Epidemiology and Infection

Original Papers

Helminths and protozoas

Impact of maternal malaria and under-nutrition on intrauterine growth restriction: a prospective ultrasound study in Democratic Republic of Congo

S. H. LANDISa1, V. LOKOMBAa2, C. V. ANANTHa3, J. ATIBUa2, R. W. RYDERa4, K. E. HARTMANNa5, J. M. THORP Jr.a6, A. TSHEFUa2 and S. R. MESHNICKa1 c1

a1 Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill, NC, USA

a2 UNC-DRC Programme, Kinshasa, Democratic Republic of Congo

a3 Division of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology and Reproductive Sciences, UMDNJ–Robert Wood Johnson Medical School, NJ, USA

a4 Department of Medicine, University of California, San Diego, CA, USA

a5 Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA

a6 Department of Obstetrics & Gynecology, University of North Carolina, Chapel Hill, NC, USA


Maternal malaria and under-nutrition are established risk factors for small-for-gestational-age (SGA) births; however, whether malaria is associated with intrauterine growth restriction (IUGR) is unknown. We investigated IUGR risk among 177 HIV-negative pregnant women enrolled in a longitudinal ultrasound study conducted in Democratic Republic of Congo from May 2005 to May 2006. Malaria infection, maternal anthropometrics, and ultrasound estimated fetal weight were measured monthly. All positive malaria cases were treated and intermittent presumptive therapy (IPTp) provided. Log-binomial regression models for IUGR were fitted using generalized estimating equations to account for statistical clustering of repeat IUGR measurements. Twenty-nine percent of fetuses experienced an episode of IUGR with the majority occurring in the third trimester. The risk of IUGR associated with malaria was greatest after three or more cumulative infections (RR 3·3, 95% CI 1·3–8·2) and was two- to eight-fold higher among women with evidence of under-nutrition. Receiving antimalarial treatment in the previous month (for IPTp or treatment) was significantly protective against IUGR (RR 0·5, 95% CI 0·3–0·7). The interaction observed between malaria and under-nutrition suggests that antenatal programmes in malaria endemic areas should incorporate nutritional screening and supplementation in addition to IPTp.

(Accepted May 28 2008)

(Online publication June 30 2008)


c1 Author for correspondence: Dr S. R. Meshnick, Department of Epidemiology, University of North Carolina at Chapel Hill, McGavran-Greenberg Hall, Campus Box 7435, Chapel Hill, NC 27599-7435, USA. (Email: meshnick@email.unc.edu)