Ultrasound Evidence of Early Fetal Growth Restriction after Maternal Malaria InfectionReport as inadecuate




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Background

Intermittent preventive treatment IPT, the main strategy to prevent malaria and reduce anaemia and low birthweight, focuses on the second half of pregnancy. However, intrauterine growth restriction may occur earlier in pregnancy. The aim of this study was to measure the effects of malaria in the first half of pregnancy by comparing the fetal biparietal diameter BPD of infected and uninfected women whose pregnancies had been accurately dated by crown rump length CRL before 14 weeks of gestation.

Methodology-Principal Findings

In 3,779 women living on the Thai-Myanmar border who delivered a normal singleton live born baby between 2001–10 and who had gestational age estimated by CRL measurement <14 weeks, the observed and expected BPD z-scores <24 weeks in pregnancies that were n = 336 and were not n = 3,443 complicated by malaria between the two scans were compared. The mean standard deviation fetal BPD z-scores in women with Plasmodium P falciparum and-or P.vivax malaria infections were significantly lower than in non-infected pregnancies; −0.57 1.13 versus −0.10 1.17, p<0.001. Even a single or an asymptomatic malaria episode resulted in a significantly lower z-score. Fetal female sex p<0.001 and low body mass index p = 0.01 were also independently associated with a smaller BPD in multivariate analysis.

Conclusions-Significance

Despite early treatment in all positive women, one or more asymptomatic P.falciparum or P.vivax malaria infections in the first half of pregnancy result in a smaller than expected mid-trimester fetal head diameter. Strategies to prevent malaria in pregnancy should include early pregnancy.



Author: Marcus J. Rijken , Aris T. Papageorghiou, Supan Thiptharakun, Suporn Kiricharoen, Saw Lu Mu Dwell, Jacher Wiladphaingern, Mupawja

Source: http://plos.srce.hr/



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