title: An analysis of timing and frequency of malaria infection during pregnancy in relation to the risk of low birth weight, anaemia and perinatal mortality in Burkina Faso.
abstract: BACKGROUND
  A prospective study aiming at assessing the effect of adding a third dose sulphadoxine-pyrimethamine (SP) to the standard two-dose intermittent preventive treatment for pregnant women was carried out in Hounde, Burkina Faso, between March 2006 and July 2008. Pregnant women were identified as earlier as possible during pregnancy through a network of home visitors, referred to the health facilities for inclusion and followed up until delivery.
  
  
  METHODS
  Study participants were enrolled at antenatal care (ANC) visits and randomized to receive either two or three doses of SP at the appropriate time. Women were visited daily and a blood slide was collected when there was fever (body temperature > 37.5°C) or history of fever. Women were encouraged to attend ANC and deliver in the health centre, where the new-born was examined and weighed. The timing and frequency of malaria infection was analysed in relation to the risk of low birth weight, maternal anaemia and perinatal mortality.
  
  
  RESULTS
  Data on birth weight and haemoglobin were available for 1,034 women. The incidence of malaria infections was significantly lower in women having received three instead of two doses of SP. Occurrence of first malaria infection during the first or second trimester was associated with a higher risk of low birth weight: incidence rate ratios of 3.56 (p < 0.001) and 1.72 (p = 0.034), respectively. After adjusting for possible confounding factors, the risk remained significantly higher for the infection in the first trimester of pregnancy (adjusted incidence rate ratio = 2.07, p = 0.002). The risk of maternal anaemia and perinatal mortality was not associated with the timing of first malaria infection.
  
  
  CONCLUSIONS
  Malaria infection during first trimester of pregnancy is associated to a higher risk of low birth weight. Women should be encouraged to use long-lasting insecticidal nets before and throughout their pregnancy.
authors.affiliation: Laboratory of Parasitology and Entomology, Centre Muraz, Bobo-Dioulasso, Burkina Faso. valinno@yahoo.fr
authors.forename: Innocent
authors.initials: I
authors.lastname: Valea
authors.forename: Halidou
authors.initials: H
authors.lastname: Tinto
authors.forename: Maxime K
authors.initials: MK
authors.lastname: Drabo
authors.forename: Lieven
authors.initials: L
authors.lastname: Huybregts
authors.forename: Hermann
authors.initials: H
authors.lastname: Sorgho
authors.forename: Jean-Bosco
authors.initials: JB
authors.lastname: Ouedraogo
authors.forename: Robert T
authors.initials: RT
authors.lastname: Guiguemde
authors.forename: Jean Pierre
authors.initials: JP
authors.lastname: van Geertruyden
authors.forename: Patrick
authors.initials: P
authors.lastname: Kolsteren
authors.forename: Umberto
authors.initials: U
authors.lastname: D'Alessandro
mesh_terms: D000328:Adult; D000740:Anemia / Q000150:complications / Q000188:drug therapy / Q000469:parasitology*; D000962:Antimalarials / Q000008:administration & dosage* / Q000627:therapeutic use; D002050:Burkina Faso; D004334:Drug Administration Schedule; D004338:Drug Combinations; D005260:Female; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D016778:Malaria, Falciparum / Q000150:complications / Q000188:drug therapy / Q000469:parasitology*; D010963:Plasmodium falciparum / Q000187:drug effects / Q000502:physiology; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000188:drug therapy / Q000469:parasitology*; D011264:Pregnancy Trimesters; D011446:Prospective Studies; D011739:Pyrimethamine / Q000008:administration & dosage* / Q000627:therapeutic use; D012306:Risk; D013413:Sulfadoxine / Q000008:administration & dosage* / Q000627:therapeutic use; D013997:Time Factors; D055815:Young Adult
chemical_list: D000962:Antimalarials; D004338:Drug Combinations; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D011739:Pyrimethamine