Influence of the number and timing of malaria episodes during pregnancy on prematurity and small-for-gestational-age in an area of low transmission

BMC Medicine

Julie A. Simpson¹  Kerryn A. Moore¹  Freya J. I. Fowkes¹  Sasithon Pukrittayakamee²  Nicholas J. White²  François Nosten³  Jacher Wiladphaingern³  Rose McGready³  Mupawjay Pimanpanarak³  Jathee Raksuansak³  Aung Myat Min³  Moo Kho Paw³ 

[1] Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne;Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University;Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University;

关键词: Malaria in pregnancy;    Preterm birth;    Small-for-gestational-age;    Timing;    Gestation;   

DOI  :  10.1186/s12916-017-0877-6

来源: DOAJ

【 摘 要 】

Abstract Background Most evidence on the association between malaria in pregnancy and adverse pregnancy outcomes focuses on falciparum malaria detected at birth. We assessed the association between the number and timing of falciparum and vivax malaria episodes during pregnancy on small-for-gestational-age (SGA) and preterm birth. Methods We analysed observational data collected from antenatal clinics on the Thailand-Myanmar border (1986–2015). We assessed the effects of the total number of malaria episodes in pregnancy on SGA and the effects of malaria in pregnancy on SGA, very preterm birth, and late preterm birth, by the gestational age at malaria detection and treatment using logistic regression models with time-dependent malaria variables (monthly intervals). World Health Organisation definitions of very preterm birth (≥28 and <32 weeks) and late preterm birth (≥32 and <37 weeks) and international SGA standards were used. Results Of 50,060 pregnant women followed, 8221 (16%) had malaria during their pregnancy. Of the 50,060 newborns, 10,005 (21%) were SGA, 540 (1%) were very preterm, and 4331 (9%) were late preterm. The rates of falciparum and vivax malaria were highest at 6 and 5 weeks’ gestation, respectively. The odds of SGA increased linearly by 1.13-fold (95% confidence interval: 1.09, 1.17) and 1.27-fold (1.21, 1.33) per episode of falciparum and vivax malaria, respectively. Falciparum malaria at any gestation period after 12–16 weeks and vivax malaria after 20–24 weeks were associated with SGA (falciparum odds ratio, OR range: 1.15–1.63 [p range: <0.001–0.094]; vivax OR range: 1.12–1.54 [p range: <0.001–0.138]). Falciparum malaria at any gestation period after 24–28 weeks was associated with either very or late preterm birth (OR range: 1.44–2.53; p range: <0.001–0.001). Vivax malaria at 24–28 weeks was associated with very preterm birth (OR: 1.79 [1.11, 2.90]), and vivax malaria at 28–32 weeks was associated with late preterm birth (OR: 1.23 [1.01, 1.50]). Many of these associations held for asymptomatic malaria. Conclusions Protection against malaria should be started as early as possible in pregnancy. Malaria control and elimination efforts in the general population can avert the adverse consequences associated with treated asymptomatic malaria in pregnancy.

【 授权许可】

Unknown