BACKGROUND: Fetal growth restriction (FGR) is associated with
increased infant mortality rates and ill-health in adulthood.
Evaluation of fetal growth requires ultrasound. As a result,
ultrasound-assisted evaluations of causes of FGR in
malaria-endemic developing countries are rare. We aimed to
determine factors associated with indicators of abnormal fetal
growth in rural lowland Papua New Guinea (PNG). METHODS: Weights
and growth of 671 ultrasound-dated singleton pregnancies (<25
gestational weeks) were prospectively monitored using estimated
fetal weights and birthweights. Maternal nutritional status and
haemoglobin levels were assessed at enrolment, and participants
were screened for malaria on several occasions. FGR was
suspected upon detection of an estimated fetal weight or
birthweight <10(th) centile (small-for-gestational age)
and/or low fetal weight gain, defined as a change in weight
z-score in the first quartile. Factors associated with fetal
weight and fetal weight gain were additionally assessed by
evaluating differences in weight z-scores and change in weight
z-scores. Log-binomial and linear mixed effect models were used
to determine factors associated with indicators of FGR. RESULTS:
SGA and low weight gain were detected in 48.3% and 37.0% of
pregnancies, respectively. Of participants, 13.8%, 21.2%, and
22.8% had a low mid-upper arm circumference (MUAC, <22 cms),
short stature (<150 cms) and anaemia (haemoglobin <90 g/L)
at first antenatal visit. 24.0% (161/671) of women had at least
one malaria infection detected in peripheral blood. A low MUAC
(adjusted risk ratio [aRR] 1.51, 95% CI 1.29, 1.76, P <
0.001), short stature (aRR 1.27, 95% CI 1.04, 1.55, P = 0.009),
and anaemia (aRR 1.27, 95% CI 1.06, 1.51, P = 0.009) were
associated with SGA, and a low body mass index was associated
with low fetal weight gain (aRR 2.10, 95% CI 1.62, 2.71, P <
0.001). Additionally, recent receipt of intermittent preventive
treatment in pregnancy was associated with increased weight
z-scores, and anaemia with reduced change in weight z-scores.
Malaria infection was associated with SGA on crude but not
adjusted analyses (aRR 1.13, 95% CI 0.95, 1.34, P = 0.172).
CONCLUSION: Macronutrient undernutrition and anaemia increased
the risk of FGR. Antenatal nutritional interventions and malaria
prevention could improve fetal growth in PNG