Prevalence and Associated Risk Factors of Malaria in the First Trimester of Pregnancy: A Preconceptional Cohort Study in Benin

Fiévet, Nadine; Yovo, Emmanuel; Cottrell, Gilles; Agbota, Gino; Massougbodji, Achille; Cot, Michel; Briand, Valérie

doi:10.1093/infdis/jiy009

Cited by 28 publications

(24 citation statements)

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“…33,35 Moreover, malaria was the most frequently reported maternal health issue during pregnancy in our cohort, and is a known risk factor for fetal growth restrictions. 36,37 Prevention and management of malaria both in pregnant women and in children must be emphasized through active engagement of makers of health decisions in parental education. Our findings highlight the need for provision of long-lasting insecticidal nets and free hospital access for pregnant women early during their first trimester, in a concerted program to reduce the incidence of cerebral palsy in endemic malaria areas such as Benin.…”

Section: Discussionmentioning

confidence: 99%

A Cross-sectional Study of the Clinical Profile of Children With Cerebral Palsy in Benin, a West African Low-Income Country

et al. 2019

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Cerebral palsy is a common cause of pediatric motor disability. Although there are increasing amounts of data on the clinical profile of children with cerebral palsy in high-income countries, corresponding information about low-income countries and developing countries is lacking. Therefore, we aimed to describe the clinical spectrum of cerebral palsy in children in Benin, a representative West African low-income country. Our cross-sectional observational study included 114 children with cerebral palsy recruited from community-based rehabilitation centers and teaching hospitals (median age: 7 years, range 2-17; sex: 66% male). Data were collected through review of medical records and interviews with children’s mothers. Assessment included risk factors, clinical subtypes according to the Surveillance of CP in Europe criteria, severity of motor outcome scored by the Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System, comorbidities, and school attendance. We recorded a high prevalence of intrapartum adverse events. Seventeen percent of children had postneonatal cerebral palsy, with cerebral malaria being the most common cause. Most children were severely affected (67.5% as bilateral spastic; 54.4% as GMFCS IV or V), but severity declined substantially with age. Only 23% of the children with cerebral palsy had attended school. Poor motor outcomes and comorbidities were associated with school nonattendance. These results suggest that intrapartum risk factors and postnatal cerebral malaria in infants are opportune targets for prevention of cerebral palsy in Sub-Saharan low-income countries.

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Section: Discussionmentioning

confidence: 99%

A Cross-sectional Study of the Clinical Profile of Children With Cerebral Palsy in Benin, a West African Low-Income Country

et al. 2019

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“…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].…”

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

Briand

Cottrell

Ndam

et al. 2020

Malar J

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Background While sub-microscopic malarial infections are frequent and potentially deleterious during pregnancy, routine molecular detection is still not feasible. This study aimed to assess the performance of a Histidine Rich Protein 2 (HRP2)-based ultrasensitive rapid diagnostic test (uRDT, Alere Malaria Ag Pf) for the detection of infections of low parasite density in pregnant women. Methods This was a retrospective study based on samples collected in Benin from 2014 to 2017. A total of 942 whole blood samples collected in 327 women in the 1st and 3rd trimesters and at delivery were tested by uRDT, conventional RDT (cRDT, SD BIOLINE Malaria Ag Pf), microscopy, quantitative polymerase chain-reaction (qPCR) and Luminex-based suspension array technology targeting P. falciparum HRP2. The performance of each RDT was evaluated using qPCR as reference standard. The association between infections detected by uRDT, but not by cRDT, with poor maternal and birth outcomes was assessed using multivariate regression models. Results The overall positivity rate detected by cRDT, uRDT, and qPCR was 11.6% (109/942), 16.2% (153/942) and 18.3% (172/942), respectively. Out of 172 qPCR-positive samples, 68 were uRDT-negative. uRDT had a significantly better sensitivity (60.5% [52.7–67.8]) than cRDT (44.2% [36.6–51.9]) and a marginally decreased specificity (93.6% [91.7–95.3] versus 95.7% [94.0–97.0]). The gain in sensitivity was particularly high (33%) and statistically significant in the 1st trimester. Only 28 (41%) out of the 68 samples which were qPCR-positive, but uRDT-negative had detectable but very low levels of HRP2 (191 ng/mL). Infections that were detected by uRDT but not by cRDT were associated with a 3.4-times (95%CI 1.29–9.19) increased risk of anaemia during pregnancy. Conclusions This study demonstrates the higher performance of uRDT, as compared to cRDTs, to detect low parasite density P. falciparum infections during pregnancy, particularly in the 1st trimester. uRDT allowed the detection of infections associated with maternal anaemia.

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“…We chose to use BMI at the first ANC visit instead of BMI at enrollment in the preconceptional cohort for three main reasons: First, there was a high variability in time to pregnancy (mean [interquartile range] = 3.9 [0.6‐21.2] mo in women who became pregnant), with variations in women's weight between inclusion in the preconception period and the beginning of pregnancy. Second, the first ANC visit was performed very early in pregnancy at a mean (SD) of 6.7 (±2.1) weeks, allowing us to use BMI at the first ANC visit as a proxy for BMI before conception . Finally, this allowed us to have a more complete data set.…”

Section: Discussionmentioning

confidence: 99%

“…weeks, allowing us to use BMI at the first ANC visit as a proxy for BMI before conception. 24 Finally, this allowed us to have a more complete data set. Sensitivity analyses using last BMI measured in the preconceptional period yielded similar results.…”

Section: Discussionmentioning

confidence: 99%

Poor maternal anthropometric status before conception is associated with a deleterious infant growth during the first year of life: a longitudinal preconceptional cohort

et al. 2019

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Summary Background According to the Developmental Origins of Health and Diseases concept, exposures in the preconception period may be critical. For the first time, we evaluated the effect of preconception poor anthropometric status on infant's growth in sub‐Saharan Africa. Methods A mother‐child cohort was followed prospectively from preconception to 1 year old in Benin. Maternal anthropometric status was assessed by prepregnancy body mass index (BMI), approximated by BMI at the first antenatal visit before 7 weeks' gestation, and gestational weight gain (GWG). BMI was categorized as underweight, normal, overweight, and obesity according to World Health Organization standards. GWG was categorized as low (<7 kg), mild (7‐12 kg), and high (>12 kg). In infant, stunting and wasting were defined as length‐for‐age and weight‐for‐length z scores less than −2 SD, respectively. We evaluated the association between BMI/GWG and infant's weight and length at birth and during the first year of life, as well as with stunting and wasting at 12 months using mixed linear and logistic regression models. Results In multivariate, preconceptional underweight was associated with a lower infant's weight at birth and during the first year (−164 g; 95% CI, −307 to −22; and −342 g; 95% CI, −624 to −61, respectively) and with a higher risk of stunting at 12 months (adjusted odds ratio [aOR] = 3.98; 95% CI, 1.01‐15.85). Furthermore, preconceptional obesity and a high GWG were associated with a higher weight and length at birth and during the first year. Conclusion Underweight and obesity before conception as well as GWG were associated with infant's growth. These results argue for preventive interventions starting as early as the preconception period to support child long‐term health.

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Prevalence and Associated Risk Factors of Malaria in the First Trimester of Pregnancy: A Preconceptional Cohort Study in Benin

Abstract: Using a preconceptional study design, we showed that malaria was highly prevalent in early pregnancy. This calls for the assessment of new strategies that could protect women as soon as the first trimester.

Cited by 28 publications

References 42 publications

A Cross-sectional Study of the Clinical Profile of Children With Cerebral Palsy in Benin, a West African Low-Income Country

A Cross-sectional Study of the Clinical Profile of Children With Cerebral Palsy in Benin, a West African Low-Income Country

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

Poor maternal anthropometric status before conception is associated with a deleterious infant growth during the first year of life: a longitudinal preconceptional cohort

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