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

• Published in: Epidemiology and infection 2009-02, Vol.137 (2), p.294-304
• Main Authors: LANDIS, S. H., LOKOMBA, V., ANANTH, C. V., ATIBU, J., RYDER, R. W., HARTMANN, K. E., THORP, J. M., TSHEFU, A., MESHNICK, S. R.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Anthropometric measurements; Biological and medical sciences; Body mass index; Congo; Democratic Republic of the Congo; Female; Fetal growth retardation; Fetal Growth Retardation - diagnostic imaging; Fetus; Fetuses; Fundamental and applied biological sciences. Psychology; Gestational age; Helminths and Protozoas; Human immunodeficiency virus; Human protozoal diseases; Humans; Infections; Infectious diseases; intrauterine growth restriction; Longitudinal Studies; Malaria; Malaria - complications; Malaria - drug therapy; Malnutrition; Malnutrition - complications; maternal nutrition; Medical sciences; Microbiology; Parasitic diseases; Physical growth; Pregnancy; Pregnancy Complications; Protozoal diseases; Risk Factors; Ultrasonic imaging; Ultrasonography; Weight gain; Young Adult
• ISSN: 0950-2688; 1469-4409
• DOI: 10.1017/S0950268808000915

Maternal malaria and under-nutrition are established risk factors for small-for-gestational-age (SGA) births; however, whether malaria is associated with intrauterine growth restriction (IUGR) is unknown. We investigated IUGR risk among 177 HIV-negative pregnant women enrolled in a longitudinal ultrasound study conducted in Democratic Republic of Congo from May 2005 to May 2006. Malaria infection, maternal anthropometrics, and ultrasound estimated fetal weight were measured monthly. All positive malaria cases were treated and intermittent presumptive therapy (IPTp) provided. Log-binomial regression models for IUGR were fitted using generalized estimating equations to account for statistical clustering of repeat IUGR measurements. Twenty-nine percent of fetuses experienced an episode of IUGR with the majority occurring in the third trimester. The risk of IUGR associated with malaria was greatest after three or more cumulative infections (RR 3·3, 95% CI 1·3–8·2) and was two- to eight-fold higher among women with evidence of under-nutrition. Receiving antimalarial treatment in the previous month (for IPTp or treatment) was significantly protective against IUGR (RR 0·5, 95% CI 0·3–0·7). The interaction observed between malaria and under-nutrition suggests that antenatal programmes in malaria endemic areas should incorporate nutritional screening and supplementation in addition to IPTp.