Ultrasound evidence of early fetal growth restriction after maternal malaria infection

Marcus J Rijken, Aris T. Papageorghiou, Supan Thiptharakun, Suporn Kiricharoen, Saw Lu Mu Dwell, Jacher Wiladphaingern, Mupawjay Pimanpanarak, Stephen H Kennedy, François Nosten, Rose McGready

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

BACKGROUND: Intermittent preventive treatment (IPT), the main strategy to prevent malaria and reduce anaemia and low birthweight, focuses on the second half of pregnancy. However, intrauterine growth restriction may occur earlier in pregnancy. The aim of this study was to measure the effects of malaria in the first half of pregnancy by comparing the fetal biparietal diameter (BPD) of infected and uninfected women whose pregnancies had been accurately dated by crown rump length (CRL) before 14 weeks of gestation.

METHODOLOGY/PRINCIPAL FINDINGS: In 3,779 women living on the Thai-Myanmar border who delivered a normal singleton live born baby between 2001-10 and who had gestational age estimated by CRL measurement <14 weeks, the observed and expected BPD z-scores (<24 weeks) in pregnancies that were (n = 336) and were not (n = 3,443) complicated by malaria between the two scans were compared. The mean (standard deviation) fetal BPD z-scores in women with Plasmodium (P) falciparum and/or P.vivax malaria infections were significantly lower than in non-infected pregnancies; -0.57 (1.13) versus -0.10 (1.17), p<0.001. Even a single or an asymptomatic malaria episode resulted in a significantly lower z-score. Fetal female sex (p<0.001) and low body mass index (p = 0.01) were also independently associated with a smaller BPD in multivariate analysis.

CONCLUSIONS/SIGNIFICANCE: Despite early treatment in all positive women, one or more (a)symptomatic P.falciparum or P.vivax malaria infections in the first half of pregnancy result in a smaller than expected mid-trimester fetal head diameter. Strategies to prevent malaria in pregnancy should include early pregnancy.

Original languageEnglish
Pages (from-to)e31411
JournalPLoS ONE [E]
Volume7
Issue number2
DOIs
Publication statusPublished - 2012

Keywords

  • Adult
  • Female
  • Fetal Growth Retardation
  • Gestational Age
  • Humans
  • Malaria
  • Malaria, Falciparum
  • Malaria, Vivax
  • Pregnancy
  • Ultrasonography, Prenatal
  • Young Adult
  • Journal Article
  • Research Support, Non-U.S. Gov't

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