Adverse birth outcomes in a malarious area

Abstract

SUMMARYTo determine factors associated with fetal growth, preterm delivery and stillbirth in an area of high malaria transmission in Southern Malawi, a cross-sectional study of pregnant women attending and delivering at two study hospitals was undertaken. A total of 243 (17 . 3 %) babies were preterm and 54 (3 . 7%) stillborn. Intra-uterine growth retardation (IUGR) occurred in 285 (20 . 3 %), of whom 109 (38 . 2%) were low birthweight and 26 (9 . 1%) preterm. Factors associated with IUGR were maternal short stature [adjusted odds ratio (AOR) 1 . 6, 95 % confidence interval (CI) 1 . 0-2 . 5] ; primigravidae (AOR 1 . 9, 95 % CI 1 . 4-2 . 7) ; placental or peripheral malaria at delivery (AOR 1 . 4, 95 % CI 1 . 0-1 . 9) and maternal anaemia at recruitment (Hb <8 g/dl) (AOR 1 . 9, 95% CI 1 . 3-2 . 7). Increasing parasite density in the placenta was associated with both IUGR (P=0 . 008) and prematurity (P=0 . 02). Factors associated with disproportionate fetal growth were maternal malnutrition [mid-upper arm circumference (MUAC) <23 cm, AOR 1 . 9, 95% CI 1 . 0-3 . 7] and primigravidae (AOR 1 . 8, 95% CI 1 . 0-3 . 1). Preterm delivery and stillbirth were associated with <5 antenatal care visits (AOR 2 . 2, 95% CI 1 . 3-3 . 7 and AOR 3 . 1, 95 % CI 1 . 4-7 . 0 respectively) and stillbirth with a positive Venereal Disease Research Laboratory (VDRL) test (AOR 4 . 7, 95 % CI 1 . 5-14 . 8). Interventions to reduce poor pregnancy outcomes must reduce the burden of malaria in pregnancy, improve antenatal care and maternal malnutrition.

Placental malarial parasitaemia and pregnancy outcome among parturients in a tertiary hospital in South- South Nigeria

“…[6][7][8][9] Various studies have linked placental malaria to maternal anaemia. 18,24 However, in this study, there was no significant association between placental malaria and maternal anaemia when controlled for the other confounding variables, using the multivariate logistic regression model.…”

“…[4][5] Although often asymptomatic, especially in immune women, malaria has been implicated in several studies as a cause of some unfavourable pregnancy outcomes. [6][7][8][9] These outcomes include anemia in pregnancy, fetal anemia, miscarriage, intra-uterine fetal death, premature labour and congenital malaria. The adverse consequences are mainly as a result of sequestration of parasitized erythrocytes present in the placental intervillous spaces, to chondroitin sulphate A (CSA) in the placenta.…”

Retardo no crescimento intrauterino, baixo peso ao nascer e prematuridade em recém-nascidos de grávidas com malária, na Colômbia

“…A malária no parto está associada com RCIU e o risco é incrementado pela quantidade de parasitas no sangue, mas a maior proporção de RCIU simétrico em altas áreas endêmicas indica que a restrição de crescimento é crônica e não devido a um efeito no final da gestação 23 .…”

“…Os recém-nascidos com baixo peso das grávidas com malária apresentaram RCIU simétrico, que pode ser conseqüência de uma infecção precoce ou crônica, semelhante ao reportado em áreas de alta endemicidade 23 . A estatura, o perímetro cefálico e o Apgar são características pouco informadas nos estudos de MG; nossos dados indicam que os recém-nascidos de grávidas com MG têm maior probabilidade de nascer com altura baixa, enquanto não há diferenças no perímetro cefálico ou no Apgar.…”

Induction of hyperglycemia in adult intrauterine growth-restricted rats: effects on renal function

“…The incidence of low birth weight is increasing in developed countries, largely because of an increasing incidence of placental insufficiency (31,32) and preterm birth (14a, 14b, 2), and remains highly prevalent in underdeveloped countries largely as a result of maternal malnutrition (9,13,15) and infection (1,4,22). Importantly, the association between low birth weight and increased risk of adult disease may, in part, be linked to the observed reduction in nephron endowment in individuals that were intrauterine growth restricted (IUGR).…”