Skip to main content
NCBI home page
Archives of Disease in Childhood. Fetal and Neonatal Edition logoLink to Archives of Disease in Childhood. Fetal and Neonatal Edition
. 1998 Sep;79(2):F135–F140. doi: 10.1136/fn.79.2.f135

Causes of preterm delivery and intrauterine growth retardation in a malaria endemic region of Papua New Guinea

S Allen, A Raiko, A O'Donnell, N Alexander, J Clegg
PMCID: PMC1720830  PMID: 9828741

Abstract

AIM—To identify causes of preterm delivery and intrauterine growth retardation (IUGR) in a malaria endemic region of Papua New Guinea.
METHODS—Independent predictors of preterm delivery and birthweight in term infants were identified using multiple regression analysis in a prospective study of 987 singleton live births delivered in Madang Hospital.
RESULTS—Overall, Plasmodium falciparum infection of the placenta was associated with a reduction in birthweight of 130 g. Malaria was significantly more common in primigravidae than multigravidae and probably contributed to both preterm delivery and IUGR. Maternal haemoglobin concentrations were significantly lower in malaria infected than non-infected women and reduced haemoglobin was the main determinant of preterm delivery. Poorer maternal nutritional status and smoking were associated with both prematurity and IUGR. Greater antenatal clinic attendance predicted increased birthweight in term infants.
CONCLUSIONS—Protection against malaria during pregnancy, especially in primigravidae, improved nutrition in women and discouragement of smoking would probably reduce both preterm delivery and IUGR. Greater use of existing antenatal clinics might increase birthweight in term infants.



Full Text

The Full Text of this article is available as a PDF (134.6 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Allen S. J., O'Donnell A., Alexander N. D., Alpers M. P., Peto T. E., Clegg J. B., Weatherall D. J. alpha+-Thalassemia protects children against disease caused by other infections as well as malaria. Proc Natl Acad Sci U S A. 1997 Dec 23;94(26):14736–14741. doi: 10.1073/pnas.94.26.14736. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Barros F. C., Huttly S. R., Victora C. G., Kirkwood B. R., Vaughan J. P. Comparison of the causes and consequences of prematurity and intrauterine growth retardation: a longitudinal study in southern Brazil. Pediatrics. 1992 Aug;90(2 Pt 1):238–244. [PubMed] [Google Scholar]
  3. Belizán J. M., Lechtig A., Villar J. Distribution of low-birth weight babies in developing countries. Am J Obstet Gynecol. 1978 Nov 15;132(6):704–705. doi: 10.1016/0002-9378(78)90882-7. [DOI] [PubMed] [Google Scholar]
  4. Bloland P., Slutsker L., Steketee R. W., Wirima J. J., Heymann D. L., Breman J. G. Rates and risk factors for mortality during the first two years of life in rural Malawi. Am J Trop Med Hyg. 1996;55(1 Suppl):82–86. doi: 10.4269/ajtmh.1996.55.82. [DOI] [PubMed] [Google Scholar]
  5. Brabin B. J. An analysis of malaria in pregnancy in Africa. Bull World Health Organ. 1983;61(6):1005–1016. [PMC free article] [PubMed] [Google Scholar]
  6. Brabin B. J., Ginny M., Alpers M., Brabin L., Eggelte T., Van der Kaay H. J. Failure of chloroquine prophylaxis for falciparum malaria in pregnant women in Madang, Papua New Guinea. Ann Trop Med Parasitol. 1990 Feb;84(1):1–9. doi: 10.1080/00034983.1990.11812428. [DOI] [PubMed] [Google Scholar]
  7. Brabin B. J., Ginny M., Sapau J., Galme K., Paino J. Consequences of maternal anaemia on outcome of pregnancy in a malaria endemic area in Papua New Guinea. Ann Trop Med Parasitol. 1990 Feb;84(1):11–24. doi: 10.1080/00034983.1990.11812429. [DOI] [PubMed] [Google Scholar]
  8. Brabin B. An assessment of low birthweight risk in primiparae as an indicator of malaria control in pregnancy. Int J Epidemiol. 1991 Mar;20(1):276–283. doi: 10.1093/ije/20.1.276. [DOI] [PubMed] [Google Scholar]
  9. Bukenya G. B., Barnes T., Nwokolo N. Low birthweight and acute childhood diarrhoea: evidence of their association in an urban settlement of Papua New Guinea. Ann Trop Paediatr. 1991;11(4):357–362. doi: 10.1080/02724936.1991.11747528. [DOI] [PubMed] [Google Scholar]
  10. Cattani J. A., Tulloch J. L., Vrbova H., Jolley D., Gibson F. D., Moir J. S., Heywood P. F., Alpers M. P., Stevenson A., Clancy R. The epidemiology of malaria in a population surrounding Madang, Papua New Guinea. Am J Trop Med Hyg. 1986 Jan;35(1):3–15. doi: 10.4269/ajtmh.1986.35.3. [DOI] [PubMed] [Google Scholar]
  11. Coakley K. J., Coakley C. A., Spooner V., Smith T. A., Javati A., Kajoi M. A review of measles admissions and deaths in the paediatric ward of Goroka Base Hospital during 1989. P N G Med J. 1991 Mar;34(1):6–12. [PubMed] [Google Scholar]
  12. D'Alessandro U., Langerock P., Bennett S., Francis N., Cham K., Greenwood B. M. The impact of a national impregnated bed net programme on the outcome of pregnancy in primigravidae in The Gambia. Trans R Soc Trop Med Hyg. 1996 Sep-Oct;90(5):487–492. doi: 10.1016/s0035-9203(96)90289-8. [DOI] [PubMed] [Google Scholar]
  13. Desowitz R. S., Alpers M. P. Placental Plasmodium falciparum parasitaemia in East Sepik (Papua New Guinea) women of different parity: the apparent absence of acute effects on mother and foetus. Ann Trop Med Parasitol. 1992 Apr;86(2):95–102. doi: 10.1080/00034983.1992.11812638. [DOI] [PubMed] [Google Scholar]
  14. Dubowitz L. M., Dubowitz V., Goldberg C. Clinical assessment of gestational age in the newborn infant. J Pediatr. 1970 Jul;77(1):1–10. doi: 10.1016/s0022-3476(70)80038-5. [DOI] [PubMed] [Google Scholar]
  15. Garner P., Brabin B. A review of randomized controlled trials of routine antimalarial drug prophylaxis during pregnancy in endemic malarious areas. Bull World Health Organ. 1994;72(1):89–99. [PMC free article] [PubMed] [Google Scholar]
  16. Garner P., Dubowitz L., Baea M., Lai D., Dubowitz M., Heywood P. Birthweight and gestation of village deliveries in Papua New Guinea. J Trop Pediatr. 1994 Feb;40(1):37–40. doi: 10.1093/tropej/40.1.37. [DOI] [PubMed] [Google Scholar]
  17. Gilles H. M., Lawson J. B., Sibelas M., Voller A., Allan N. Malaria, anaemia and pregnancy. Ann Trop Med Parasitol. 1969 Jun;63(2):245–263. doi: 10.1080/00034983.1969.11686625. [DOI] [PubMed] [Google Scholar]
  18. Klufio C. A., Kariwiga G. A comparison of unbooked mothers delivering at Port Moresby General Hospital with mothers seen antenatally: socioeconomic and reproductive characteristics. P N G Med J. 1992 Mar;35(1):3–9. [PubMed] [Google Scholar]
  19. Klufio C. A., Kariwiga G., MacDonald R. Normal birthweight at Port Moresby General Hospital: a retrospective survey of normal term births to determine birthweight distribution. P N G Med J. 1992 Mar;35(1):10–16. [PubMed] [Google Scholar]
  20. Kramer M. S. Determinants of low birth weight: methodological assessment and meta-analysis. Bull World Health Organ. 1987;65(5):663–737. [PMC free article] [PubMed] [Google Scholar]
  21. McCormick M. C. The contribution of low birth weight to infant mortality and childhood morbidity. N Engl J Med. 1985 Jan 10;312(2):82–90. doi: 10.1056/NEJM198501103120204. [DOI] [PubMed] [Google Scholar]
  22. Nosten F., ter Kuile F., Maelankiri L., Chongsuphajaisiddhi T., Nopdonrattakoon L., Tangkitchot S., Boudreau E., Bunnag D., White N. J. Mefloquine prophylaxis prevents malaria during pregnancy: a double-blind, placebo-controlled study. J Infect Dis. 1994 Mar;169(3):595–603. doi: 10.1093/infdis/169.3.595. [DOI] [PubMed] [Google Scholar]
  23. Nosten F., ter Kuile F., Maelankirri L., Decludt B., White N. J. Malaria during pregnancy in an area of unstable endemicity. Trans R Soc Trop Med Hyg. 1991 Jul-Aug;85(4):424–429. doi: 10.1016/0035-9203(91)90205-d. [DOI] [PubMed] [Google Scholar]
  24. Osman N. B., Folgosa E., Bergström S. An incident case-referent study of threatening preterm birth and genital infection. J Trop Pediatr. 1995 Oct;41(5):267–272. doi: 10.1093/tropej/41.5.267. [DOI] [PubMed] [Google Scholar]
  25. Parkin J. M., Hey E. N., Clowes J. S. Rapid assessment of gestational age at birth. Arch Dis Child. 1976 Apr;51(4):259–263. doi: 10.1136/adc.51.4.259. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Primhak R. A., MacGregor D. F. Ethnic and environmental factors affecting fetal growth in Papua New Guinea. Ann Hum Biol. 1991 May-Jun;18(3):235–243. doi: 10.1080/03014469100001552. [DOI] [PubMed] [Google Scholar]
  27. Pritchard D. I., Quinnell R. J., Moustafa M., McKean P. G., Slater A. F., Raiko A., Dale D. D., Keymer A. E. Hookworm (Necator americanus) infection and storage iron depletion. Trans R Soc Trop Med Hyg. 1991 Mar-Apr;85(2):235–238. doi: 10.1016/0035-9203(91)90038-z. [DOI] [PubMed] [Google Scholar]
  28. Reinhardt M. C., Ambroise-Thomas P., Cavallo-Serra R., Meylan C., Gautier R. Malaria at delivery in Abidjan. Helv Paediatr Acta Suppl. 1978 Dec;(41):65–84. [PubMed] [Google Scholar]
  29. Steketee R. W., Wirima J. J., Hightower A. W., Slutsker L., Heymann D. L., Breman J. G. The effect of malaria and malaria prevention in pregnancy on offspring birthweight, prematurity, and intrauterine growth retardation in rural Malawi. Am J Trop Med Hyg. 1996;55(1 Suppl):33–41. doi: 10.4269/ajtmh.1996.55.33. [DOI] [PubMed] [Google Scholar]
  30. Villar J., Belizán J. M. The relative contribution of prematurity and fetal growth retardation to low birth weight in developing and developed societies. Am J Obstet Gynecol. 1982 Aug 1;143(7):793–798. doi: 10.1016/0002-9378(82)90012-6. [DOI] [PubMed] [Google Scholar]
  31. Wilcox A. J., Russell I. T. Birthweight and perinatal mortality: II. On weight-specific mortality. Int J Epidemiol. 1983 Sep;12(3):319–325. doi: 10.1093/ije/12.3.319. [DOI] [PubMed] [Google Scholar]
  32. Woodruff A. W., Adamson E. A., El Suni A., Maughan T. S., Kaku M., Bundru N. Infants in Juba, Southern Sudan: the first six months of life. Lancet. 1983 Jul 30;2(8344):262–264. doi: 10.1016/s0140-6736(83)90242-8. [DOI] [PubMed] [Google Scholar]

Articles from Archives of Disease in Childhood. Fetal and Neonatal Edition are provided here courtesy of BMJ Publishing Group

RESOURCES