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

Mtove, George, Chico, R. Matthew, Madanitsa, Mwayiwawo, Barsosio, Hellen C., Msemo, Omari Abdul, Saidi, Queen, Gore-Langton, Georgia R., Minja, Daniel T. R, Mukerebe, Crispin, Gesase, Samwel, Mwapasa, Victor, Phiri, Kamija S., Hansson, Helle, Dodd, James, Magnussen, Pascal, Kavishe, Reginald A., Mosha, Franklin, Kariuki, Simon, Lusingu, John P. A, Gutman, Julie R., Alifrangis, Michael, terKuile, Feiko ORCID: https://orcid.org/0000-0003-3663-5617 and Schmiegelow, Christentze (2023) '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'. International Journal of Infectious Diseases, Vol 135, pp. 28-40.

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Abstract

Objective

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 versus 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 enrolment 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

1,435 pregnant women had fetal/birth weight assessed 3,950 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% CI]: 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.

Item Type:	Article
Subjects:	WA Public Health > Health Problems of Special Population Groups > WA 309 Women's health WC Communicable Diseases > Sexually Transmitted Diseases > WC 140 Sexually transmitted diseases WC Communicable Diseases > Tropical and Parasitic Diseases > WC 750 Malaria WQ Obstetrics > WQ 20 Research (General) WQ Obstetrics > Pregnancy > WQ 200 General works
Faculty: Department:	Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI):	https://doi.org/10.1016/j.ijid.2023.07.012
SWORD Depositor:	JISC Pubrouter
Depositing User:	JISC Pubrouter
Date Deposited:	31 Jul 2023 10:24
Last Modified:	06 Nov 2023 15:22
URI:	https://archive.lstmed.ac.uk/id/eprint/22870

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