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.
Subject(s)
Anemia, Neonatal/parasitology , Fetal Diseases/parasitology , Malaria/blood , Malaria/prevention & control , Pregnancy Complications, Parasitic/blood , Pregnancy Complications, Parasitic/prevention & control , Anemia, Neonatal/blood , Anemia, Neonatal/epidemiology , Antimalarials/therapeutic use , Cross-Sectional Studies , Drug Combinations , Female , Fetal Blood/parasitology , Fetal Diseases/blood , Fetal Diseases/epidemiology , Hemoglobins/metabolism , Humans , Infant, Newborn , Malaria/epidemiology , Malawi/epidemiology , Odds Ratio , Parasitemia/blood , Parasitemia/parasitology , Pregnancy , Pregnancy Complications, Parasitic/epidemiology , Pregnancy Complications, Parasitic/parasitology , Prevalence , Pyrimethamine/therapeutic use , Regression Analysis , Risk Factors , Sulfadoxine/therapeutic useABSTRACT
Preliminary results are presented from this study which indicate that 84.8% of pregnant women present at first antenatal visit with anemia (Hb 11g/dl) an 8.7% of their infants (n = 230) have a hemoglobin at birth below 14g/dl. There is an association between pregnancy anemia and malaria. A case control study in pregnant women and an infant cohort study to 18 months of age, are employed to study the cause and effects of anemia and malaria on women and their infants health.
