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Impact of maternal malaria and under-nutrition on intrauterine growth restriction: a prospective ultrasound study in Democratic Republic of Congo

  • S. H. LANDIS (a1), V. LOKOMBA (a2), C. V. ANANTH (a3), J. ATIBU (a2), R. W. RYDER (a4), K. E. HARTMANN (a5), J. M. THORP (a6), A. TSHEFU (a2) and S. R. MESHNICK (a1)
  • DOI:
  • Published online: 01 June 2008

Maternal malaria and under-nutrition are established risk factors for small-for-gestational-age (SGA) births; however, whether malaria is associated with intrauterine growth restriction (IUGR) is unknown. We investigated IUGR risk among 177 HIV-negative pregnant women enrolled in a longitudinal ultrasound study conducted in Democratic Republic of Congo from May 2005 to May 2006. Malaria infection, maternal anthropometrics, and ultrasound estimated fetal weight were measured monthly. All positive malaria cases were treated and intermittent presumptive therapy (IPTp) provided. Log-binomial regression models for IUGR were fitted using generalized estimating equations to account for statistical clustering of repeat IUGR measurements. Twenty-nine percent of fetuses experienced an episode of IUGR with the majority occurring in the third trimester. The risk of IUGR associated with malaria was greatest after three or more cumulative infections (RR 3·3, 95% CI 1·3–8·2) and was two- to eight-fold higher among women with evidence of under-nutrition. Receiving antimalarial treatment in the previous month (for IPTp or treatment) was significantly protective against IUGR (RR 0·5, 95% CI 0·3–0·7). The interaction observed between malaria and under-nutrition suggests that antenatal programmes in malaria endemic areas should incorporate nutritional screening and supplementation in addition to IPTp.

Corresponding author
*Author for correspondence: Dr S. R. Meshnick, Department of Epidemiology, University of North Carolina at Chapel Hill, McGavran-Greenberg Hall, Campus Box 7435, Chapel Hill, NC 27599-7435, USA. (Email:
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1.MC McCormick , The health and development status of very low-birthweight children at school age. Journal of the American Medical Association 1992; 267: 22042208.

4.J Villar , JM Belizan . The relative contribution of prematurity and fetal growth retardation to low birth weight in developing and developed societies. American Journal of Obstetrics and Gynecology 1982; 143: 793798.

5.R Resnik . Intrauterine growth restriction. Obstetrics and Gynecology 2002; 99: 490496.

7.AD Sullivan , Malaria infection during pregnancy: Intrauterine growth retardation and preterm delivery in Malawi. Journal of Infectious Diseases 1999; 179: 15801583.

8.C Menendez , The impact of placental malaria on gestational age and birth weight. Journal of Infectious Diseases 2000; 181: 17401745.

12.FH Verhoeff , An analysis of intra-uterine growth retardation in rural Malawi. European Journal of Clinical Nutrition 2001; 55: 682689.

14.J Fedrick , P Adelstein . Factors associated with low birth weight of infants delivered at term. British Journal of Obstetrics and Gynaecology 1978; 85: 17.

15.LE Edwards , Pregnancy in the underweight woman. Course, outcome, and growth patterns of the infant. American Journal of Obstetrics and Gynecology 1979; 135: 297302.

18.M Cedergren . Effects of gestational weight gain and body mass index on obstetric outcome in Sweden. International Journal of Gynaecology and Obstetrics 2006; 93: 269274.

21.F Hadlock , Estimating fetal age: Computer-assisted analysis of multiple fetal growth parameters. Radiology 1984; 152: 497501.

22.F Hadlock , Estimation of fetal weight with the use of the head, body and femur measurements – a prospective study. American Journal of Obstetrics and Gynecology 1985; 151: 333337.

23.ET Abrams , Malaria during pregnancy and foetal haematological status in Blantyre, Malawi. Malaria Journal 2005; 4: 39.

24.FP Hadlock , RB Harrist , J Martinez-Poyer . In utero analysis of fetal growth: a sonographic weight standard. Radiology 1991; 181: 129133.

27.K-Y Liang , SL Zeger . Longitudinal data analysis using generalized linear models. Biometrika 1986; 73: 1322.

29.BF Abrams , RK Laros Jr.. Prepregnancy weight, weight gain, and birth weight. American Journal of Obstetrics and Gynecology 1986; 154: 503509.

31.BJ Brabin , The sick placenta-the role of malaria. Placenta 2004; 25: 359378.

33.RD Newman , Burden of malaria during pregnancy in areas of stable and unstable transmission in Ethiopia during a nonepidemic year. Journal of Infectious Diseases 2003; 187: 17651772.

36.CA Hickey , Prenatal weight gain patterns and birth weight among nonobese black and white women. Obstetrics and Gynecology 1996; 88: 490496.

37.B Abrams , S Selvin . Maternal weight gain pattern and birth weight. Obstetrics and Gynecology 1995; 86: 163169.

39.C Menendez , AF Fleming , PL Alonso . Malaria-related anaemia. Parasitology Today 2000; 16: 469476.

40.M Wilcox , Birth weight for pregnancies dated by ultrasonography in a multicultural British population. British Medical Journal 1993; 307: 588591.

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