Abstract

BACKGROUND: Clinical trials of interventions for preventing malaria in pregnancy often use measures of malaria at delivery as their primary outcome. Although the objective of these interventions is to improve birth outcomes, data on associations between different measures of malaria at delivery and adverse birth outcomes are limited.METHODS: Data came from 637 Ugandan women enrolled in a randomized controlled trial of intermittent preventive treatment of malaria in pregnancy. Malaria at delivery was detected using peripheral and placental blood microscopy, placental blood loop mediated isothermal amplification (LAMP) and placental histopathology. Multivariate analyses were used to estimate associations between measures of malaria at delivery and risks of low birth weight (LBW), small-for-gestational age (SGA) and preterm birth (PTB).RESULTS: Detection of malaria parasites by microscopy or LAMP was not associated with adverse birth outcomes. Presence of malaria pigment detected by histopathology in > 30% of high-powered fields was strongly associated with LBW (aRR=3.42, p=0.02) and SGA (aRR=4.24, p<0.001), but not preterm birth (aRR=0.88, p=0.87).CONCLUSIONS: A semi-quantitative classification system based on histopathologically detected malaria pigment provided the best surrogate measure of adverse birth outcomes in a high transmission setting and should be considered for use in malaria in pregnancy intervention studies.

View details for DOI 10.1093/infdis/jiaa156

View details for PubMedID 32249917