The Impact of Malaria in Pregnancy on Changes in Blood Pressure in Children During Their First Year of Life

Abstract

Abstract-We established a maternal birth cohort in Ibadan, Nigeria, where malaria is hyperendemic, to assess how intrauterine exposure to malaria affected infant blood pressure (BP) development. In a local maternity hospital, healthy pregnant women had regular blood films for malaria parasites from booking to delivery. Growth and BP were measured on 318 babies, all followed from birth to 3 and 12 months. Main outcomes were standardized measures of anthropometry and change in BP to 1 year. Babies exposed to maternal malaria were globally smaller at birth, and boys remained smaller at 3 months and 1 year. Change in systolic BP (SBP) during the year was greater in boys than in girls (20.9 versus 15.7 mm Hg; P=0.002) but greater in girls exposed to maternal malaria (18.7 versus 12.7 mm Hg; 95% confidence interval, 1-11 mm Hg; P=0.02). Eleven percent of boys (greater than twice than expected) had a SBP ≥95th percentile (hypertensive, US criteria), of whom 68% had maternal malaria exposure. On regression analysis (β coefficients, mm Hg), sex (boys>girls; β=4.4; 95% confidence interval, 1.1-7.7; P=0.01), maternal malaria exposure (3.64; 0.3-6.9; P=0.03), and weight change (2.4; 0.98-3.8/1 standard deviation score; P=0.001) all independently increased SBP change to 1 year, whereas increase in length decreased SBP (−1.98; −3.6 to −0.40). In conclusion, malaria-exposed boys had excess hypertension, whereas malariaexposed girls a greater increase in SBP. Intrauterine exposure to malaria had sex-dependent effects on BP, independent of infant growth. Because infant-child-adult BP tracking is powerful, a malarial effect may contribute to the African burden of hypertension. (Hypertension. 2014;63:167-172.)

2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension

“…Clearly, the present scarcity of European research needs to be amended and expanded beyond the present general knowledge that, as in USA, African-origin people in Europe have more hypertension associated with greater CV risk than the European ancestry population. So far, some evidence has been obtained that differences may be related to in utero and postnatal development and growth, including overt malnutrition, malaria in pregnancy or epigenetic influences [1039][1040][1041][1042]. Persistent social disadvantages from individual and structural racism, including neighborhood segregation [1043][1044][1045], ethnic disparities or inequalities in access to care are increasingly recognized as driving factors for resulting differences in hypertension and increased CV morbidity and mortality [1046,1047].…”

The Malaria-High Blood Pressure Hypothesis

“… 18 – 21 In a study conducted in Ibadan, Nigeria, infants of mothers who experienced malaria during pregnancy had a higher increase in BP levels during the first year of life compared with those who did not. 22 Because BP levels track strongly through to adulthood, such differences could significantly influence the prevalence of adult hypertension. 23 – 25 By virtue of its association with hypertensive disorders of pregnancy that are themselves risk factors for essential hypertension in women, 26 , 27 malaria likely contributes to an intergenerational vicious cycle of disease susceptibility because hypertensive parents bear children who develop hypertension more frequently.…”

Longitudinal study of cardiometabolic risk from early adolescence to early adulthood in an ethnically diverse cohort

“…Over 50 years ago, infants, universally breast fed, gained weight and height similarly to the UK children for the first 6 months, then when weaned, growth faltered, although in the Gambian setting without overt malnutrition 27. Recent studies in Nigeria, with parasitaemia examined throughout pregnancy, suggest that birth dimensions were lower and infant BP by age 1 year had climbed faster, even adjusting for catch-up growth 28. Postnatal child growth is also affected by other inherent (eg, haemoglobin genotype) exposure to obesogenic neighbourhoods (eg, high density of fast food outlets),29 earlier maturation and mixed feeding as infants.…”