GESTATIONAL MALARIA - ASSESSMENT OF ITS CONSEQUENCES ON FETAL GROWTH

In a region of Africa (Nord-Kivu, Zaire) where malaria is endemic, cir culating malaria parasites, malaria-associated placental lesions, and a low hemoglobin level (< 10 g/dl) were observed, either singly or in combination, in 73.1% of women (n = 461) delivering at the maternity h ospital. These pathologic findings were associated with low birthweigh t in 18.1% of the newborns, whereas the prevalence of low birthweight was 6.4% among cases without these findings (P < 0.05). Parasitemia wa s observed in 17.4% of all mothers and was associated with a significa nt decrease in birthweight. Malaria-associated lesions were found in 5 2.5% of all placentas and were associated with a decrease in birthweig ht, head circumference, and ponderal index of the newborns. Such lesio ns were more frequently observed among primiparae (60.5%) than among m ultiparae (49.5%; P < 0.05). Lastly, a low hemoglobin level, found in 38.6% of the mothers, was associated with a decrease in birthweight, l ength, and head circumference. The differences in the physical effects associated with each of the pathologic conditions suggest that parasi temia, placental lesions, and anemia result in acute, subacute, and ch ronic impairment of fetal growth, respectively. Moreover, their delete rious effects may be cumulative, since the most dramatically affected physical patterns were found when the pathologic findings were associa ted in the same patient. Frequent antenatal monitoring of maternal hem oglobin and parasitemia, accompanied, when necessary, with curative tr eatments, may help to reduce the prevalence of intrauterine growth ret ardation and its procession of perinatal complications.