title: The effects of malaria and intermittent preventive treatment during pregnancy on fetal anemia in Malawi.
abstract: BACKGROUND
  Fetal anemia is common in malarious areas and is a risk factor for infant morbidity and mortality. Malaria during pregnancy may cause decreased cord hemoglobin (Hb) and fetal anemia among newborns. Intermittent preventive treatment during pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) is protective against malaria but may also affect hematopoiesis and contribute to fetal anemia.
  
  
  METHODS
  Peripheral, placental, and cord blood were examined for malaria parasitemia and Hb concentration in a cross-section of 3848 mothers and infants delivered at Queen Elizabeth Central Hospital in Blantyre, Malawi between 1997 and 2006. Unconditional linear and logistic regressions were performed with multiple imputation for missing covariates to assess the associations between malaria, IPTp with SP, and fetal anemia.
  
  
  RESULTS
  The overall prevalence of fetal anemia was 7.9% (n = 304). Malaria parasitemia at delivery was associated with an adjusted decrease in cord Hb of -0.24 g/dL (95% confidence interval [CI], -.42 to -.05). The adjusted prevalence odds ratio for the effect of malaria on fetal anemia was 1.41 (95% CI, 1.05-1.90). Primigravidae who did not take IPTp had infants at highest risk for fetal anemia, and density of parasitemia was correlated with the decrease in cord Hb. There was no significant association between SP use and cord Hb or fetal anemia.
  
  
  CONCLUSIONS
  Malaria during pregnancy, but not IPTp, decreases cord Hb and is a risk factor for fetal anemia in Malawi. Intermittent preventive treatment during pregnancy with SP may continue to be safe and effective in preventing malaria during pregnancy and fetal anemia despite development of SP resistance.
authors: Department of Epidemiology, University of North Carolina, Chapel Hill, NC 27599-7435, USA. rogawski@unc.edu
authors: Elizabeth T
authors: ET
authors: Rogawski
authors: Ebbie
authors: E
authors: Chaluluka
authors: Malcolm E
authors: ME
authors: Molyneux
authors: Gaoqian
authors: G
authors: Feng
authors: Stephen J
authors: SJ
authors: Rogerson
authors: Steven R
authors: SR
authors: Meshnick
mesh_terms: D000751:Anemia, Neonatal / Q000097:blood / Q000453:epidemiology / Q000469:parasitology*; D000962:Antimalarials / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D004338:Drug Combinations; D005260:Female; D005312:Fetal Blood / Q000469:parasitology; D005315:Fetal Diseases / Q000097:blood / Q000453:epidemiology / Q000469:parasitology*; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007231:Infant, Newborn; D008288:Malaria / Q000097:blood* / Q000453:epidemiology / Q000517:prevention & control*; D008295:Malawi / Q000453:epidemiology; D016017:Odds Ratio; D018512:Parasitemia / Q000097:blood / Q000469:parasitology; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000097:blood* / Q000453:epidemiology / Q000469:parasitology / Q000517:prevention & control*; D015995:Prevalence; D011739:Pyrimethamine / Q000627:therapeutic use; D012044:Regression Analysis; D012307:Risk Factors; D013413:Sulfadoxine / Q000627:therapeutic use
chemical_list: D000962:Antimalarials; D004338:Drug Combinations; D006454:Hemoglobins; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D011739:Pyrimethamine