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. 2023 Oct:135:28-40.
doi: 10.1016/j.ijid.2023.07.012. Epub 2023 Jul 28.

Fetal growth and birth weight are independently reduced by malaria infection and curable sexually transmitted and reproductive tract infections in Kenya, Tanzania, and Malawi: A pregnancy cohort study

George Mtove  1 , R Matthew Chico  2 , Mwayiwawo Madanitsa  3 , Hellen C Barsosio  4 , Omari Abdul Msemo  5 , Queen Saidi  6 , Georgia R Gore-Langton  2 , Daniel T R Minja  5 , Crispin Mukerebe  5 , Samwel Gesase  5 , Victor Mwapasa  7 , Kamija S Phiri  7 , Helle Hansson  8 , James Dodd  9 , Pascal Magnussen  8 , Reginald A Kavishe  6 , Franklin Mosha  6 , Simon Kariuki  4 , John P A Lusingu  5 , Julie R Gutman  10 , Michael Alifrangis  8 , Feiko O Ter Kuile  9 , Christentze Schmiegelow  8
Affiliations

Fetal growth and birth weight are independently reduced by malaria infection and curable sexually transmitted and reproductive tract infections in Kenya, Tanzania, and Malawi: A pregnancy cohort study

George Mtove et al. Int J Infect Dis. 2023 Oct.

Abstract

Objectives: Malaria and sexually transmitted and reproductive tract infections (STIs/RTIs) are highly prevalent in sub-Saharan Africa and associated with poor pregnancy outcomes. We investigated the individual and combined effects of malaria and curable STIs/RTIs on fetal growth in Kenya, Tanzania, and Malawi.

Methods: This study was nested within a randomized trial comparing monthly intermittent preventive treatment for malaria in pregnancy with sulfadoxine-pyrimethamine vs dihydroartemisinin-piperaquine, alone or combined with azithromycin. Fetal weight gain was assessed by serial prenatal ultrasound. Malaria was assessed monthly, and Treponema pallidum, Neisseria gonorrhoeae, Trichomonas vaginalis, Chlamydia trachomatis, and bacterial vaginosis at enrollment and in the third trimester. The effect of malaria and STIs/RTIs on fetal weight/birthweight Z-scores was evaluated using mixed-effects linear regression.

Results: In total, 1435 pregnant women had fetal/birth weight assessed 3950 times. Compared to women without malaria or STIs/RTIs (n = 399), malaria-only (n = 267), STIs/RTIs only (n = 410) or both (n = 353) were associated with reduced fetal growth (adjusted mean difference in fetal/birth weight Z-score [95% confidence interval]: malaria = -0.18 [-0.31,-0.04], P = 0.01; STIs/RTIs = -0.14 [-0.26,-0.03], P = 0.01; both = -0.20 [-0.33,-0.07], P = 0.003). Paucigravidae experienced the greatest impact.

Conclusion: Malaria and STIs/RTIs are associated with poor fetal growth especially among paucigravidae women with dual infections. Integrated antenatal interventions are needed to reduce the burden of both malaria and STIs/RTIs.

Keywords: Bacterial vaginosis; Birthweight; Fetal growth; Malaria in pregnancy; Reproductive tract infection; Sexually transmitted infection.

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Conflict of interest statement

Declarations of Competing Interest The authors have no competing interests to declare.

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