Plasmodium falciparum malaria in pregnancy causes adverse pregnancy outcomes, most notably reduced birth weight and maternal anemia. Preventive treatment that is safe during pregnancy has been shown to effectively reduce rates of malaria in pregnancy, yet in malaria-endemic regions rates of adverse pregnancy outcomes remain high. We sought to explore the association of malaria in pregnancy and other risk factors with poor outcomes, among a cohort of pregnant women who received the recommended preventative treatment for malaria at antenatal care. The prevalence of malaria at the first antenatal care visit was 11%, and malaria infection was associated with lower measures of fetal growth, as measured by ultrasound. Among live, term births, the mean birth weight was not significantly different for malaria-positive vs. malaria-negative women. However, among women with under-nutrition, as measured by low body-mass-index, malaria exposure was associated with significantly decreased birth weight (mean difference -370 grams, 95% CI -728, -12 g). The rates of maternal anemia (hemoglobin <11.0 g/dL) and moderate/severe anemia (hemoglobin < 9.0 g/dL) at antenatal care were 70% and 27%, respectively. Moderate/severe maternal anemia at first antenatal care was associated with malaria as diagnosed by microscopy (aRR 2.06, 95% CI 1.24, 3.44) as was high-intensity hookworm infection in multivariate regression (aRR 2.37, 95% CI 1.44, 3.91). Our findings suggest the importance of good preventative treatment for malaria in pregnancy to minimize the impact of exposure to malaria on fetal and newborn growth. However, under-nutrition has an important role and research and programs to improve maternal nutritional health may be important to important to further improving birth outcomes in low-resource settings. Furthermore, given the high prevalence of anemia seen in our study, also associated with under-nutrition, as well as hookworm, and malaria, further research is needed to optimize interventions around pregnancy to improve maternal and newborn health in malaria-endemic regions.Doctor of Philosoph
