Fetal growth and birth weight are independently reduced by malaria infection and curable sexually transmitted and reproductive tract infections in Kenya, Tanzania, and Malawi: A pregnancy cohort study

• Published in: International journal of infectious diseases Vol. 135; pp. 28 - 40
• Main Authors: Mtove, George, Chico, R. Matthew, Madanitsa, Mwayiwawo, Barsosio, Hellen C., Msemo, Omari Abdul, Saidi, Queen, Gore-Langton, Georgia R., Minja, Daniel T.R., Mukerebe, Crispin, Gesase, Samwel, Mwapasa, Victor, Phiri, Kamija S., Hansson, Helle, Dodd, James, Magnussen, Pascal, Kavishe, Reginald A., Mosha, Franklin, Kariuki, Simon, Lusingu, John P.A., Gutman, Julie R., Alifrangis, Michael, ter Kuile, Feiko O., Schmiegelow, Christentze
• Format: Journal Article
• Language: English
• Published: Canada Elsevier Ltd 01.10.2023; Elsevier
• Subjects: Bacterial vaginosis; Birth Weight; Birthweight; Cohort Studies; Female; Fetal Development; Fetal growth; Fetal Weight; Humans; Kenya - epidemiology; Malaria - drug therapy; Malaria - epidemiology; Malaria - prevention & control; Malaria in pregnancy; Malawi - epidemiology; Pregnancy; Pregnancy Outcome; Reproductive tract infection; Reproductive Tract Infections; Sexually Transmitted Diseases; Sexually transmitted infection; Tanzania - epidemiology; Kenya; Malawi; Tanzania; Fetal growth; Bacterial vaginosis; Sexually transmitted infection; Reproductive tract infection; Malaria in pregnancy; Birthweight
• ISSN: 1201-9712; 1878-3511; 1878-3511
• DOI: 10.1016/j.ijid.2023.07.012

•Largest study to date on the effect of malaria on fetal growth using ultrasound.•First to assess fetal growth after sexually transmitted/reproductive tract infection.•Dual burden of the infections negatively impact fetal growth.•First- and second-time mothers are especially vulnerable to the infections.•Integrated antenatal care is needed to reduce the burden. Malaria and sexually transmitted and reproductive tract infections (STIs/RTIs) are highly prevalent in sub-Saharan Africa and associated with poor pregnancy outcomes. We investigated the individual and combined effects of malaria and curable STIs/RTIs on fetal growth in Kenya, Tanzania, and Malawi. This study was nested within a randomized trial comparing monthly intermittent preventive treatment for malaria in pregnancy with sulfadoxine-pyrimethamine vs dihydroartemisinin-piperaquine, alone or combined with azithromycin. Fetal weight gain was assessed by serial prenatal ultrasound. Malaria was assessed monthly, and Treponema pallidum, Neisseria gonorrhoeae, Trichomonas vaginalis, Chlamydia trachomatis, and bacterial vaginosis at enrollment and in the third trimester. The effect of malaria and STIs/RTIs on fetal weight/birthweight Z-scores was evaluated using mixed-effects linear regression. In total, 1435 pregnant women had fetal/birth weight assessed 3950 times. Compared to women without malaria or STIs/RTIs (n = 399), malaria-only (n = 267), STIs/RTIs only (n = 410) or both (n = 353) were associated with reduced fetal growth (adjusted mean difference in fetal/birth weight Z-score [95% confidence interval]: malaria = -0.18 [-0.31,-0.04], P = 0.01; STIs/RTIs = -0.14 [-0.26,-0.03], P = 0.01; both = -0.20 [-0.33,-0.07], P = 0.003). Paucigravidae experienced the greatest impact. Malaria and STIs/RTIs are associated with poor fetal growth especially among paucigravidae women with dual infections. Integrated antenatal interventions are needed to reduce the burden of both malaria and STIs/RTIs.