THE EFFECT OF PLACENTAL MALARIA INFECTION ON PERINATAL-MORTALITY IN RURAL MALAWI

Perinatal deaths (fetal or infant deaths from the 28th week of pregnan cy up to the seventh day after birth) occur as a result of adverse con ditions during pregnancy, labor, and delivery, or in the first few day s of life. Placental malaria infection is known to increase the risk o f delivery of a low birth weight infant, thus, potentially increasing the risk of perinatal and infant mortality. To better understand the r elationship among the adverse events in pregnancy, including placental malaria infection, adverse conditions in labor, and birth weight to p erinatal mortality, we investigated the perinatal mortality among a co hort of infants born to rural Malawian women for whom placental malari a infection status and birth weight were documented. Among the 2,063 m other-singleton infant pairs, there were 111 perinatal deaths (53.8 pe rinatal deaths per 1,000 births). The risk of perinatal death increase d as birth weight decreased. Risk factors identified for perinatal mor tality among all infants excluding birth weight included abnormal deli very (cesarean section, breech, or vacuum extraction), a history of a late fetal or neonatal death in the most recent previous birth among m ultiparous women, reactive maternal syphilis serology, nulliparity, an d low socioeconomic status. Placental malaria infection was not associ ated with increased perinatal mortality, but was associated with lower perinatal mortality among normal birth weight (greater than or equal to 2,500 g) infants (odds ratio = 0.35, 95% confidence interval = 0.14 , 0.92). Interventions to address these risk factors could have a subs tantial impact on reducing perinatal mortality in this population.