title: Risk factors for malaria and adverse birth outcomes in a prospective cohort of pregnant women resident in a high malaria transmission area of Papua New Guinea.
abstract: BACKGROUND
  Low birth weight (LBW), anaemia and malaria are common in Papua New Guinean women.
  
  
  METHODS
  To identify risk factors for LBW, anaemia and preterm delivery (PTD), pregnant women recruited into a cohort study in Madang, Papua New Guinea, were followed to delivery.
  
  
  RESULTS
  Of 470 women enrolled, delivery data were available for 328 (69.7%). By microscopy, 34.4% (113/328) of women had malaria parasitaemia at enrolment and 12.5% (41/328) at delivery; at each time point, PCR detected sub-microscopic parasitaemia in substantially more. Most infections were with Plasmodium falciparum; the remainder being predominantly P. vivax. Anaemia and smoking were associated with lower birth weight, and LBW (16.7%; 51/305) and PTD (21.8%; 63/290) were common. Histopathologically diagnosed chronic placental malaria was associated with LBW (adjusted odds ratio [aOR] 3.3; p=0.048) and PTD (aOR 4.2; p=0.01). Lack of maternal education predisposed to PTD. Sub-microscopic parasitaemia at delivery appeared to increase the risk of LBW. Of the genetic polymorphisms, Southeast Asian ovalocytosis, α(+)-thalassaemia and complement receptor 1 (CR1) deficiency, a CR1 heterozygous genotype was associated with decreased risk of anaemia and substantial but non-significant effects were noted in other comparisons.
  
  
  CONCLUSIONS
  In coastal Papua New Guinea, malaria and anaemia are important causes of adverse pregnancy outcomes.
authors.affiliation: Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria 3050, Australia Institute of Glycomics, Griffith University, Southport, Queensland 4215, Australia.
authors.forename: Danielle I
authors.initials: DI
authors.lastname: Stanisic
authors.affiliation: Burnet Institute, Melbourne, Victoria, Australia Centre for Epidemiology and Biostatistics, University of Melbourne, Parkville, Victoria, Australia.
authors.forename: Kerryn A
authors.initials: KA
authors.lastname: Moore
authors.affiliation: Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea.
authors.forename: Francesca
authors.initials: F
authors.lastname: Baiwog
authors.affiliation: Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea.
authors.forename: Alice
authors.initials: A
authors.lastname: Ura
authors.affiliation: Department of Medicine (RMH), The University of Melbourne, Parkville, Victoria 3010, Australia.
authors.forename: Caroline
authors.initials: C
authors.lastname: Clapham
authors.affiliation: Case Western Reserve University, Cleveland Ohio, USA Veterans Affairs Medical Center, Cleveland, Ohio, USA.
authors.forename: Christopher L
authors.initials: CL
authors.lastname: King
authors.affiliation: Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Siba
authors.affiliation: Burnet Institute, Melbourne, Victoria, Australia Department of Medicine (RMH), The University of Melbourne, Parkville, Victoria 3010, Australia Department of Microbiology, Monash University, Victoria, Australia.
authors.forename: James G
authors.initials: JG
authors.lastname: Beeson
authors.affiliation: Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria 3050, Australia CRESIB, University of Barcelona, Barcelona, Spain.
authors.forename: Ivo
authors.initials: I
authors.lastname: Mueller
authors.affiliation: Burnet Institute, Melbourne, Victoria, Australia Department of Epidemiology and Preventive Medicine and Department of Infectious Diseases, Monash University, Melbourne, Victoria, Australia.
authors.forename: Freya J
authors.initials: FJ
authors.lastname: Fowkes
authors.affiliation: Department of Medicine (RMH), The University of Melbourne, Parkville, Victoria 3010, Australia sroger@unimelb.edu.au.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Rogerson
mesh_terms: D000293:Adolescent; D000328:Adult; D000740:Anemia / Q000469:parasitology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008288:Malaria / Q000150:complications* / Q000453:epidemiology / Q000209:etiology / Q000635:transmission; D010219:Papua New Guinea / Q000453:epidemiology; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology*; D015597:Pregnancy Complications, Parasitic / Q000453:epidemiology*; D011256:Pregnancy Outcome; D047928:Premature Birth / Q000469:parasitology*; D011446:Prospective Studies; D012307:Risk Factors
keywords: Genetics; Low birth weight; Plasmodium; Pregnancy; Preterm delivery