Effect of malaria in pregnancy on foetal cortical brain development: a longitudinal observational study

Abstract

Background: Malaria in pregnancy has a negative impact on foetal growth, but it is not known whether this also affects the foetal nervous system. The aim of this study was to examine the effects of malaria on foetal cortex development by three-dimensional ultrasound.

Methods: Brain images were acquired using a portable ultrasound machine and a 3D ultrasound transducer. All recordings were analysed, blinded to clinical data, using the 4D view software package. The foetal supra-tentorial brain volume was determined and cortical development was qualitatively followed by scoring the appearance and development of six sulci. Multilevel analysis was used to study brain volume and cortical development in individual foetuses.

Results: Cortical grading was possible in 161 out of 223 (72%) serial foetal brain images in pregnant women living in a malaria endemic area. There was no difference between foetal cortical development or brain volumes at any time in pregnancy between women with immediately treated malaria infections and non-infected pregnancies.

Conclusion: The percentage of images that could be graded was similar to other neuro-sonographic studies. Maternal malaria does not have a gross effect on foetal brain development, at least in this population, which had access to early detection and effective treatment of malaria.

Figure 1

Summary of morbidity. The x-axis is the gestational age in weeks. Each pregnant woman is shown as a horizontal line; the upper 22 horizontal lines represent women with malaria infections. The left column indicates the parity and the age of each pregnant woman, the right column shows the sex and weight of the newborn. The vertical red lines mark the first, second and third trimester. Blue boxes are P. vivax infections, and red triangles P. falciparum infections. Each black dot is an antenatal clinic consultation including a malaria screening, a cross (+) is a delivery, and could have a blue or red colour indicating P. vivax or P. falciparum infection at delivery, respectively. Abbreviations: F = Female, G = Gravida, M = Male, P = Parity, Y = Year.

Figure 2

Head circumference and cerebral volume. The x-axis is the gestational age in weeks; the y-axis represents the head circumference in millimetres or cerebral volume in centilitres. The blue lines represent foetuses from women with malaria infections (n = 22) and the red lines show foetuses from women without malaria infections (n = 22) in pregnancy.

Figure 3

Development of foetal cortex (Sylvian fissure, superior temporal, central, parieto-occipital, calcarine and cingulate sulcus). The x-axis is the gestational age in weeks; the y-axis represents the grading of the Sylvian fissure, superior temporal, central, parieto-occipital, calcarine and cingulate sulcus. The blue lines represent foetuses from women with malaria infections (n = 22) and the red lines show foetuses from women without malaria infections (n = 22) in pregnancy.