Causes of preterm delivery and intrauterine growth retardation in a malaria endemic region of Papua New Guinea

Abstract

Aim-To identify causes of preterm delivery and intrauterine growth retardation (IUGR) in a malaria endemic region of Papua New Guinea. Methods-Independent predictors of preterm delivery and birthweight in term infants were identified using multiple regression analysis in a prospective study of 987 singleton live births delivered in Madang Hospital. Results-Overall, Plasmodiumfalciparum infection of the placenta was associated with a reduction in birthweight of 130 g. Malaria was significantly more common in primigravidae than multigravidae and probably contributed to both preterm delivery and IUGR. Maternal haemoglobin concentrations were significantly lower in malaria infected than noninfected women and reduced haemoglobin was the main determinant of preterm delivery. Poorer maternal nutritional status and smoking were associated with both prematurity and IUGR. Greater antenatal clinic attendance predicted increased birthweight in term infants. Conclusions-Protection against malaria during pregnancy, especially in primigravidae, improved nutrition in women and discouragement of smoking would probably reduce both preterm delivery and IUGR. Greater use of existing antenatal clinics might increase birthweight in term infants. (Arch Dis Child Fetal Neonatal Ed 1998;79:F135-F140)

Malaria in pregnancy in the Asia-Pacific region

“…In India and Papua New Guinea, P falciparum resistance to chloroquine and sulfadoxine-pyrimethamine is high. 20,29,35,36,40,41,42 Despite diff erences in transmission, this fi nding could be a result of increased clearance of parasites from the maternal and placental blood by the more eff ective artemisinin-based combination therapies. …”

“…9,31,37,60 Even asymptomatic malaria episodes could cause anaemia, 37 and women during their second or subsequent pregnancies are more anaemic than are women in their fi rst pregnancy. 37,42,48,50 Severe maternal anaemia during pregnancy increases risk of premature labour 37,41 and stillbirth, 61,62 and reduces birthweight. 37,48,58 Data from Thailand suggest that risk of P vivax malaria increases after start of haematinic supplementation (iron and folate).…”

“…The median reduction in birthweight in the reviewed studies was 150 g (range 1-650; fi gure 3) for P falciparum or mixed infections, 20,29,36,37,41,42,44,47,48,88,89 and 108 g (107-310) for P vivax malaria. 9,29,37 Birthweight reduction occurs mainly in fi rst pregnancies with P falciparum malaria but also in subsequent pregnancies, and even with one episode of P vivax or P falciparum malaria.…”

“…Longlasting Allen 1998 41 Benet 2006 42 Kaushik 1992 88 Nosten 1991 48 Poesproprodjo 2008 37 Singh 1999 29 Brabin 1990 Primip 89 Brabin 1990 Multip 89 Hamer 2009 Review insecticide-treated bednets are distributed in all countries, 14 but reports in the past 3 years have shown low availability or use by pregnant women. 26,34,128 Case management is available everywhere, but in reality malaria smears are obtained from pregnant women only when fever or other malarial symptoms are present and these symptoms are often not checked by health workers.…”

Pharmacokinetic Properties of Conventional and Double-Dose Sulfadoxine-Pyrimethamine Given as Intermittent Preventive Treatment in Infancy

“…The age-adjusted hepatic clearance, CL H , was determined using a sigmoid maximum effect (E max ) model (7) HillCL )], where TVCL H is the population average value for hepatic clearance, PMA is the postmenstrual age (the age of the infant recorded from the last menstrual cycle of the mother during pregnancy rather than birth), HillCL is the Hill coefficient for hepatic clearance, and MATCL 50 is the PMA at which CL H is 50% of the mature value. When an accurate PMA could not be obtained, it was estimated from the postnatal age (PNA) and average gestation in PNG (3,15,21). CL R was adjusted to a standardized value for an estimated glomerular filtration rate (eGFR) of 120 ml/min/1.76 m 2 , i.e., TVCL R ϫ (eGFR/120), where CL R is the adjusted renal clearance, TVCL R is the population average value for renal clearance, and the eGFR was determined from the cystatin C concentration (CysC) as 91.62 ϫ (1/ CysC 1.123 ) (20).…”