Adverse birth outcomes in a malarious area

To determine factors associated with fetal growth, preterm delivery and stillbirth in an area of high malaria transmission in Southern Malawi, a cross-sectional study of pregnant women attending and delivering at two study hospitals was undertaken. A total of 243 (17(.)3%) babies were preterm and 54 (3(.)7%) stillborn. Intra-uterine growth retardation (IUGR) occurred in 285 (20(.)3%), of whom 109 (38(.)2%) were low birthweight and 26 (9(.)1%) preterm. Factors associated with IUGR were maternal short stature [adjusted odds ratio (AOR) 1(.)6, 95 % confidence interval (0) 1(.)0-2(.)5]; primigravidae (AOR 1(.)9, 95 % CI 1(.)4-2(.)7); placental or peripheral malaria at delivery (AOR 1(.)4, 95% CI 1(.)0-1(.)9) and maternal anaemia at recruitment (Hb < 8 g/dl) (AOR 1-9, 95% CI 1(.)3-2(.)7). Increasing parasite density in the placenta was associated with both IUGR (P = 0(.)008) and prematurity (P = 0(.)02). Factors associated with disproportionate fetal growth were maternal malnutrition [mid-upper arm circumference (MUAC) < 23 cm, AOR 1(.)9, 95% CI 1(.)0-3(.)7] and primigravidae (AOR 1(.)8, 95% CI 1(.)0-3(.)1). Preterm delivery and stillbirth were associated with < 5 antenatal care visits (AOR 2(.)2, 95 % CI 1(.)3-3(.)7 and AOR 3(.)1, 95 % CI 1(.)4-7(.)0 respectively) and stillbirth with a positive Venereal Disease Research Laboratory (VDRL) test (AOR 4(.)7, 95 % CI 1(.)5-14(.)8). Interventions to reduce poor pregnancy outcomes must reduce the burden of malaria in pregnancy, improve antenatal care and maternal malnutrition.