The burden of malaria in pregnancy in malaria-endemic areas

Pregnant women in malarious areas may experience a variety of adverse conse quences from malaria infection including maternal anemia, placental accumul ation of parasites, low birth weight (LBW) from prematurity and intrauterin e growth retardation (IUGR), fetal parasite exposure and congenital infecti on, and infant mortality (IM) linked to preterm-LBW and IUGR-LBW. We review ed studies between 1985 and 2000 and summarized the malaria population attr ibutable risk (PAR) that accounts for both the prevalence of the risk facto rs in the population and the magnitude of the associated risk for anemia, L BW, and IM. Consequences from anemia and human immunodeficiency virus infec tion in these studies were also considered. Population attributable risks w ere substantial: malaria was associated with anemia (PAR range = 3-15%, LEW (8-14%), preterm-LBW (8-36%), IUGR-LBW (13-70%), and IM (3-8%). Human immu nodeficiency virus was associated with anemia (PAR range = 12-14%), LEW (11 -38%), and direct transmission in 20-40% of newborns, with direct mortality consequences. Maternal anemia was associated with LEW (PAR range = 7-18%). and fetal anemia was associated with increased IM (PAR not available). We estimate that each year 75,000 to 200,000 infant deaths are associated with malaria infection in pregnancy. The failure to apply known effective antim alarial interventions through antenatal programs continues to contribute su bstantially to infant deaths globally.