The effect of timing and frequency of Plasmodium falciparum infection during pregnancy on the risk of low birth weight and maternal anemia
Open accessAbstract
Plasmodium falciparum infection during pregnancy causes maternal anemia and low birth weight (LBW), but the effect of frequency and timing of infection on the severity of these adverse effects is unknown. We conducted a cohort study recruiting 2462 pregnant women in Malawi. Microscopy was used to diagnose malaria at enrollment, follow-up and delivery. Birth weight and maternal hemoglobin were measured at delivery. The association between timing and frequency of infection and LBW and maternal anemia was analyzed using a binomial regression model. Compared with uninfected women, (i) the risk of LBW increased with the number of malaria episodes [one episode: prevalence ratio (PR) 1.62 (95% CI 1.07-2.46); two episodes: PR 2.41 (95% CI 1.39-4.18)]; (ii) the risk for maternal anemia increased with the number of malaria episodes [one episode: PR 1.15 (95% CI 0.86-1.54); two episodes: PR 1.82 (95% CI 1.28-2.62)]; and (iii) the risk of LBW was higher with infection in the second (PR 1.71; 95% CI 1.06-2.74) than third trimester or at delivery (PR 1.55; 95% CI 0.88-2.75). The timing and frequency of P. falciparum infection during pregnancy affected the risk of LBW but only frequency of infection had an effect on the risk of maternal anemia. Identification of gestational periods when malaria causes most adverse outcomes will facilitate effective targeting of interventions.
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Malaria infections in the first or second trimester of pregnancy increase the risk of anaemia.
“Malaria infections in the first or second trimester of pregnancy increase the risk of anaemia,24,30 though one study reported an increased risk also for infections occurring in the third trimester.30”
From Malaria in pregnancy. (2013) · cites this paper as [24]
Results §3.6 reports no significant increase in maternal anaemia at delivery for infections detected in the second or third trimester compared with no parasitaemia. The Discussion says the study could not assess first-trimester infections; it instead associates anaemia risk with the number of infection episodes, not their timing. (LLM, conf=0.88)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredPrimigravidae are at higher risk of malaria than multigravidae, though less in low transmission settings, while in epidemic areas the risk is not affected by parity.
“Parity also affects the risk of malaria as primigravidae are at higher risk than multigravidae,18–20, 23–24 though less in low transmission settings,15 while in epidemic areas, the risk is not affected by parity.25”
From Malaria in pregnancy. (2013) · cites this paper as [24]
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“A recent longitudinal study has also reported that the risk of LBW is higher with increased frequency of malaria episodes and with infections occurring in the second than in the third trimester or at delivery [30].”
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“A study in Malawi found a dose-response relationship between the number of malaria infections diagnosed by microscopy and risk of LBW but also did not measure submicroscopic parasitemia or placental outcomes [23].”
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“Remarkably, a high number of infections during pregnancy leads to an increased risk of LBW independently of the timing (22, 24).”
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“reported a similar estimate caused by greater than or equal to two parasitemia episodes on the risk of LBW and maternal anemia.(18) In this latter study, parasitemia at delivery was”
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“malaria in the pregnant woman, which suggests that malaria injury may be cumulative.(41) Malaria infections occurring at the beginning of pregnancy are more apt to determine LBW”
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Pre-clinical and clinical development of the first placental malaria vaccine
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A brief review on features of falciparum malaria during pregnancy
Manirakiza, A., Serdouma, E., Ngbalé, R. N., Moussa, S., Gondjé, S., Degana, R. M., Bata, G. G. B., Moyen, J. M., Delmont, J. P., Grésenguet, G., et al. (2017) · Journal of Public Health in Africa · doi:10.4081/jphia.2017.668 · Cited by 22 · see citing works
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“falciparum infection on pregnancy outcomes in 2,462 subjects was unable to evaluate the effects in early pregnancy because only six women in their first trimester attended the antenatal clinic where recruitment was taking place [39].”
BackgroundChandrasiri, U., Fowkes, F. J. I., Beeson, J. G., Richards, J. S., Kamiza, S., Maleta, K. M., Ashorn, P., & Rogerson, S. J. (2016) · Malaria Journal · doi:10.1186/s12936-016-1597-7 · Cited by 17 · see citing works
Self-citationDeforestation and infant mortality: Evidence from Indonesia
Chakrabarti, A. (2020) · Economics & Human Biology · doi:10.1016/j.ehb.2020.100943 · Cited by 15 · see citing works
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“LBW and severe maternal anaemia are associated with frequent malaria episodes and the timing of infections [16], and it is likely that the reduction in these outcomes is due in part at least, to a reduction in the risk of recurrent malaria.”
BackgroundMalaria elimination in Malawi: Research needs in highly endemic, poverty-stricken contexts
Wilson, M. L., Walker, E. D., Mzilahowa, T., Mathanga, D. P., & Taylor, T. E. (2011) · Acta Tropica · doi:10.1016/j.actatropica.2011.11.002 · Cited by 14 · see citing works
“Other studies have characterized the timing and frequency of P .falciparum infection on pregnancy outcomes including low birth weight and maternal anemia (Kalilani et al., 2010).”
BackgroundOdongo, C. O., Odida, M., Wabinga, H., Obua, C., & Byamugisha, J. K. (2016) · Malaria Research and Treatment · doi:10.1155/2016/1839795 · Cited by 15 · see citing works
Tshiongo, J. K., Matuvanga, T. Z., Mitashi, P., Maketa, V., Schallig, H. D. F. H., Mens, P. F., Mavoko, H. M., & Matangila, J. R. (2024) · Tropical Medicine and Infectious Disease · doi:10.3390/tropicalmed9050092 · Cited by 15 · see citing works
“During the peri-natal period, MiP increases the risk of low birth weight [8,11,12].”
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“thus suffer impaired uteroplancental blood flow and maternal anaemia, which leads to foetal growth restriction subsequently low birth weight [34, 48].”
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AN OVERVIEW ON MALARIA IN SUB-SAHARAN WITH SPECIAL REFERENCE TO TANZANIA
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“In Malawi, Kalilani et al. [32] found that there was a high risk of low birth weight in the second trimester.”
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“The study also reported that inflammatory infiltration of the intervillous spaces is associated with LBW especially when mononuclear cells are highly increased [25].”
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A novel murine model of post-implantation malaria-induced preterm birth
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- Authors
- Kalilani, L., Mofolo, I., Chaponda, M., Rogerson, S. J., & Meshnick, S. R.
- Affiliations
- University of Malawi (MW)
- The University of Melbourne (AU)
- University of North Carolina at Chapel Hill (US)
- Venue
- Transactions of the Royal Society of Tropical Medicine and Hygiene
- Publisher
- Oxford University Press (OUP)
- Published
- 2010-06
- Volume
- 104
- Issue
- 6
- Pages
- 416-422
- ISSN
- 0035-9203 (ISSN-L)
- PMC
- PMC4844554
- OpenAlex
- W2029197325
- Cited by
- 74
- References
- 31
- Citations by year
- 2025: 3 · 2024: 3 · 2023: 2 · 2022: 2 · 2021: 1 · 2020: 4 · 2019: 5 · 2018: 4 · 2017: 8 · 2016: 10 · 2015: 2 · 2014: 5 · 2013: 9 · 2012: 5
- FWCI
- 7.95
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Transactions of the Royal Society of Tropical Medicine and Hygiene (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Carolina Digital Repository (University of North Carolina at Chapel Hill) (submittedVersion)
- UNC Libraries
- Funders
- Wellcome Trust
- Centers for Disease Control and Prevention
- U.S. Public Health Service (S1935-21/21)
- Fogarty International Center (D43TW006568)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Malaria Research and Control
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
- Keywords
- Plasmodium falciparum, malaria in pregnancy, low birth weight, anemia in pregnancy, timing of infection, pregnancy trimesters, hemoglobin, pregnancy outcomes
- MeSH terms
- Adolescent, Adult, Anemia, Female, Humans, Infant, Low Birth Weight, Infant, Newborn, Malawi, Plasmodium falciparum, Pregnancy, Regression Analysis, Risk Factors, Severity of Illness Index, Time Factors, Cohort Studies, Pregnancy Complications, Parasitic, Malaria, Falciparum, Infectious Disease Transmission, Vertical, Young Adult
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