher among newborns from women infected with P falciparum during pregnancy. Multivariate logistic regression analyses revealed that P falciparum infection during pregnancy represented a significant risk factor for the occurrence of small head circumference in newborns (prospective cohort study: odds ratio, 3.15; 95% CI, 1.52-6.53; P = .002; retrospective cohort study: odds ratio, 1.91; 95% CI, 1.21-3.04; P = .006). Placental pathologic findings corroborated this association, with more syncytial nuclear aggregates and inflammatory infiltrates occurring in placentas of newborns born with decreased head circumference. This study indicates that falciparum malaria during pregnancy is associated with decreased head circumference in newborns, which is in turn associated with evidence of placental malaria.

Highlights

Having malaria during pregnancy, especially falciparum malaria, can be devastating and fulminant, leading to high mortality rates for both mother and fetus, with approximately 125 million pregnancies at risk of infection each year.[1]
The prevalence of newborns with a small head (19 [30.7%] in the prospective cohort study and 30 [36.6%] in the retrospective cohort study) and the prevalence of microcephaly among newborns (5 [8.1%] in the prospective cohort study and 6 [7.3%] in the retrospective cohort study) were higher among newborns from women infected with P falciparum during pregnancy
This study indicates that falciparum malaria during pregnancy is associated with decreased head circumference in newborns, which is in turn associated with evidence of placental malaria

Summary

Introduction

Especially falciparum malaria, can be devastating and fulminant, leading to high mortality rates for both mother and fetus, with approximately 125 million pregnancies at risk of infection each year.[1]. Several studies have reported the association of intrauterine infections with a high risk of low birth weight and brain injury among newborns.[7] A group of microorganisms termed TORCH, which includes hepatitis virus, HIV, and most recently Zika virus, are frequently associated with decreased HC in newborns.8,9Although the brain insult is defined by the cranium size, it reflects a reduction of brain volume and an impairment of cognitive abilities.[10] to investigate the association of having malaria during pregnancy with fetal head growth, we analyzed data from both a prospective and a retrospective cohort of newborns who were delivered between 2012 and 2015 in the far western Brazilian Amazonian region

Methods

Results

Discussion

Conclusion