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Background: Malaria in early pregnancy occurs at a time when the placenta is developing, with possible consequences for placental function and fetal growth. We assessed the association between first trimester malaria and fetal growth documented through repeated ultrasound scans.Methods: The RECIPAL preconceptional cohort included 411 Beninese pregnant women followed from 7 weeks' gestation (wg) until delivery. Among them, 218 had 4 scans for fetal monitoring at 16, 22, 28, and 34 wg. Multivariate seemingly unrelated regression models were used to assess association of microscopic malaria in the first trimester (<15 wg) with abdominal circumference, head circumference, biparietal diameter, and femur length throughout pregnancy.Results: Of 39% (86/218) of women with at least 1 microscopic malarial infection during pregnancy, 52.3% (45/86) were infected in the first trimester. Most women (88.5%) were multiparous. There was no association between adjusted z-scores for fetal growth parameters and first trimester malaria. Parity, newborn sex, socioeconomic level, and maternal body mass index significantly influenced fetal growth.Conclusions: In a context where malaria infections in pregnancy are well detected and treated, their adverse effect on fetal growth may be limited. Our results argue in favor of preventing and treating infections as early as the first trimester. [ABSTRACT FROM AUTHOR]

Background According to the Developmental Origins of Health and Diseases paradigm, the fetal period is highly vulnerable and may have profound effects on later health. Few studies assessed the effect of small-for-gestational age (SGA), a proxy for fetal growth impairment, on risk of malaria during infancy in Africa. Methods We used data from a cohort of 398 mother-child pairs, followed from early pregnancy to age 1 year in Benin. Malaria was actively and passively screened using thick blood smear. We assessed the effect of SGA on risk of malaria infection and clinical malaria from birth to 12 months, after stratifying on the infant's age using a logistic mixed regression model. Results After adjustment for potential confounding factors and infant's exposure to mosquitoes, SGA was associated with a 2-times higher risk of malaria infection (adjusted odds ratio [aOR] = 2.16; 95% confidence interval [CI], 1.04–4.51; P =.039) and clinical malaria (aOR = 2.33; 95% CI, 1.09–4.98; P =.030) after age 6 months. Conclusion Results suggest higher risk of malaria during the second semester of life in SGA infants, and argue for better follow-up of these infants after birth, as currently for preterm babies. [ABSTRACT FROM AUTHOR]

Background: There is a lack of data on the burden of malaria in the first trimester of pregnancy in Africa, mainly because pregnant women generally attend the maternity clinic late. Bed nets are rarely provided to women before the second trimester of pregnancy and intermittent preventive treatment with sulfadoxine-pyrimethamine is not recommended before the second trimester, leaving women insufficiently or not protected in early pregnancy.Methods: To assess the burden of first trimester malaria, 387 women were followed up monthly from preconception to delivery. They were screened for malaria monthly from early pregnancy until delivery. A logistic multilevel model was used to assess maternal factors associated with malaria during the first trimester.Results: The proportion of women with at least 1 microscopic malaria infection during the first trimester of pregnancy was 20.8%. Women infected with malaria preconception were more likely to be infected during the first trimester (adjusted odds ratio: 2.68; 95% confidence interval, 1.24-5.78). Early gestational age was also positively correlated with malaria infection.Conclusions: Using a preconceptional study design, we showed that malaria was highly prevalent in early pregnancy. This calls for the assessment of new strategies that could protect women as soon as the first trimester. [ABSTRACT FROM AUTHOR]

Background. In the context of the increasing resistance to sulfadoxine-pyrimethamine (SP), we evaluated the efficacy of mefloquine (MQ) for intermittent preventive treatment during pregnancy (IPTp). Methods. A multicenter, open-label equivalence trial was conducted in Benin from July 2005 through April 2008.Women of all gravidities were randomized to receive SP (1500 mg of sulfadoxine and 75 mg of pyrimethamine) or 15 mg/kg MQ in a single intake twice during pregnancy. The primary end point was the proportion of low- birth-weight (LBW) infants (body weight, <2500 g; equivalence margin, 5%). Results. A total of 1601 women were randomized to receive MQ (n = 802) or SP (n = 799). In the modified intention-to-treat analysis, which assessed only live singleton births, 59 (8%) of 735 women who were given MQ and 72 (9.8%) of 730 women who were given SP gave birth to LBW infants (difference between low birth weights in treatment groups, -1.8%; 95% confidence interval [CI], -4.8% to 1.1%]), establishing equivalence between the drugs. The per-protocol analysis showed consistent results. MQ was more efficacious than SP in preventing placental malaria (prevalence, 1.7% vs 4.4% of women; P = .005), clinical malaria (incidence rate, 26 cases/10,000 person-months vs. 68 cases/10,000 person-months; P = .007), and maternal anemia at delivery (as defined by a hemoglobin level <10 g/dL) (prevalence, 16% vs 20%; marginally significant at P = .09). Adverse events (mainly vomiting, dizziness, tiredness, and nausea) were more commonly associated with the use of MQ (prevalence, 78% vs 32%; P < 10-3). One woman in the MQ group had severe neuropsychiatric symptoms. Conclusions. MQ proved to be highly efficacious-both clinically and parasitologically-for use as IPTp. However, its low tolerability might impair its effectiveness and requires further investigations. Clinical Trials Registration. NCT00274235. [ABSTRACT FROM AUTHOR]

Background. In West Africa, treatment for the prevention of malaria during pregnancy has recently changed from chloroquine (CQ) prophylaxis to intermittent preventive treatment (IPTp). We assessed the benefits of IPTp with respect to those of CQ, using a before-after study. Methods. CQ efficacy was evaluated during a cross-sectional survey conducted in Benin between April 2004 and April 2005. IPTp efficacy was assessed using data from an ongoing clinical trial to compare sulfadoxine-pyrimethamine with mefloquine that began in the same maternity clinics during July 2005; the present analysis is limited to women who delivered between November 2005 and November 2006. Treatment assignments were not unblinded. We compared the efficacy of the 2 strategies against low birth weight and placental infection by performing multiple logistic regressions. Results. A total of 1699 women (1090 in the CQ group and 609 in the IPTp group) who delivered live singletons were analyzed. Characteristics of women in the CQ group were similar to those of women in the IPTp group. We showed that women in the IPTp group had a significantly decreased risk of delivering an infant with a low birth weight (adjusted odds ratio [aOR], 0.54; 95% confidence interval [CI], 0.38-0.78) and placental infection (aOR, 0.15; 95% CI, 0.09-0.24). Conclusion. We clearly evidenced that IPTp is substantially more beneficial than CQ for the prevention of malaria during pregnancy. [ABSTRACT FROM AUTHOR]

A correction to the article "Increased Risk of Malaria During the First Year of Life in Small-Birth-Gestational-Age Infants: A Longitudinal Study in Benin" is presented concerning the title.