title: A cohort study of Plasmodium falciparum malaria in pregnancy and associations with uteroplacental blood flow and fetal anthropometrics in Kenya.
abstract: OBJECTIVE
  To use ultrasound to explore the impact of malaria in pregnancy on fetal growth and newborn outcomes among a cohort of women enrolled in an intermittent presumptive treatment in pregnancy (IPTp) with sulfadoxine/pyrimethamine (SP) program in coastal Kenya.
  
  
  METHODS
  Enrolled women were tested for malaria at first prenatal care visit, and physical and ultrasound examinations were performed. In total, 477 women who had term, live births had malaria tested at delivery and their birth outcomes assessed, and were included in the study.
  
  
  RESULTS
  Peripheral malaria was detected via polymerase chain reaction among 10.9% (n=87) at first prenatal care visit and 8.8% (n=36) at delivery. Insecticide-treated bed nets (ITNs) were used by 73.6% (n=583) and were associated with decreased malaria risk. There was a trend for impaired fetal growth and placental blood flow in malaria-infected women in the second trimester, but not later in pregnancy. Among women with low body mass index (BMI), malaria was associated with reduced birth weight (P=0.04); anthropometric measures were similar otherwise.
  
  
  CONCLUSIONS
  With IPTp-SP and ITNs, malaria in pregnancy was associated with transient differences in utero, and reduced birth weight was restricted to those with low BMI.
authors.affiliation: Social, Statistical and Environmental Sciences, Research Triangle Institute, Durham, USA; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA. Electronic address: mcclure@rti.org.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: McClure
authors.affiliation: Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA.
authors.forename: Steven R
authors.initials: SR
authors.lastname: Meshnick
authors.affiliation: Department of Obstetrics and Gynecology, University Hospital, Cleveland, USA.
authors.forename: Noam
authors.initials: N
authors.lastname: Lazebnik
authors.affiliation: Center for Global Health and Diseases, Case Western Reserve University, Cleveland, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Mungai
authors.affiliation: Center for Global Health and Diseases, Case Western Reserve University, Cleveland, USA.
authors.forename: Christopher L
authors.initials: CL
authors.lastname: King
authors.affiliation: Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Hudgens
authors.affiliation: Department of Obstetrics and Gynecology, Columbia University School of Medicine, New York, USA.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Goldenberg
authors.affiliation: Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA.
authors.forename: Anna-Maria
authors.initials: AM
authors.lastname: Siega-Riz
authors.affiliation: Center for Global Health and Diseases, Case Western Reserve University, Cleveland, USA.
authors.forename: Arlene E
authors.initials: AE
authors.lastname: Dent
mesh_terms: D000328:Adult; D000886:Anthropometry; D000962:Antimalarials / Q000008:administration & dosage; D015331:Cohort Studies; D004338:Drug Combinations; D005260:Female; D047109:Fetal Development; D006801:Humans; D007231:Infant, Newborn; D007630:Kenya; D016778:Malaria, Falciparum / Q000503:physiopathology* / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D021041:Placental Circulation; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000503:physiopathology* / Q000517:prevention & control; D011739:Pyrimethamine / Q000008:administration & dosage; D013413:Sulfadoxine / Q000008:administration & dosage; D055815:Young Adult
chemical_list: D000962:Antimalarials; D004338:Drug Combinations; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D011739:Pyrimethamine
keywords: Fetal growth; Malaria in pregnancy; Sub-Saharan Africa