title: Causes of preterm delivery and intrauterine growth retardation in a malaria endemic region of Papua New Guinea.
abstract: OBJECTIVE
  To identify causes of preterm delivery and intrauterine growth retardation (IUGR) in a malaria endemic region of Papua New Guinea.
  
  
  METHODS
  Independent predictors of preterm delivery and birthweight in term infants were identified using multiple regression analysis in a prospective study of 987 singleton live births delivered in Madang Hospital.
  
  
  RESULTS
  Overall, Plasmodium falciparum infection of the placenta was associated with a reduction in birthweight of 130 g. Malaria was significantly more common in primigravidae than multigravidae and probably contributed to both preterm delivery and IUGR. Maternal haemoglobin concentrations were significantly lower in malaria infected than noninfected women and reduced haemoglobin was the main determinant of preterm delivery. Poorer maternal nutritional status and smoking were associated with both prematurity and IUGR. Greater antenatal clinic attendance predicted increased birthweight in term infants.
  
  
  CONCLUSIONS
  Protection against malaria during pregnancy, especially in primigravidae, improved nutrition in women and discouragement of smoking would probably reduce both preterm delivery and IUGR. Greater use of existing antenatal clinics might increase birthweight in term infants.
authors.affiliation: Institute of Molecular Medicine, John Radcliffe Hospital, Headington, Oxford. sallen@hammer.imm.ox.ac.uk
authors.forename: S J
authors.initials: SJ
authors.lastname: Allen
authors.forename: A
authors.initials: A
authors.lastname: Raiko
authors.forename: A
authors.initials: A
authors.lastname: O'Donnell
authors.forename: N D
authors.initials: ND
authors.lastname: Alexander
authors.forename: J B
authors.initials: JB
authors.lastname: Clegg
mesh_terms: D000328:Adult; D005260:Female; D005317:Fetal Growth Retardation / Q000209:etiology* / Q000469:parasitology; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007231:Infant, Newborn; D016778:Malaria, Falciparum / Q000097:blood / Q000150:complications*; D009748:Nutrition Disorders / Q000150:complications; D007752:Obstetric Labor, Premature / Q000097:blood / Q000209:etiology* / Q000469:parasitology; D010219:Papua New Guinea; D010298:Parity; D010342:Patient Acceptance of Health Care; D010920:Placenta / Q000469:parasitology; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000097:blood; D011295:Prenatal Care; D012907:Smoking / Q000009:adverse effects
chemical_list: D006454:Hemoglobins