Impact of Malaria during Pregnancy on Low Birth Weight in Sub-Saharan Africa

It is estimated that each year over 30 million women become pregnant in malarious areas of Africa, with most living in areas of stable malaria transmission. Although the cast majority of women with malaria infections during pregnancy remain asymptomatic, infection increases the risk of maternal anemia and delivering a low-birth-weight (LBW) baby. LBW (2,500 g) is an important risk factor for infant mortality, and this review focuses on the impact of malaria during pregnacy on LBW and subsequent infant mortality in sub-Saharan Africa. There have been many papers describing the impact of malaria during pregnancy and, more recently, attempts to quantify this burden. However, there remains a poor understanding of the effects under different levels of transmission and in different gravidity groups. It is frequently reported that primigravidae and secundigravidae are the most at risk, and much of the literature on the burden of malaria during pregnancy has focused on women of these gravidities. However, there is an increasing recognition that women of higher gravidities may also be at risk, particularly in areas of high transmission levels. The aim of this review was to investigate the impact of malaria during pregnancy on low birth weight (LBW) across all gravidities by collating data from areas in sub-Saharan Africa with various levels of malaria transmission. The present review benefits from a wealth of recently published data on malaria and LBW for all pregnant women in these areas and undertakes a novel analysis of the associations between LBW and rate of malaria transmission. A similar analysis of maternal anemia has been conducted previously.

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Clinical Microbiology Reviews
Guyatt HL, et al