Ultrasound Evidence of Early Fetal Growth Restriction after Maternal Malaria Infection
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BACKGROUND: Intermittent preventive treatment (IPT), the main strategy to prevent malaria and reduce anaemia and low birthweight, focuses on the second half of pregnancy. However, intrauterine growth restriction may occur earlier in pregnancy. The aim of this study was to measure the effects of malaria in the first half of pregnancy by comparing the fetal biparietal diameter (BPD) of infected and uninfected women whose pregnancies had been accurately dated by crown rump length (CRL) before 14 weeks of gestation. METHODOLOGY/PRINCIPAL FINDINGS: In 3,779 women living on the Thai-Myanmar border who delivered a normal singleton live born baby between 2001-10 and who had gestational age estimated by CRL measurement <14 weeks, the observed and expected BPD z-scores (<24 weeks) in pregnancies that were (n = 336) and were not (n = 3,443) complicated by malaria between the two scans were compared. The mean (standard deviation) fetal BPD z-scores in women with Plasmodium (P) falciparum and/or P.vivax malaria infections were significantly lower than in non-infected pregnancies; -0.57 (1.13) versus -0.10 (1.17), p<0.001. Even a single or an asymptomatic malaria episode resulted in a significantly lower z-score. Fetal female sex (p<0.001) and low body mass index (p = 0.01) were also independently associated with a smaller BPD in multivariate analysis. CONCLUSIONS/SIGNIFICANCE: Despite early treatment in all positive women, one or more (a)symptomatic P.falciparum or P.vivax malaria infections in the first half of pregnancy result in a smaller than expected mid-trimester fetal head diameter. Strategies to prevent malaria in pregnancy should include early pregnancy.
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Registration of births is incomplete in many low-income countries and dating pregnancies reliably is particularly challenging.
“Registration of births is incomplete in many LIC 34 and dating pregnancies reliably a particularly challenging issue 35.”
From The overlap between miscarriage and extreme preterm birth in a limited-resource setting on the Thailand-Myanmar border: a population cohort study (2018) · cites this paper as [34]
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- Authors
- Rijken, M. J., Papageorghiou, A. T., Thiptharakun, S., Kiricharoen, S., Dwell, S. L. M., Wiladphaingern, J., Pimanpanarak, M., Kennedy, S. H., Nosten, F., & McGready, R.
- Affiliations
- Shoklo Malaria Research Unit (TH)
- University of Oxford (GB)
- Mahidol University (TH)
- Corresponding author
- Rijken, Marcus J.
- ORCID
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2012-02-09
- Volume
- 7
- Issue
- 2
- Pages
- e31411
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC3276538
- OpenAlex
- W1997274073
- Cited by
- 80
- References
- 53
- Citations by year
- 2026: 1 · 2025: 3 · 2023: 4 · 2022: 3 · 2021: 3 · 2020: 6 · 2019: 6 · 2018: 5 · 2017: 9 · 2016: 5 · 2015: 7 · 2014: 9 · 2013: 14 · 2012: 5
- FWCI
- 10.81
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- PLoS ONE (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- St George's Online Research Archive (St George's University of London) (acceptedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- Greater South Information System
- Funders
- Eli Lilly and Company
- Wellcome Trust (089275)
- National Institute for Health and Care Research
- Mahidol University
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Malaria Research and Control
- Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Keywords
- malaria in pregnancy, fetal growth restriction, Plasmodium falciparum, Plasmodium vivax, biparietal diameter, first trimester, intermittent preventive treatment, low birth weight, maternal body mass index, fetal sex, Thai-Myanmar border
- MeSH terms
- Adult, Female, Fetal Growth Retardation, Gestational Age, Humans, Malaria, Pregnancy, Ultrasonography, Prenatal, Malaria, Falciparum, Malaria, Vivax, Young Adult
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