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The effect of timing and frequency of Plasmodium falciparum infection during pregnancy on the risk of low birth weight and maternal anemia.

ABSTRACT: Plasmodium falciparum infection during pregnancy causes maternal anemia and low birth weight (LBW), but the effect of frequency and timing of infection on the severity of these adverse effects is unknown. We conducted a cohort study recruiting 2462 pregnant women in Malawi. Microscopy was used to diagnose malaria at enrollment, follow-up and delivery. Birth weight and maternal hemoglobin were measured at delivery. The association between timing and frequency of infection and LBW and maternal anemia was analyzed using a binomial regression model. Compared with uninfected women, (i) the risk of LBW increased with the number of malaria episodes [one episode: prevalence ratio (PR) 1.62 (95% CI 1.07-2.46); two episodes: PR 2.41 (95% CI 1.39-4.18)]; (ii) the risk for maternal anemia increased with the number of malaria episodes [one episode: PR 1.15 (95% CI 0.86-1.54); two episodes: PR 1.82 (95% CI 1.28-2.62)]; and (iii) the risk of LBW was higher with infection in the second (PR 1.71; 95% CI 1.06-2.74) than third trimester or at delivery (PR 1.55; 95% CI 0.88-2.75). The timing and frequency of P. falciparum infection during pregnancy affected the risk of LBW but only frequency of infection had an effect on the risk of maternal anemia. Identification of gestational periods when malaria causes most adverse outcomes will facilitate effective targeting of interventions.

SUBMITTER: Kalilani L

PROVIDER: S-EPMC4844554 | biostudies-literature | 2010 Jun

REPOSITORIES: biostudies-literature

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The effect of timing and frequency of Plasmodium falciparum infection during pregnancy on the risk of low birth weight and maternal anemia.

Kalilani Linda L Mofolo Innocent I Chaponda Marjorie M Rogerson Stephen J SJ Meshnick Steven R SR

Transactions of the Royal Society of Tropical Medicine and Hygiene 20100306 6

Plasmodium falciparum infection during pregnancy causes maternal anemia and low birth weight (LBW), but the effect of frequency and timing of infection on the severity of these adverse effects is unknown. We conducted a cohort study recruiting 2462 pregnant women in Malawi. Microscopy was used to diagnose malaria at enrollment, follow-up and delivery. Birth weight and maternal hemoglobin were measured at delivery. The association between timing and frequency of infection and LBW and maternal ane ...[more]

PMID: 20207387

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Project description:Importance:Gestational weight gain is a determinant of infant birth weight, but it is unclear whether its timing in pregnancy may hold implications in this regard. Previous studies have yielded conflicting findings on the association of maternal weight gain in early pregnancy with birth weight. However, as these studies have typically recruited women during the first trimester, they are inherently limited by a reliance on self-reported pregravid weight. Objective:To evaluate the associations of directly measured maternal pregravid weight and the timing of subsequent weight gain across pregnancy with infant birth weight. Design, Setting, and Participants:In this prospective, preconception, observational cohort study, 1164 newly married women in Liuyang, China, underwent pregravid evaluation at a median of 19.9 weeks before a singleton pregnancy during which they underwent serial weight measurements. The study was conducted from February 1, 2009, to November 4, 2015. Data analysis was performed between September 1, 2016, and May 6, 2017. Exposure:Maternal weight gain was calculated for the following 10 gestational intervals: from pregravid to less than 14, 14 to 18, 19 to 23, 24 to 28, 29 to 30, 31 to 32, 33 to 34, 35 to 36, 37 to 38, and 39 to 40 weeks. Main Outcomes and Measures:Associations of pregravid weight and weight gain within each of the 10 gestational intervals with the outcome of infant birth weight. Results:The mean (SD) age of the 1164 women included in the study was 25.3 (3.1) years. Pregravid weight was consistently associated with infant birth weight. However, among the 10 gestational intervals, only weight gain from pregravid to 14 weeks and from 14 to 18 weeks was associated with birth weight. Birth weight increased by 13.6 g/kg (95% CI, 3.2-24.1 g/kg) of maternal weight gain from pregravid to 14 weeks and by 26.1 g/kg (95% CI, 3.8-48.4 g/kg) of maternal weight gain from 14 to 18 weeks. Conclusion and Relevance:Maternal weight only in the first half of gestation is a determinant of infant birth weight. Before pregnancy and early gestation may be a critical window for intervention to affect subsequent birth weight.

Project description:Rationale:Improved birth weight outcomes have been reported for infants of mothers imprisoned during pregnancy relative to similarly disadvantaged mothers, however, findings are equivocal and evidence is lacking from jurisdictions outside the United States. Objective:To investigate whether maternal imprisonment during pregnancy is a determinant of low birth weight (<2500?g) for Indigenous and non-Indigenous infants in Western Australia. Methods:A longitudinal sample of 41,910 singleton infants born in Western Australia (October 1985-December 2013), was identified with linked administrative data and examined by five mutually exclusive categories of maternal corrections history; (i) imprisonment in pregnancy, (ii) imprisonment before pregnancy, (iii) first imprisonment after birth, (iv) community-based corrections record without imprisonment at any time, and (v) no corrections record at any time. Univariate and multivariate Poisson regression was performed to determine key risk factors for low birth weight. Prevalence of risk factors were calculated by maternal corrections history. Results:After adjusting for other significant pregnancy risks, maternal imprisonment before (Indigenous RR 2.02, 95%CI 1.84-2.22, p<.001; non-Indigenous RR 2.48, 95%CI 1.98-3.12, p<.001) or during (Indigenous RR 1.96, 95%CI 1.68-2.29, p<.001; non-Indigenous RR 2.12, 95%CI 1.48-3.03, p<.001) pregnancy remained strong determinants of low birth weight, and carried greater risk than imprisonment after birth (Indigenous RR 1.58, 95%CI 1.44-1.74, p<.001; non-Indigenous RR 1.75, 95%CI 1.51-2.04, p<.001) or community-based corrections orders (Indigenous RR 1.32, 95%CI 1.21-1.43, p<.001; non-Indigenous RR 1.40, 95%CI 1.05-1.88, p<.001), relative to no corrections record. Pregnancy risk factors more prevalent amongst infants whose mothers were imprisoned before or during pregnancy included substance-use related service contacts, hospitalisation for injury, mental health service contacts, and having a sibling in contact with the child protection system. Conclusion:Western Australian infants with mothers imprisoned before or during pregnancy experience elevated risk of low birth weight and exposure to maternal substance use, injury and mental distress in pregnancy.

Dataset Information

The effect of timing and frequency of Plasmodium falciparum infection during pregnancy on the risk of low birth weight and maternal anemia.

Publications

The effect of timing and frequency of Plasmodium falciparum infection during pregnancy on the risk of low birth weight and maternal anemia.

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