Abstract
BackgroundThe association between malaria during pregnancy and low birth weight (LBW) is well described. This manuscript aims to quantify the relative contribution of malaria to small-for-gestational-age (SGA) infants and preterm birth (PTB) in pregnancies accurately dated by ultrasound on the Thai-Myanmar border at the Shoklo Malaria Research Unit.Methods and FindingsFrom 2001 to 2010 in a population cohort of prospectively followed pregnancies, we analyzed all singleton newborns who were live born, normal, weighed in the first hour of life and with a gestational age (GA) between 28+0 and 41+6 weeks. Fractional polynomial regression was used to determine the mean birthweight and standard deviation as functions of GA. Risk differences and factors of LBW and SGA were studied across the range of GA for malaria and non-malaria pregnancies. From 10,264 newborns records, population centiles were created.Women were screened for malaria by microscopy a median of 22 [range 1–38] times and it was detected and treated in 12.6% (1,292) of pregnancies. Malaria was associated with LBW, PTB, and SGA compared to those without malaria. Nearly two-thirds of PTB were classified as LBW (68% (539/789)), most of which 83% (447/539) were not SGA. After GA 39 weeks, 5% (298/5,966) of non-LBW births were identified as SGA. Low body mass index, primigravida, hypertension, smoking and female sex of the newborn were also significantly and independently associated with LBW and SGA consistent with previous publications.ConclusionsTreated malaria in pregnancy was associated with an increased risk for LBW, PTB, and SGA, of which the latter are most important for infant survival. Using LBW as an endpoint without adjusting for GA incorrectly estimated the effects of malaria in pregnancy. Ultrasound should be used for dating pregnancies and birth weights should be expressed as a function (or adjusted for GA) of GA in future malaria in pregnancy studies.
Highlights
Pregnant women infected with Plasmodium falciparum and P.vivax malaria have an increased risk to deliver an infant with low birthweight (LBW;,2500 g) [1], which is associated with increased infant mortality [2]
Treated malaria in pregnancy was associated with an increased risk for low birth weight (LBW), preterm birth (PTB), and SGA, of which the latter are most important for infant survival
Using LBW as an endpoint without adjusting for gestational age (GA) incorrectly estimated the effects of malaria in pregnancy
Summary
Pregnant women infected with Plasmodium falciparum and P.vivax malaria have an increased risk to deliver an infant with low birthweight (LBW; ,2500 g) [1], which is associated with increased infant mortality [2]. Infants with LBW can be preterm births (PTB; ,37 weeks gestation), small for gestational age (SGA; birthweight below the population specific 10thcentile for the gestational age), or both [3]. These children have different short and long-term needs and outcomes [4]. The association between malaria during pregnancy and low birth weight (LBW) is well described This manuscript aims to quantify the relative contribution of malaria to small-for-gestational-age (SGA) infants and preterm birth (PTB) in pregnancies accurately dated by ultrasound on the Thai-Myanmar border at the Shoklo Malaria Research Unit
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
