Abstract:
Background
Few studies have assessed the impact of first-trimester malaria infection during pregnancy.
We estimated this impact on adverse maternal and pregnancy outcomes.
Methods
In a convenience sample of women from the ASPIRIN (Aspirin Supplementation for Preg-
nancy Indicated risk Reduction In Nulliparas) trial in Kenya, Zambia, and the Democratic
Republic of the Congo, we tested for first-trimester Plasmodium falciparum infection using
quantitative polymerase chain reaction. We estimated site-specific effects on pregnancy
outcomes using parametric g-computation.
Results
Compared to uninfected women, we observed the adjusted site-specific prevalence differ-
ences (PDs) among women with first-trimester malaria of the following pregnancyoutcomes: preterm birth among Congolese (aPD = 0.06 [99% CI: -0.04, 0.16]), Kenyan
(0.03 [-0.04, 0.09]), and Zambian (0.00 [-0.10, 0.20]) women; low birth weight among Con-
golese (0.07 [-0.03, 0.16]), Kenyan (0.01 [-0.04, 0.06]) and Zambian (-0.04 [-0.13, 0.16])
women; spontaneous abortion among Congolese (0.00 [-0.05, 0.04]), Kenyan (0.00 [-0.04,
0.04]), and Zambian (0.02 [-0.07, 0.24]) women, and anemia later in pregnancy among Con-
golese (0.04 [-0.09, 0.16]), Kenyan (0.05 [-0.06, 0.17]), and Zambian (0.07 [-0.12, 0.36])
women. The pooled PD for anemia later in pregnancy (26–30 weeks) was 0.08 [99% CI:
0.00, 0.16].
Conclusions
First-trimester malaria was associated with increased prevalence of anemia later in preg-
nancy. We identified areas for further investigation including effects of first-trimester malaria
on preterm birth and low birth weight.
