Malaria, malnutrition, and birthweight: A meta-analysis using individual participant data

Abstract

BackgroundFour studies previously indicated that the effect of malaria infection during pregnancy on the risk of low birthweight (LBW; <2,500 g) may depend upon maternal nutritional status. We investigated this dependence further using a large, diverse study population.Methods and findingsWe evaluated the interaction between maternal malaria infection and maternal anthropometric status on the risk of LBW using pooled data from 14,633 pregnancies from 13 studies (6 cohort studies and 7 randomized controlled trials) conducted in Africa and the Western Pacific from 1996–2015. Studies were identified by the Maternal Malaria and Malnutrition (M3) initiative using a convenience sampling approach and were eligible for pooling given adequate ethical approval and availability of essential variables. Study-specific adjusted effect estimates were calculated using inverse probability of treatment-weighted linear and log-binomial regression models and pooled using a random-effects model. The adjusted risk of delivering a baby with LBW was 8.8% among women with malaria infection at antenatal enrollment compared to 7.7% among uninfected women (adjusted risk ratio [aRR] 1.14 [95% confidence interval (CI): 0.91, 1.42]; N = 13,613), 10.5% among women with malaria infection at delivery compared to 7.9% among uninfected women (aRR 1.32 [95% CI: 1.08, 1.62]; N = 11,826), and 15.3% among women with low mid-upper arm circumference (MUAC <23 cm) at enrollment compared to 9.5% among women with MUAC ≥ 23 cm (aRR 1.60 [95% CI: 1.36, 1.87]; N = 9,008). The risk of delivering a baby with LBW was 17.8% among women with both malaria infection and low MUAC at enrollment compared to 8.4% among uninfected women with MUAC ≥ 23 cm (joint aRR 2.13 [95% CI: 1.21, 3.73]; N = 8,152). There was no evidence of synergism (i.e., excess risk due to interaction) between malaria infection and MUAC on the multiplicative (p = 0.5) or additive scale (p = 0.9). Results were similar using body mass index (BMI) as an anthropometric indicator of nutritional status. Meta-regression results indicated that there may be multiplicative interaction between malaria infection at enrollment and low MUAC within studies conducted in Africa; however, this finding was not consistent on the additive scale, when accounting for multiple comparisons, or when using other definitions of malaria and malnutrition. The major limitations of the study included availability of only 2 cross-sectional measurements of malaria and the limited availability of ultrasound-based pregnancy dating to assess impacts on preterm birth and fetal growth in all studies.ConclusionsPregnant women with malnutrition and malaria infection are at increased risk of LBW compared to women with only 1 risk factor or none, but malaria and malnutrition do not act synergistically.

Prevalence and associations of small for gestational age in a cohort of women birthing in Honiara, the Solomon Islands.

“…The causes of SGA in the Solomon Islands are varied, but major contributors include poor antenatal care, malaria and malnutrition [7,19,20]. There are significant geographical and economic barriers to accessing quality and timely antenatal care in the Solomon Islands, with many women booking late and attending much fewer than the WHO recommended 8 visits to reduce perinatal morbidity and mortality.…”

“…There is poor health awareness amongst many women around the importance of early, and frequent, antenatal visits. Currently, it is recommended that women receive malaria prophylaxis during the antenatal period [7], however compliance with this is difficult to measure and relies on antenatal attendance. Furthermore, this relies on adequate supply of anti-malarial prophylaxis, which is often inconsistent in the community setting.…”

“…Infants born SGA have increased mortality and morbidity in the neonatal period and beyond as they are more likely to have neonatal infections, perinatal respiratory distress syndrome, jaundice, polycythemia, hypoglycemia, poor feeding, and hypothermia [1,3,6]. Furthermore, infants born SGA are at higher risk of long-term adverse health outcomes, such as coronary artery disease, stroke, hypertension and type 2 diabetes [7]. Improving these short-and long-term outcomes requires improved diagnosis of SGA, so that appropriate surveillance and management strategies are in place.…”

The association between Helicobacter pylori seropositivity and low birthweight in a Sudanese maternity hospital

“…1 Maternal infection with malarial parasites (e.g. 2,4,5 However, other maternal and/or perinatal infections (e.g. 2,4,5 However, other maternal and/or perinatal infections (e.g.…”

“…Plasmodium falciparum) is a preventable cause of LBW among endemic countries, particularly those in Sub-Saharan Africa. 2,4,5 However, other maternal and/or perinatal infections (e.g. Helicobacter pylori) can also lead to LBW.…”