THE EFFECT OF MALARIA AND MALARIA PREVENTION IN PREGNANCY ON OFFSPRING BIRTH-WEIGHT, PREMATURITY, AND INTRAUTERINE GROWTH-RETARDATION IN RURAL MALAWI

While there is broad evidence for the adverse effects of Plasmodium fa lciparum infection in pregnancy, and the World Health Organization rec ommends preventive strategies, there is markedly reduced efficacy in s ub-Saharan Africa of the most widely available, affordable and used an timalarial drug for chemoprophylaxis-chloroquine (CQ). During 1987-199 0, we studied pregnant women in an area of high malaria endemicity in rural Malawi to compare the efficacy of CQ (the drug recommended by na tional policy) with mefloquine (MQ, a relatively new and highly effect ive antimalarial) in preventing low birth weight (LBW) due to prematur ity and intrauterine growth 1,766 women monitored during at least thei r last six weeks of pregnancy with observed ingestion of their regimen and facility delivery of a live born singleton, their babies had a me an +/- SD birth weight of 2,905 +/- 461 gm and 16.8% had LBW. In a mul tivariate analysis, factors significantly associated with LBW included : first birth (odds ratio [OR] = 4.27), female infant (OR = 2.99), mat ernal human immunodeficiency virus infection (OR = 2.66), low maternal weight (OR = 1.95), and placental blood P. falciparum infection (OR = 1.71). Factors significantly associated with IUGR-LBW included first birth, female infant, low maternal weight, and placental malaria. Fact ors significantly associated with preterm-LBW included maternal syphil is infection, umbilical cord blood malaria, first birth, low maternal weight, and female infant. Use of an effective antimalarial (MQ) was p rotective against LBW through its effect on reducing placental and umb ilical cord blood malaria infection. The proportion of LBW babies born to women on MQ (12.5% [parity-adjusted for the population of deliveri ng women]) was significantly lower than the proportion born to women o n CQ (15.5%; P = 0.05). Effective prevention of malaria in pregnant wo men in malaria-endemic settings may reduce the likelihood of LBW by 5- 14%, and may reduce the amount of preventable LBW by more than 30%. Wh en evaluating antenatal care programs, health policy makers must consi der providing an effective preventive drug (either MQ or other drugs i dentified in additional studies, e.g., sulfa-pyrimethamine compounds) as a means to prevent low birth weight and its consequences.