Abstract
BackgroundIntermittent preventive treatment (IPT), the main strategy to prevent malaria and reduce anaemia and low birthweight, focuses on the second half of pregnancy. However, intrauterine growth restriction may occur earlier in pregnancy. The aim of this study was to measure the effects of malaria in the first half of pregnancy by comparing the fetal biparietal diameter (BPD) of infected and uninfected women whose pregnancies had been accurately dated by crown rump length (CRL) before 14 weeks of gestation.Methodology/Principal FindingsIn 3,779 women living on the Thai-Myanmar border who delivered a normal singleton live born baby between 2001–10 and who had gestational age estimated by CRL measurement <14 weeks, the observed and expected BPD z-scores (<24 weeks) in pregnancies that were (n = 336) and were not (n = 3,443) complicated by malaria between the two scans were compared. The mean (standard deviation) fetal BPD z-scores in women with Plasmodium (P) falciparum and/or P.vivax malaria infections were significantly lower than in non-infected pregnancies; −0.57 (1.13) versus −0.10 (1.17), p<0.001. Even a single or an asymptomatic malaria episode resulted in a significantly lower z-score. Fetal female sex (p<0.001) and low body mass index (p = 0.01) were also independently associated with a smaller BPD in multivariate analysis.Conclusions/SignificanceDespite early treatment in all positive women, one or more (a)symptomatic P.falciparum or P.vivax malaria infections in the first half of pregnancy result in a smaller than expected mid-trimester fetal head diameter. Strategies to prevent malaria in pregnancy should include early pregnancy.
Highlights
Malaria remains one of the most common parasitic infection of human pregnancy [1,2,3,4], and it lowers birthweight whether or not maternal symptoms are present [5]
Difficulties in estimating gestational age (GA) accurately and diagnosing malaria infection in early pregnancy have complicated the interpretation of previous malaria studies on fetal growth [9,11]
The aim of this study was to assess whether malaria infection affects early fetal growth by comparing the fetal biparietal diameter (BPD) before 24 weeks gestation in infected and uninfected women whose pregnancies had been accurately dated by crown rump length (CRL) measurement before 14 weeks
Summary
Malaria remains one of the most common parasitic infection of human pregnancy [1,2,3,4], and it lowers birthweight whether or not maternal symptoms are present [5]. Even a single episode of treated Plasmodium (P.) falciparum or P.vivax malaria during pregnancy has a negative effect on birthweight [6,7] The mechanisms of this reduction in birthweight include placental insufficiency by sequestration of malaria parasites leading to intrauterine growth restriction (IUGR), premature labour or a combination of the two [8,9]. The aim of this study was to assess whether malaria infection affects early fetal growth by comparing the fetal biparietal diameter (BPD) before 24 weeks gestation in infected and uninfected women whose pregnancies had been accurately dated by crown rump length (CRL) measurement before 14 weeks. The aim of this study was to measure the effects of malaria in the first half of pregnancy by comparing the fetal biparietal diameter (BPD) of infected and uninfected women whose pregnancies had been accurately dated by crown rump length (CRL) before 14 weeks of gestation
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