No abstract

The incidence of placental malaria at parturition and its effects on the conceptus have been investigated in The Gambia, West Africa. Malarious placentae occurred in 1300 (20.2%) of 6427 singleton births, in 32 (18.6%) of 172 sets of twins and in none of six sets of triplets. Plasmodium falciparum infections predominated; P. malariae or P. ovale infections were found in only nine instances. In the large group of single births placental malaria occurred less frequently (12.0%) in residents of urban than of other, more rural, communities (27.1%). In the former group incidence showed no clear change with season; in the latter group it was highest in the trimester following the end of the rains and lowest in the second half of the dry season. In both residential groups it was more frequent in primiparae (urban 16.1%; other 46.9%) than in multiparae (urban 8.9%; other 20.3%). The sex of the child did not influence malaria incidence. Dense placental infections were more frequent in primiparae. Stillbirth rates of singleton infants were significantly higher for males than for females, but no clear and consistent relationship between stillbirth and placental malaria was detected. Mean singleton birthweights were depressed by about 170 g in the presence of malaria; the deficits were statistically significant only among first born infants and tended to diminish progressively with increasing maternal parity. No distinct gradient linking birthweight with ascending density of placental parasitaemia was observed. Singleton birthweights of 2.5 kg or less occurred more frequently in association with malarious than non-malarious placentae and the association was more marked among first born than later birth rank infants. Differences between the weights of malarious and non-malarious placentae were small and not significant. The findings of the study are discussed in relation to the widely prevalent view that pregnancy exacerbates maternal malaria by attenuating acquired immunity.

I. Skinfold thicknesses at seven sites were measured during and after pregnancy in eightyfour women ; in forty-eight of these, total body water was measured concurrently.2. Early in pregnancy (10 weeks) the skinfold measurements were highly correlated with each other and with maternal weight, ratio of observed weight to standard weight-for-height, 'dry' (water-free) weight, and with calculated estimates of body fat.3. At nearly all sites, skinfold thicknesses increased up to about 30 weeks of pregnancy. Increases were greater at 'central' and least at 'peripheral' sites, and were not proportional to the initial skinfold thickness.4. From 30 to 38 weeks of pregnancy, the patterns were variable: the mid-thigh skinfold continued to increase and at the other sites there was little change or a decrease.5. All sites decreased by a surprisingly large amount between 38 weeks of pregnancy and the end of the first post-partum week. The evidence suggests that this change, which was not related to the presence or absence of oedema, occurred about the time of parturition.6. From the end of the first post-partum week to 6-8 weeks post partunz, the changes were again variable. 7.The increase of skinfolds during pregnancy was greater in underweight than in overweight women, and in primiparae than in multiparae. The pattern of change was not affected in any consistent manner by oedema.8. The changes in skinfold thicknesses during pregnancy, especially up to about 30 weeks, showed patterns similar to those of total body-weight and 'dry' body-weight. A formula is given by means of which 'dry' weight can be predicted from five skinfolds, height and duration of gestation.