Impact of malaria at the end of pregnancy on infant mortality and morbidity

Abstract

Background: There is some consensus that malaria in pregnancy may negatively affect infant's mortality and malaria morbidity, but there is less evidence concerning the factors involved.

Methods: A total of 1030 Mozambican pregnant women were enrolled in a randomized, placebo-controlled trial of intermittent preventive treatment with sulfadoxine-pyrimethamine, and their infants were followed up throughout infancy. Overall mortality and malaria morbidity rates were recorded. The association of maternal and fetal risk factors with infant mortality and malaria morbidity was assessed.

Results: There were 58 infant deaths among 997 live-born infants. The risk of dying during infancy was increased among infants born to women with acute placental infection (odds ratio [OR], 5.08 [95% confidence interval (CI), 1.77-14.53)], parasitemia in cord blood (OR, 19.31 [95% CI, 4.44-84.02]), low birth weight (OR, 2.82 [95% CI, 1.27-6.28]) or prematurity (OR, 3.19 [95% CI, 1.14-8.95]). Infants born to women who had clinical malaria during pregnancy (OR, 1.96 [95% CI, 1.13-3.41]) or acute placental infection (OR, 4.63 [95% CI, 2.10-10.24]) had an increased risk of clinical malaria during infancy.

Conclusions: Malaria infection at the end of pregnancy and maternal clinical malaria negatively impact survival and malaria morbidity in infancy. Effective clinical management and prevention of malaria in pregnancy may improve infant's health and survival.

Trial registration: ClinicalTrials.gov NCT00209781.

Figure 1.

Time to first or only clinical malaria episode in infants born to women with placental malaria compared with those born to women without placental malaria, by parity. Infants born to women of all parities (A), primigravid women (B), women with 1–3 previous pregnancies (C), and women with ≥4 previous pregnancies (D). P values adjusted by season: <.001 (primigravid women), .014 (1–3 previous pregnancies), <.001 (≥4 pregnancies), and <.001 (all gravidities). P values adjusted by previous malaria episodes during pregnancy: .002 (primigravid women), <.026 (1–3 previous pregnancies), <.001 (≥4 pregnancies), and <.001 (all gravidities).