The impact of placental malaria on gestational age and birth weight.

TLDR: It is shown that placental malaria causes prematurity even in high-transmission areas, and the impact of maternal malaria on infant mortality may be greater than was thought previously.

Abstract: Maternal malaria is associated with reduced birth weight, which is thought to be effected through placental insufficiency, which leads to intrauterine growth retardation (IUGR). The impact of malaria on preterm delivery is unclear. The effects of placental malaria‐related changes on birth weight and gestational age were studied in 1177 mothers (and their newborns) from Tanzania. Evidence of malaria infection was found in 75.5% of placental samples. Only massive mononuclear intervillous inflammatory infiltration (MMI) was associated with increased risk of low birth weight (odds ratio [OR], 4.0). Maternal parasitized red blood cells and perivillous fibrin deposition both were associated independently with increased risk of premature delivery (OR, 3.2; OR, 2.1, respectively). MMI is an important mechanism in the pathogenesis of IUGR in malaria-infected placentas. This study also shows that placental malaria causes prematurity even in high-transmission areas. The impact of maternal malaria on infant mortality may be greater than was thought previously. Despite recommendations that malaria be controlled among pregnant women in endemic areas [1], malaria during pregnancy remains a significant cause of maternal and infant mortality and morbidity. Problems related to compliance with drug regimens and the use of partially effective antimalarials are some of the reasons that have led many countries to question, and in many cases abandon, malaria control for pregnant women.