Impact of maternal malaria and under-nutrition on intrauterine growth restriction: a prospective ultrasound study in Democratic Republic of Congo

Landis, Sarah H.; Lokomba, Victor; Ananth, Cande V.; Atibu, Joseph; Ryder, Robert W.; Hartmann, Katherine E.; Thorp, John M.; Tshefu, Antoinette; Meshnick, Steven R.

doi:10.1017/s0950268808000915

Cited by 66 publications

(79 citation statements)

References 34 publications

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“…Although we observed no effect of peripheral parasitemia at delivery, having greater than or equal to three episodes of peripheral parasitemia over follow-up increased LBW risk. This finding is consistent with the study conducted in the Democratic Republic of Congo by Landis and others, 17 in which having greater than or equal to three infections was associated with an increased risk of intrauterine growth retardation. Additionally, another study conducted in Malawi among a similar population reported a similar estimate caused by greater than or equal to two parasitemia episodes on the risk of LBW and maternal anemia.…”

Section: Discussionsupporting

confidence: 93%

Effect of HIV Infection and Plasmodium falciparum Parasitemia on Pregnancy Outcomes in Malawi

Nkhoma

Kalilani-Phiri

Mwapasa

et al. 2012

The American Journal of Tropical Medicine and Hygiene

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Abstract. Plasmodium falciparum and human immunodeficiency virus (HIV) are both risk factors for low birth weight (LBW) and maternal anemia, and they may interact to increase risk of adverse pregnancy outcomes. In 2005 and 2006, we followed 831 pregnant women attending antenatal care clinics in southern Malawi through delivery. HIV was associated with increased risk of LBW (adjusted prevalence ratio [PR adj ] = 3.08, 95% confidence interval [CI] = 1.40, 6.79). Having greater than or equal to three episodes of peripheral parasitemia was also associated with increased risk of LBW (PR adj = 2.68, 95% CI = 1.06, 6.79). Among multigravidae, dual infection resulted in 9.59 (95% CI = 2.51, 36.6) times the risk of LBW compared with uninfected multigravidae. HIV infection and placental parasitemia were each associated with increased risk of anemia. Thus, HIV infection and parasitemia are important independent risk factors for adverse pregnancy outcomes. Among multigravidae, HIV infection and placental parasitemia may interact to produce an impact greater than the sum of their independent effects.

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Section: Discussionsupporting

confidence: 93%

Effect of HIV Infection and Plasmodium falciparum Parasitemia on Pregnancy Outcomes in Malawi

Nkhoma

Kalilani-Phiri

Mwapasa

et al. 2012

The American Journal of Tropical Medicine and Hygiene

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“…From the 182 women, 1,268 blood samples were available for both microscopy and molecular analysis. Full details of the study have been published elsewhere (24) . FIG.…”

Section: Resultsmentioning

confidence: 99%

“…Additionally, pooling samples for molecular diagnosis of malaria could make real-time PCR assays more feasible for large, clinical, resource-limited malaria studies. A previous longitudinal cohort of 182 pregnant women in Kinshasa documented high rates of antenatal malaria by blood smear and an association between repeated infection and intrauterine growth retardation (24). We employed a sample pooling/real-time PCR testing strategy for malaria for both quality control and investigation of the impact of submicroscopic parasitemia on birth outcomes.…”

mentioning

confidence: 99%

High-Throughput Pooling and Real-Time PCR-Based Strategy for Malaria Detection

et al. 2010

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Molecular assays can provide critical information for malaria diagnosis, speciation, and drug resistance, but their cost and resource requirements limit their application to clinical malaria studies. This study describes the application of a resource-conserving testing algorithm employing sample pooling for real-time PCR assays for malaria in a cohort of 182 pregnant women in Kinshasa. A total of 1,268 peripheral blood samples were collected during the study. Using a real-time PCR assay that detects all Plasmodium species, microscopypositive samples were amplified individually; the microscopy-negative samples were amplified after pooling the genomic DNA (gDNA) of four samples prior to testing. Of 176 microscopy-positive samples, 74 were positive by the real-time PCR assay; the 1,092 microscopy-negative samples were initially amplified in 293 pools, and subsequently, 35 samples were real-time PCR positive (3%). With the real-time PCR result as the referent standard, microscopy was 67.9% sensitive (95% confidence interval [CI], 58.3% to 76.5%) and 91.2% specific (95% CI, 89.4% to 92.8%) for malaria. In total, we detected 109 parasitemias by real-time PCR and, by pooling samples, obviated over 50% of reactions and halved the cost of testing. Our study highlights both substantial discordance between malaria diagnostics and the utility and parsimony of employing a sample pooling strategy for molecular diagnostics in clinical and epidemiologic malaria studies.

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“…For 10 of the 13 studies, pregnant women were identified and recruited at one of their self-initiated ANC, usually the booking visit10 20 22 27–32 but sometimes at a subsequent visit 26. The EMEP study enrolled women early in pregnancy, but a subset of these same women were also enrolled in a cross-sectional study at delivery, the intermittent preventive treatment in pregnancy (IPTp)-MON study 23…”

Section: Pooled Cohort Descriptionmentioning

confidence: 99%

“…To date, it remains unclear whether the susceptibility to, and the impact of, malarial infection are affected by maternal nutritional status. A small number of studies suggest that macronutrient nutritional status modifies the effects of malaria in pregnancy, specifically the impact of P. falciparum parasitaemia on fetal growth and birth weight 10–12. Although largely overlooked, this may not be surprising given that both macronutrient and micronutrient nutritional status affect immune function more broadly 13…”

Section: Introductionmentioning

confidence: 99%

Maternal Malaria and Malnutrition (M3) initiative, a pooled birth cohort of 13 pregnancy studies in Africa and the Western Pacific

et al. 2016

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PurposeThe Maternal Malaria and Malnutrition (M3) initiative has pooled together 13 studies with the hope of improving understanding of malaria–nutrition interactions during pregnancy and to foster collaboration between nutritionists and malariologists.ParticipantsData were pooled on 14 635 singleton, live birth pregnancies from women who had participated in 1 of 13 pregnancy studies. The 13 studies cover 8 countries in Africa and Papua New Guinea in the Western Pacific conducted from 1996 to 2015.Findings to dateData are available at the time of antenatal enrolment of women into their respective parent study and at delivery. The data set comprises essential data such as malaria infection status, anthropometric assessments of maternal nutritional status, presence of anaemia and birth weight, as well as additional variables such gestational age at delivery for a subset of women. Participating studies are described in detail with regard to setting and primary outcome measures, and summarised data are available from each contributing cohort.Future plansThis pooled birth cohort is the largest pregnancy data set to date to permit a more definite evaluation of the impact of plausible interactions between poor nutritional status and malaria infection in pregnant women on fetal growth and gestational length. Given the current comparative lack of large pregnancy cohorts in malaria-endemic settings, compilation of suitable pregnancy cohorts is likely to provide adequate statistical power to assess malaria–nutrition interactions, and could point towards settings where such interactions are most relevant. The M3 cohort may thus help to identify pregnant women at high risk of adverse outcomes who may benefit from tailored intensive antenatal care including nutritional supplements and alternative or intensified malaria prevention regimens, and the settings in which these interventions would be most effective.

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Impact of maternal malaria and under-nutrition on intrauterine growth restriction: a prospective ultrasound study in Democratic Republic of Congo

Cited by 66 publications

References 34 publications

Effect of HIV Infection and Plasmodium falciparum Parasitemia on Pregnancy Outcomes in Malawi

Effect of HIV Infection and Plasmodium falciparum Parasitemia on Pregnancy Outcomes in Malawi

High-Throughput Pooling and Real-Time PCR-Based Strategy for Malaria Detection

Maternal Malaria and Malnutrition (M3) initiative, a pooled birth cohort of 13 pregnancy studies in Africa and the Western Pacific

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