title: Placental malaria increases malaria risk in the first 30 months of life.
abstract: BACKGROUND
  Plasmodium falciparum infection during pregnancy is associated with stillbirth, fetal growth restriction, and low birth weight. An additional consequence may be increased risk of malaria in early life, although the epidemiological evidence of this consequence is limited.
  
  
  METHODS
  A cohort of 527 children were observed actively every month for 30 months after delivery. Offspring of mothers with microscopically detectable placental P. falciparum infection at the time of delivery were defined as exposed. The outcome measure was malaria (parasitemia and fever). Analyses were performed using Cox proportional hazard models and were stratified by gravidity.
  
  
  RESULTS
  Overall, offspring of mothers with placental P. falciparum infection had a significantly higher risk of clinical malaria during the first 30 months of life (adjusted hazard ratio, 2.1; 95% confidence interval [CI], 1.2-3.7). The adjusted hazard ratio for offspring of multigravidae was 2.6 (95% CI, 1.3-5.3), and that for primigravidae was 1.5 (95% CI, 0.6-3.8). The offspring of placenta-infected primigravidae had no episodes of malaria during the first year of life.
  
  
  CONCLUSIONS
  Our findings show that active placental P. falciparum infection detected at delivery is associated with an approximately 2-fold greater risk of malaria during early life, compared with noninfection. The fact that persons born to infected multigravidae rather than primigravidae appear to be at greater risk emphasizes the importance of preventing malaria in mothers of all gravidities.
authors.affiliation: Medical Research Unit, Albert Schweitzer Hospital, Lambaréné, Gabon, South Africa.
authors.forename: Norbert G
authors.initials: NG
authors.lastname: Schwarz
authors.forename: Ayola A
authors.initials: AA
authors.lastname: Adegnika
authors.forename: Lutz P
authors.initials: LP
authors.lastname: Breitling
authors.forename: Julian
authors.initials: J
authors.lastname: Gabor
authors.forename: Selidji T
authors.initials: ST
authors.lastname: Agnandji
authors.forename: Robert D
authors.initials: RD
authors.lastname: Newman
authors.forename: Bertrand
authors.initials: B
authors.lastname: Lell
authors.forename: Saadou
authors.initials: S
authors.lastname: Issifou
authors.forename: Maria
authors.initials: M
authors.lastname: Yazdanbakhsh
authors.forename: Adrian J F
authors.initials: AJ
authors.lastname: Luty
authors.forename: Peter G
authors.initials: PG
authors.lastname: Kremsner
authors.forename: Martin P
authors.initials: MP
authors.lastname: Grobusch
mesh_terms: D000328:Adult; D000818:Animals; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008288:Malaria / Q000453:epidemiology*; D008297:Male; D010922:Placenta Diseases / Q000469:parasitology*; D010963:Plasmodium falciparum / Q000302:isolation & purification*; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic; D016016:Proportional Hazards Models; D012306:Risk