Effects of Malaria in the First Trimester of Pregnancy on Poor Maternal and Birth Outcomes in Benin

Abstract

Background In sub-Saharan Africa, malaria in the first half of pregnancy is harmful for both the mother and her fetus. However, malaria in the first trimester of pregnancy, when women are usually not protected against malaria, has been little investigated. For the first time, we assessed the effects of malaria in the first trimester on maternal and birth outcomes using a preconceptional study design. Methods From June 2014 to March 2017, 1214 women of reproductive age were recruited and followed monthly until 411 became pregnant. The pregnant women were then followed from 5–6 weeks of gestation until delivery. Path analysis was used to assess the direct effect (ie, not mediated by malaria in the second or third trimester) of malaria in the first trimester on maternal anemia and poor birth outcomes. The cumulative effect of infections during pregnancy on the same outcomes was also evaluated. Results The prevalence of malaria infections in the first trimester was 21.8%. Malaria in the first trimester was significantly associated with maternal anemia in the third trimester (adjusted odds ratio 2.25, 95% confidence interval 1.11–4.55). While we did not find evidence of any direct effect of first trimester malaria infections on birth outcomes, their association with infections later in pregnancy tended to increase the risk of low birth weights. Conclusions Malaria infections in the first trimester were highly prevalent and have deleterious effects on maternal anemia. They highlight the need for additional preventive measures, starting in early pregnancy or even before conception.

Factors associated with sub-microscopic placental malaria and its association with adverse pregnancy outcomes among HIV-negative women in Dar es Salaam, Tanzania: a cohort study

“…Our findings that sub-microscopic placental malaria was associated with a reduced risk of SGA birth was similar to results from a study done in Benin [37] despite differences in diagnostic methods and timing. The potential mechanism for this finding is unknown, but we speculate that it may involve the acquisition of antibodies in the placenta that inhibited the binding of P. falciparum-infected erythrocytes to the placental receptor chondroitin sulfate A (CSA) [38].…”

Malaria in the third trimester and maternal‐perinatal outcome

“…As malaria is a cause of anemia, having several episodes increases the risk of anemia with its perinatal complications. Some researchers found that women who had malaria in the first trimester were more at risk of anemia in the third trimester 17 …”

Prevalence and clinical impact of malaria infections detected with a highly sensitive HRP2 rapid diagnostic test in Beninese pregnant women

“…Besides, the administration of IPTp-SP is only recommended from the second trimester onwards. The accurate identification and treatment of women with sub-microscopic infections in the first trimester of pregnancy may be of high clinical relevance considering the high prevalence and significant deleterious effects of these early infections [7][8][9].…”