Abstract
BackgroundMalaria in pregnancy (MiP) is a major cause of fetal growth restriction and low birth weight in endemic areas of sub-Saharan Africa. Understanding of the impact of MiP on infant growth and infant risk of malaria or morbidity is poorly characterized. The objective of this study was to describe the impact of MIP on subsequent infant growth, malaria and morbidity.MethodsBetween 2006 and 2009, 82 % (832/1018) of pregnant women with live-born singletons and ultrasound determined gestational age were enrolled in a prospective cohort with active weekly screening and treatment for malaria. Infants were followed monthly for growth and morbidity and received active monthly screening and treatment for malaria during their first year of life. Multivariate analyses were performed to analyse the association between malaria exposure during pregnancy and infants’ growth, malaria infections, diarrhoea episodes and acute respiratory infections.ResultsMedian time of infant follow-up was 12 months and infants born to a mother who had MiP were at increased risk of impaired height and weight gain (−2.71 cm, 95 % CI −4.17 to −1.25 and −0.42 kg, 95 % CI −0.76 to −0.08 at 12 months for >1 MiP compared to no MiP) and of malaria infection (relative risk 10.42, 95 % CI 2.64–41.10 for infants born to mothers with placental malaria). The risks of infant growth restriction and infant malaria infection were maximal when maternal malaria occurred in the 12 weeks prior to delivery. Recurrent MiP was also associated with acute respiratory infection (RR 1.96, 95 % CI 1.25–3.06) and diarrhoea during infancy (RR 1.93, 95 % CI 1.02–3.66).ConclusionThis study shows that despite frequent active screening and prompt treatment of MiP, impaired growth and an increased risk of malaria and non-malaria infections can be observed in the infants. Effective preventive measures in pregnancy remain a research priority.This study was registered with ClinicalTrials.gov, number NCT00495508.
Highlights
Malaria in pregnancy (MiP) is a major cause of fetal growth restriction and low birth weight in endemic areas of sub-Saharan Africa
Study population characteristics Of the 1218 women enrolled in the cohort, 60 % were enrolled before 20 weeks gestation, 1069 had delivery outcomes, and 1018 newborns were enrolled in the infant cohort
Infants who were included in this study were born to mothers with a greater education level (p = 0.001) and enrolled at a lower gestational age in the cohort (p < 0.001) when compared to those who were excluded
Summary
Malaria in pregnancy (MiP) is a major cause of fetal growth restriction and low birth weight in endemic areas of sub-Saharan Africa. Malaria in pregnancy (MiP) remains a leading cause of miscarriage, preterm delivery, intrauterine growth restriction (IUGR) and low birth weight (LBW) in malaria-endemic areas of sub-Saharan Africa, Asia and South America [1,2,3,4,5]. MiP is responsible for IUGR and preterm birth that are, in turn, associated with infant mortality and morbidity [16,17,18,19]. The accurate determination of both gestational age (GA) and weight at birth is, an important factor that should be included in the analysis of the effect of MiP on the risk of malaria infection in infant [24]
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