Malaria and Fetal Growth Alterations in the 3rd Trimester of Pregnancy: A Longitudinal Ultrasound Study

Abstract

BackgroundPregnancy associated malaria is associated with decreased birth weight, but in-utero evaluation of fetal growth alterations is rarely performed. The objective of this study was to investigate malaria induced changes in fetal growth during the 3rd trimester using trans-abdominal ultrasound.MethodsAn observational study of 876 pregnant women (398 primi- and secundigravidae and 478 multigravidae) was conducted in Tanzania. Fetal growth was monitored with ultrasound and screening for malaria was performed regularly. Birth weight and fetal weight were converted to z-scores, and fetal growth evaluated as fetal weight gain from the 26th week of pregnancy.ResultsMalaria infection only affected birth weight and fetal growth among primi- and secundigravid women. Forty-eight of the 398 primi- and secundigravid women had malaria during pregnancy causing a reduction in the newborns z-score of −0.50 (95% CI: −0.86, −0.13, P = 0.008, multiple linear regression). Fifty-eight percent (28/48) of the primi- and secundigravidae had malaria in the first half of pregnancy, but an effect on fetal growth was observed in the 3rd trimester with an OR of 4.89 for the fetal growth rate belonging to the lowest 25% in the population (95%CI: 2.03–11.79, P<0.001, multiple logistic regression). At an individual level, among the primi- and secundigravidae, 27% experienced alterations of fetal growth immediately after exposure but only for a short interval, 27% only late in pregnancy, 16.2% persistently from exposure until the end of pregnancy, and 29.7% had no alterations of fetal growth.ConclusionsThe effect of malaria infections was observed during the 3rd trimester, despite infections occurring much earlier in pregnancy, and different mechanisms might operate leading to different patterns of growth alterations. This study highlights the need for protection against malaria throughout pregnancy and the recognition that observed changes in fetal growth might be a consequence of an infection much earlier in pregnancy.

Differential roles of inflammation and apoptosis in initiation of mid-gestational abortion in malaria-infected C57BL/6 and A/J mice

“…Emerging clues, however, indicate the impact of malaria is profound at this point in gestation [2, 29]. Advances in understanding of malarial pathogenesis in humans during the early, highly vulnerable phases of pregnancy are few because the affected placenta is unavailable for study.…”

“…Although ultrasound studies suggest that the negative impact of malaria is detectable during early pregnancy in humans [29], most studies in malaria during pregnancy are conducted at term when the placenta is expelled. Therefore, little is known about the impact of malaria in early pregnancy because the placenta is not accessible for direct assessment.…”

Aetiology of Acute Febrile Episodes in Children Attending Korogwe District Hospital in North-Eastern Tanzania

“…The prevalence of HIV infection among women attending the antenatal clinic at KDH was 2.5% for 2010 [23]. Pneumococcal and rotavirus vaccines were introduced into Tanzania in January 2013 as part of the Expanded Program on Immunization.…”

Maternal Malaria and Malnutrition (M3) initiative, a pooled birth cohort of 13 pregnancy studies in Africa and the Western Pacific

“…The six prospective cohort studies were all designed to assess risk factors and consequences of malaria infection and/or antimalarial treatment during pregnancy in different locations and among different study populations 1020 23 26 31 32…”