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Malaria, malnutrition, and birthweight: A meta-analysis using individual participant data.

Abstract Four studies previously indicated that the effect of malaria infection during pregnancy on the risk of low birthweight (LBW; <2,500 g) may depend upon maternal nutritional status. We investigated this dependence further using a large, diverse study population.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title plos medicine
Publication Year Start




PMID- 28792500
OWN - NLM
STAT- MEDLINE
DA  - 20170809
DCOM- 20170828
LR  - 20170828
IS  - 1549-1676 (Electronic)
IS  - 1549-1277 (Linking)
VI  - 14
IP  - 8
DP  - 2017 Aug
TI  - Malaria, malnutrition, and birthweight: A meta-analysis using individual
      participant data.
PG  - e1002373
LID - 10.1371/journal.pmed.1002373 [doi]
AB  - BACKGROUND: Four studies previously indicated that the effect of malaria
      infection during pregnancy on the risk of low birthweight (LBW; &lt;2,500 g) may
      depend upon maternal nutritional status. We investigated this dependence further 
      using a large, diverse study population. METHODS AND FINDINGS: We evaluated the
      interaction between maternal malaria infection and maternal anthropometric status
      on the risk of LBW using pooled data from 14,633 pregnancies from 13 studies (6
      cohort studies and 7 randomized controlled trials) conducted in Africa and the
      Western Pacific from 1996-2015. Studies were identified by the Maternal Malaria
      and Malnutrition (M3) initiative using a convenience sampling approach and were
      eligible for pooling given adequate ethical approval and availability of
      essential variables. Study-specific adjusted effect estimates were calculated
      using inverse probability of treatment-weighted linear and log-binomial
      regression models and pooled using a random-effects model. The adjusted risk of
      delivering a baby with LBW was 8.8% among women with malaria infection at
      antenatal enrollment compared to 7.7% among uninfected women (adjusted risk ratio
      [aRR] 1.14 [95% confidence interval (CI): 0.91, 1.42]; N = 13,613), 10.5% among
      women with malaria infection at delivery compared to 7.9% among uninfected women 
      (aRR 1.32 [95% CI: 1.08, 1.62]; N = 11,826), and 15.3% among women with low
      mid-upper arm circumference (MUAC &lt;23 cm) at enrollment compared to 9.5% among
      women with MUAC &gt;/= 23 cm (aRR 1.60 [95% CI: 1.36, 1.87]; N = 9,008). The risk of
      delivering a baby with LBW was 17.8% among women with both malaria infection and 
      low MUAC at enrollment compared to 8.4% among uninfected women with MUAC &gt;/= 23
      cm (joint aRR 2.13 [95% CI: 1.21, 3.73]; N = 8,152). There was no evidence of
      synergism (i.e., excess risk due to interaction) between malaria infection and
      MUAC on the multiplicative (p = 0.5) or additive scale (p = 0.9). Results were
      similar using body mass index (BMI) as an anthropometric indicator of nutritional
      status. Meta-regression results indicated that there may be multiplicative
      interaction between malaria infection at enrollment and low MUAC within studies
      conducted in Africa; however, this finding was not consistent on the additive
      scale, when accounting for multiple comparisons, or when using other definitions 
      of malaria and malnutrition. The major limitations of the study included
      availability of only 2 cross-sectional measurements of malaria and the limited
      availability of ultrasound-based pregnancy dating to assess impacts on preterm
      birth and fetal growth in all studies. CONCLUSIONS: Pregnant women with
      malnutrition and malaria infection are at increased risk of LBW compared to women
      with only 1 risk factor or none, but malaria and malnutrition do not act
      synergistically.
FAU - Cates, Jordan E
AU  - Cates JE
AUID- ORCID: http://orcid.org/0000-0003-4300-7416
AD  - Department of Epidemiology, UNC-Chapel Hill, Chapel Hill, North Carolina, United 
      States of America.
FAU - Unger, Holger W
AU  - Unger HW
AD  - Department of Obstetrics and Gynaecology, Edinburgh Royal Infirmary, Edinburgh,
      United Kingdom.
AD  - Department of Medicine at the Doherty Institute, The University of Melbourne,
      Parkville, Victoria, Australia.
FAU - Briand, Valerie
AU  - Briand V
AD  - UMR216-MERIT, French National Research Institute for Sustainable Development
      (IRD), Paris Descartes University, Paris, France.
FAU - Fievet, Nadine
AU  - Fievet N
AD  - UMR216-MERIT, French National Research Institute for Sustainable Development
      (IRD), Paris Descartes University, Paris, France.
FAU - Valea, Innocent
AU  - Valea I
AUID- ORCID: http://orcid.org/0000-0002-3085-0490
AD  - Unite de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la
      Sante-DRO, Bobo-Dioulasso, Burkina Faso.
AD  - Departement de Recherche Clinique, Centre Muraz, Bobo-Dioulasso, Burkina Faso.
FAU - Tinto, Halidou
AU  - Tinto H
AUID- ORCID: http://orcid.org/0000-0003-4653-7041
AD  - Unite de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la
      Sante-DRO, Bobo-Dioulasso, Burkina Faso.
AD  - Departement de Recherche Clinique, Centre Muraz, Bobo-Dioulasso, Burkina Faso.
FAU - D'Alessandro, Umberto
AU  - D'Alessandro U
AUID- ORCID: http://orcid.org/0000-0001-6341-5009
AD  - Medical Research Council Unit, The Gambia; London School of Hygiene and Tropical 
      Medicine, London, United Kingdom.
FAU - Landis, Sarah H
AU  - Landis SH
AD  - Worldwide Epidemiology, GlaxoSmithKline, Uxbridge, United Kingdom.
FAU - Adu-Afarwuah, Seth
AU  - Adu-Afarwuah S
AD  - Department of Nutrition and Food Science, University of Ghana, Legon, Accra,
      Ghana.
FAU - Dewey, Kathryn G
AU  - Dewey KG
AD  - Department of Nutrition, University of California, Davis, California, United
      States of America.
FAU - Ter Kuile, Feiko O
AU  - Ter Kuile FO
AD  - Department of Clinical Sciences, Liverpool School of Tropical Medicine,
      Liverpool, United Kingdom.
FAU - Desai, Meghna
AU  - Desai M
AD  - Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global
      Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United
      States of America.
FAU - Dellicour, Stephanie
AU  - Dellicour S
AUID- ORCID: http://orcid.org/0000-0002-2981-242X
AD  - Department of Clinical Sciences, Liverpool School of Tropical Medicine,
      Liverpool, United Kingdom.
FAU - Ouma, Peter
AU  - Ouma P
AD  - Kenya Medical Research Institute (KEMRI)/ Centre for Global Health Research,
      Kisumu, Kenya.
FAU - Gutman, Julie
AU  - Gutman J
AD  - Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global
      Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United
      States of America.
FAU - Oneko, Martina
AU  - Oneko M
AD  - Kenya Medical Research Institute (KEMRI)/ Centre for Global Health Research,
      Kisumu, Kenya.
FAU - Slutsker, Laurence
AU  - Slutsker L
AD  - Malaria and Neglected Tropical Diseases, Center for Malaria Control and
      Elimination, PATH, Seattle, Washington, United States of America.
FAU - Terlouw, Dianne J
AU  - Terlouw DJ
AUID- ORCID: http://orcid.org/0000-0001-5327-8995
AD  - Department of Clinical Sciences, Liverpool School of Tropical Medicine,
      Liverpool, United Kingdom.
AD  - Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.
FAU - Kariuki, Simon
AU  - Kariuki S
AD  - Kenya Medical Research Institute (KEMRI)/ Centre for Global Health Research,
      Kisumu, Kenya.
FAU - Ayisi, John
AU  - Ayisi J
AD  - Kenya Medical Research Institute (KEMRI)/ Centre for Global Health Research,
      Kisumu, Kenya.
FAU - Madanitsa, Mwayiwawo
AU  - Madanitsa M
AD  - Department of Clinical Sciences, Liverpool School of Tropical Medicine,
      Liverpool, United Kingdom.
AD  - School of Public Health and Family Medicine, College of Medicine, University of
      Malawi, Blantyre, Malawi.
FAU - Mwapasa, Victor
AU  - Mwapasa V
AD  - School of Public Health and Family Medicine, College of Medicine, University of
      Malawi, Blantyre, Malawi.
FAU - Ashorn, Per
AU  - Ashorn P
AD  - Center for Child Health Research University of Tampere School of Medicine and
      Tampere University Hospital, Tampere, Finland.
FAU - Maleta, Kenneth
AU  - Maleta K
AUID- ORCID: http://orcid.org/0000-0002-2536-3938
AD  - School of Public Health and Family Medicine, College of Medicine, University of
      Malawi, Blantyre, Malawi.
FAU - Mueller, Ivo
AU  - Mueller I
AD  - Walter and Eliza Hall Institute, Parkville, Victoria, Australia.
FAU - Stanisic, Danielle
AU  - Stanisic D
AD  - Institute for Glycomics, Griffith University, Gold Coast, Queensland, Australia.
FAU - Schmiegelow, Christentze
AU  - Schmiegelow C
AUID- ORCID: http://orcid.org/0000-0002-9360-9741
AD  - Centre for Medical Parasitology, Depart. Of Immunology and Microbiology, Faculty 
      of Health Science, University of Copenhagen, Copenhagen, Denmark.
FAU - Lusingu, John P A
AU  - Lusingu JPA
AD  - Centre for Medical Parasitology, Depart. Of Immunology and Microbiology, Faculty 
      of Health Science, University of Copenhagen, Copenhagen, Denmark.
AD  - National Institute for Medical Research, Tanga Centre, Tanga, Tanzania.
FAU - van Eijk, Anna Maria
AU  - van Eijk AM
AD  - Department of Clinical Sciences, Liverpool School of Tropical Medicine,
      Liverpool, United Kingdom.
FAU - Bauserman, Melissa
AU  - Bauserman M
AUID- ORCID: http://orcid.org/0000-0002-4992-9895
AD  - Department of Pediatrics, Division of Neonatal-Perinatal Medicine, School of
      Medicine, UNC-Chapel Hill, Chapel Hill, North Carolina, United States of America.
AD  - Department of Nutrition, UNC-Chapel Hill, Chapel Hill, North Carolina, United
      States of America.
FAU - Adair, Linda
AU  - Adair L
AD  - Department of Nutrition, UNC-Chapel Hill, Chapel Hill, North Carolina, United
      States of America.
FAU - Cole, Stephen R
AU  - Cole SR
AD  - Department of Epidemiology, UNC-Chapel Hill, Chapel Hill, North Carolina, United 
      States of America.
FAU - Westreich, Daniel
AU  - Westreich D
AD  - Department of Epidemiology, UNC-Chapel Hill, Chapel Hill, North Carolina, United 
      States of America.
FAU - Meshnick, Steven
AU  - Meshnick S
AD  - Department of Epidemiology, UNC-Chapel Hill, Chapel Hill, North Carolina, United 
      States of America.
FAU - Rogerson, Stephen
AU  - Rogerson S
AUID- ORCID: http://orcid.org/0000-0003-4287-1982
AD  - Department of Medicine at the Doherty Institute, The University of Melbourne,
      Parkville, Victoria, Australia.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
DEP - 20170808
PL  - United States
TA  - PLoS Med
JT  - PLoS medicine
JID - 101231360
SB  - IM
MH  - Africa South of the Sahara/epidemiology
MH  - Asia/epidemiology
MH  - Female
MH  - Humans
MH  - Infant, Low Birth Weight/*physiology
MH  - Infant, Newborn
MH  - Malaria/*epidemiology/parasitology
MH  - Malnutrition/*epidemiology/etiology
MH  - Pacific Islands/epidemiology
MH  - Pregnancy
MH  - Prevalence
PMC - PMC5549702
EDAT- 2017/08/10 06:00
MHDA- 2017/08/29 06:00
CRDT- 2017/08/10 06:00
PHST- 2017/03/06 [received]
PHST- 2017/07/11 [accepted]
AID - 10.1371/journal.pmed.1002373 [doi]
AID - PMEDICINE-D-17-00777 [pii]
PST - epublish
SO  - PLoS Med. 2017 Aug 8;14(8):e1002373. doi: 10.1371/journal.pmed.1002373.
      eCollection 2017 Aug.