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The Effects of Malaria and Intermittent Preventive Treatment During Pregnancy on Fetal Anemia in Malawi

Rogawski, E. T., Chaluluka, E., Molyneux, Malcolm E, Feng, G., Rogerson, S. J. and Meshnick, S. R. (2012) 'The Effects of Malaria and Intermittent Preventive Treatment During Pregnancy on Fetal Anemia in Malawi'. Clinical Infectious Diseases, Vol 55, Issue 8, pp. 1096-1102.

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Abstract

Background. Fetal anemia is common in malarious areas and is a risk factor for infant morbidity and mortality. Malaria during pregnancy may cause decreased cord hemoglobin (Hb) and fetal anemia among newborns. Intermittent preventive treatment during pregnancy (IPTp) with sulfadoxine–pyrimethamine (SP) is protective against malaria but may also affect hematopoiesis and contribute to fetal anemia.

Methods. Peripheral, placental, and cord blood were examined for malaria parasitemia and Hb concentration in a cross-section of 3848 mothers and infants delivered at Queen Elizabeth Central Hospital in Blantyre, Malawi between 1997 and 2006. Unconditional linear and logistic regressions were performed with multiple imputation for missing covariates to assess the associations between malaria, IPTp with SP, and fetal anemia.

Results. The overall prevalence of fetal anemia was 7.9% (n = 304). Malaria parasitemia at delivery was associated with an adjusted decrease in cord Hb of −0.24 g/dL (95% confidence interval [CI], −.42 to −.05). The adjusted prevalence odds ratio for the effect of malaria on fetal anemia was 1.41 (95% CI, 1.05–1.90). Primigravidae who did not take IPTp had infants at highest risk for fetal anemia, and density of parasitemia was correlated with the decrease in cord Hb. There was no significant association between SP use and cord Hb or fetal anemia.

Conclusions. Malaria during pregnancy, but not IPTp, decreases cord Hb and is a risk factor for fetal anemia in Malawi. Intermittent preventive treatment during pregnancy with SP may continue to be safe and effective in preventing malaria during pregnancy and fetal anemia despite development of SP resistance.

Item Type: Article
Subjects: WC Communicable Diseases > Tropical and Parasitic Diseases > WC 750 Malaria
WC Communicable Diseases > Tropical and Parasitic Diseases > WC 770 Therapy
WH Hemic and Lymphatic Systems > Hematologic Diseases. Immunologic Factors. Blood Banks > WH 155 Anemia
WQ Obstetrics > Childbirth. Prenatal Care > WQ 175 Prenatal care
WQ Obstetrics > Pregnancy Complications > WQ 252 Hematologic complications
WQ Obstetrics > Pregnancy Complications > WQ 256 Infectious diseases
Digital Object Identifer (DOI): https://doi.org/10.1093/cid/cis597
Depositing User: Martin Chapman
Date Deposited: 18 Dec 2014 15:40
Last Modified: 15 Jun 2018 14:38
URI: http://archive.lstmed.ac.uk/id/eprint/4692

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