title: Placental malaria is associated with reduced early life weight development of affected children independent of low birth weight.
abstract: BACKGROUND
  Infection with Plasmodium falciparum during pregnancy contributes substantially to the disease burden in both mothers and offspring. Placental malaria may lead to intrauterine growth restriction or preterm delivery resulting in low birth weight (LBW), which, in general, is associated with increased infant morbidity and mortality. However, little is known about the possible direct impact of the specific disease processes occurring in PM on longer term outcomes such as subsequent retarded growth development independent of LBW.
  
  
  METHODS
  In an existing West-African cohort, 783 healthy infants with a birth weight of at least 2,000 g were followed up during their first year of life. The aim of the study was to investigate if Plasmodium falciparum infection of the placenta, assessed by placental histology, has an impact on several anthropometric parameters, measured at birth and after three, six and 12 months using generalized estimating equations models adjusting for moderate low birth weight.
  
  
  RESULTS
  Independent of LBW, first to third born infants who were exposed to either past, chronic or acute placental malaria during pregnancy had significantly lower weight-for-age (-0.43, 95% CI: -0.80;-0.07), weight-for-length (-0.47, 95% CI: -0.84; -0.10) and BMI-for-age z-scores (-0.57, 95% CI: -0.84; -0.10) compared to infants born to mothers who were not diagnosed with placental malaria (p = 0.019, 0.013, and 0.012, respectively). Interestingly, the longitudinal data on histology-based diagnosis of PM also document a sharp decline of PM prevalence in the Sukuta cohort from 16.5% in 2002 to 5.4% in 2004.
  
  
  CONCLUSIONS
  It was demonstrated that PM has a negative impact on the infant's subsequent weight development that is independent of LBW, suggesting that the longer term effects of PM have been underestimated, even in areas where malaria transmission is declining.
authors.affiliation: MRC Laboratories, Atlantic Boulevard, Fajara, PO Box 273 Banjul, The Gambia. bwalther@mrc.gm
authors.forename: Brigitte
authors.initials: B
authors.lastname: Walther
authors.forename: David J C
authors.initials: DJ
authors.lastname: Miles
authors.forename: Sarah
authors.initials: S
authors.lastname: Crozier
authors.forename: Pauline
authors.initials: P
authors.lastname: Waight
authors.forename: Melba S
authors.initials: MS
authors.lastname: Palmero
authors.forename: Olubukola
authors.initials: O
authors.lastname: Ojuola
authors.forename: Ebrima
authors.initials: E
authors.lastname: Touray
authors.forename: Marianne
authors.initials: M
authors.lastname: van der Sande
authors.forename: Hilton
authors.initials: H
authors.lastname: Whittle
authors.forename: Sarah
authors.initials: S
authors.lastname: Rowland-Jones
authors.forename: Katie L
authors.initials: KL
authors.lastname: Flanagan
mesh_terms: D000293:Adolescent; D000328:Adult; D001706:Biopsy; D002648:Child; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005714:Gambia / Q000453:epidemiology; D006128:Growth; D006130:Growth Disorders / Q000453:epidemiology / Q000469:parasitology*; D006801:Humans; D007223:Infant; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D016778:Malaria, Falciparum / Q000150:complications* / Q000188:drug therapy / Q000469:parasitology; D008297:Male; D010920:Placenta / Q000469:parasitology* / Q000473:pathology; D010963:Plasmodium falciparum; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000188:drug therapy / Q000473:pathology; D011297:Prenatal Exposure Delayed Effects; D015995:Prevalence; D012959:Socioeconomic Factors; D055815:Young Adult