title: Adverse birth outcomes in a malarious area.
abstract: To determine factors associated with fetal growth, preterm delivery and stillbirth in an area of high malaria transmission in Southern Malawi, a cross-sectional study of pregnant women attending and delivering at two study hospitals was undertaken. A total of 243 (17.3%) babies were preterm and 54 (3.7%) stillborn. Intra-uterine growth retardation (IUGR) occurred in 285 (20.3%), of whom 109 (38.2%) were low birthweight and 26 (9.1%) preterm. Factors associated with IUGR were maternal short stature [adjusted odds ratio (AOR) 1.6, 95% confidence interval (CI) 1.0-2.5]; primigravidae (AOR 1.9, 95% CI 1.4-2.7); placental or peripheral malaria at delivery (AOR 1.4, 95% CI 1.0-1.9) and maternal anaemia at recruitment (Hb<8 g/dl) (AOR 1.9, 95% CI 1.3-2.7). Increasing parasite density in the placenta was associated with both IUGR (P=0.008) and prematurity (P=0.02). Factors associated with disproportionate fetal growth were maternal malnutrition [mid-upper arm circumference (MUAC)<23 cm, AOR 1.9, 95% CI 1.0-3.7] and primigravidae (AOR 1.8, 95% CI 1.0-3.1). Preterm delivery and stillbirth were associated with <5 antenatal care visits (AOR 2.2, 95% CI 1.3-3.7 and AOR 3.1, 95% CI 1.4-7.0 respectively) and stillbirth with a positive Venereal Disease Research Laboratory (VDRL) test (AOR 4.7, 95% CI 1.5-14.8). Interventions to reduce poor pregnancy outcomes must reduce the burden of malaria in pregnancy, improve antenatal care and maternal malnutrition.
authors.affiliation: Child and Reproductive Health Group, Liverpool School of Tropical Medicine, Liverpool, UK.
authors.forename: B F
authors.initials: BF
authors.lastname: Kalanda
authors.forename: F H
authors.initials: FH
authors.lastname: Verhoeff
authors.forename: L
authors.initials: L
authors.lastname: Chimsuku
authors.forename: G
authors.initials: G
authors.lastname: Harper
authors.forename: B J
authors.initials: BJ
authors.lastname: Brabin
mesh_terms: D003430:Cross-Sectional Studies; D005260:Female; D005313:Fetal Death / Q000209:etiology*; D005317:Fetal Growth Retardation / Q000209:etiology*; D005865:Gestational Age; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D008288:Malaria / Q000150:complications*; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic; D047928:Premature Birth / Q000209:etiology*; D012307:Risk Factors