Neurocognitive outcomes in Malawian children exposed to malaria during pregnancy: An observational birth cohort study.
<h4>Background</h4>Annually 125 million pregnancies are at risk of malaria infection. However, the impact of exposure to malaria in pregnancy on neurodevelopment in children is not well understood. We hypothesized that malaria in pregnancy and associated maternal immune activation result...
Guardado en:
| Autores principales: | , , , , , , , , , , , , , , , |
|---|---|
| Formato: | article |
| Lenguaje: | EN |
| Publicado: |
Public Library of Science (PLoS)
2021
|
| Materias: | |
| Acceso en línea: | https://doaj.org/article/ac68e436b0704e5999f51cce5401ff57 |
| Etiquetas: |
Agregar Etiqueta
Sin Etiquetas, Sea el primero en etiquetar este registro!
|
| id |
oai:doaj.org-article:ac68e436b0704e5999f51cce5401ff57 |
|---|---|
| record_format |
dspace |
| spelling |
oai:doaj.org-article:ac68e436b0704e5999f51cce5401ff572021-12-02T19:55:46ZNeurocognitive outcomes in Malawian children exposed to malaria during pregnancy: An observational birth cohort study.1549-12771549-167610.1371/journal.pmed.1003701https://doaj.org/article/ac68e436b0704e5999f51cce5401ff572021-09-01T00:00:00Zhttps://doi.org/10.1371/journal.pmed.1003701https://doaj.org/toc/1549-1277https://doaj.org/toc/1549-1676<h4>Background</h4>Annually 125 million pregnancies are at risk of malaria infection. However, the impact of exposure to malaria in pregnancy on neurodevelopment in children is not well understood. We hypothesized that malaria in pregnancy and associated maternal immune activation result in neurodevelopmental delay in exposed offspring.<h4>Methods and findings</h4>Between April 2014 and April 2015, we followed 421 Malawian mother-baby dyads (median [IQR] maternal age: 21 [19, 28] years) who were previously enrolled (median [IQR] gestational age at enrollment: 19.7 [17.9, 22.1] weeks) in a randomized controlled malaria prevention trial with 5 or 6 scheduled assessments of antenatal malaria infection by PCR. Children were evaluated at 12, 18, and/or 24 months of age with cognitive tests previously validated in Malawi: the Malawi Developmental Assessment Tool (MDAT) and the MacArthur-Bates Communicative Development Inventories (MCAB-CDI). We assessed the impact of antenatal malaria (n [%] positive: 240 [57.3]), placental malaria (n [%] positive: 112 [29.6]), and maternal immune activation on neurocognitive development in children. Linear mixed-effects analysis showed that children exposed to antenatal malaria between 33 and 37 weeks gestation had delayed language development across the 2-year follow-up, as measured by MCAB-CDI (adjusted beta estimate [95% CI], -7.53 [-13.04, -2.02], p = 0.008). Maternal immune activation, characterized by increased maternal sTNFRII concentration, between 33 and 37 weeks was associated with lower MCAB-CDI language score (adjusted beta estimate [95% CI], -8.57 [-13.09, -4.06], p < 0.001). Main limitations of this study include a relatively short length of follow-up and a potential for residual confounding that is characteristic of observational studies.<h4>Conclusions</h4>This mother-baby cohort presents evidence of a relationship between malaria in pregnancy and neurodevelopmental delay in offspring. Malaria in pregnancy may be a modifiable risk factor for neurodevelopmental injury independent of birth weight or prematurity. Successful interventions to prevent malaria during pregnancy may reduce the risk of neurocognitive delay in children.Andrea M WeckmanAndrea L ConroyMwayiwawo MadanitsaBruno GnaneswaranChloe R McDonaldLinda Kalilani-PhiriJaya ChandnaDoreen AliVictor MwapasaCarole KhairallahKyaw Lay ThwaiSteven R MeshnickSteve M TaylorFeiko O Ter KuileKevin C KainMelissa GladstonePublic Library of Science (PLoS)articleMedicineRENPLoS Medicine, Vol 18, Iss 9, p e1003701 (2021) |
| institution |
DOAJ |
| collection |
DOAJ |
| language |
EN |
| topic |
Medicine R |
| spellingShingle |
Medicine R Andrea M Weckman Andrea L Conroy Mwayiwawo Madanitsa Bruno Gnaneswaran Chloe R McDonald Linda Kalilani-Phiri Jaya Chandna Doreen Ali Victor Mwapasa Carole Khairallah Kyaw Lay Thwai Steven R Meshnick Steve M Taylor Feiko O Ter Kuile Kevin C Kain Melissa Gladstone Neurocognitive outcomes in Malawian children exposed to malaria during pregnancy: An observational birth cohort study. |
| description |
<h4>Background</h4>Annually 125 million pregnancies are at risk of malaria infection. However, the impact of exposure to malaria in pregnancy on neurodevelopment in children is not well understood. We hypothesized that malaria in pregnancy and associated maternal immune activation result in neurodevelopmental delay in exposed offspring.<h4>Methods and findings</h4>Between April 2014 and April 2015, we followed 421 Malawian mother-baby dyads (median [IQR] maternal age: 21 [19, 28] years) who were previously enrolled (median [IQR] gestational age at enrollment: 19.7 [17.9, 22.1] weeks) in a randomized controlled malaria prevention trial with 5 or 6 scheduled assessments of antenatal malaria infection by PCR. Children were evaluated at 12, 18, and/or 24 months of age with cognitive tests previously validated in Malawi: the Malawi Developmental Assessment Tool (MDAT) and the MacArthur-Bates Communicative Development Inventories (MCAB-CDI). We assessed the impact of antenatal malaria (n [%] positive: 240 [57.3]), placental malaria (n [%] positive: 112 [29.6]), and maternal immune activation on neurocognitive development in children. Linear mixed-effects analysis showed that children exposed to antenatal malaria between 33 and 37 weeks gestation had delayed language development across the 2-year follow-up, as measured by MCAB-CDI (adjusted beta estimate [95% CI], -7.53 [-13.04, -2.02], p = 0.008). Maternal immune activation, characterized by increased maternal sTNFRII concentration, between 33 and 37 weeks was associated with lower MCAB-CDI language score (adjusted beta estimate [95% CI], -8.57 [-13.09, -4.06], p < 0.001). Main limitations of this study include a relatively short length of follow-up and a potential for residual confounding that is characteristic of observational studies.<h4>Conclusions</h4>This mother-baby cohort presents evidence of a relationship between malaria in pregnancy and neurodevelopmental delay in offspring. Malaria in pregnancy may be a modifiable risk factor for neurodevelopmental injury independent of birth weight or prematurity. Successful interventions to prevent malaria during pregnancy may reduce the risk of neurocognitive delay in children. |
| format |
article |
| author |
Andrea M Weckman Andrea L Conroy Mwayiwawo Madanitsa Bruno Gnaneswaran Chloe R McDonald Linda Kalilani-Phiri Jaya Chandna Doreen Ali Victor Mwapasa Carole Khairallah Kyaw Lay Thwai Steven R Meshnick Steve M Taylor Feiko O Ter Kuile Kevin C Kain Melissa Gladstone |
| author_facet |
Andrea M Weckman Andrea L Conroy Mwayiwawo Madanitsa Bruno Gnaneswaran Chloe R McDonald Linda Kalilani-Phiri Jaya Chandna Doreen Ali Victor Mwapasa Carole Khairallah Kyaw Lay Thwai Steven R Meshnick Steve M Taylor Feiko O Ter Kuile Kevin C Kain Melissa Gladstone |
| author_sort |
Andrea M Weckman |
| title |
Neurocognitive outcomes in Malawian children exposed to malaria during pregnancy: An observational birth cohort study. |
| title_short |
Neurocognitive outcomes in Malawian children exposed to malaria during pregnancy: An observational birth cohort study. |
| title_full |
Neurocognitive outcomes in Malawian children exposed to malaria during pregnancy: An observational birth cohort study. |
| title_fullStr |
Neurocognitive outcomes in Malawian children exposed to malaria during pregnancy: An observational birth cohort study. |
| title_full_unstemmed |
Neurocognitive outcomes in Malawian children exposed to malaria during pregnancy: An observational birth cohort study. |
| title_sort |
neurocognitive outcomes in malawian children exposed to malaria during pregnancy: an observational birth cohort study. |
| publisher |
Public Library of Science (PLoS) |
| publishDate |
2021 |
| url |
https://doaj.org/article/ac68e436b0704e5999f51cce5401ff57 |
| work_keys_str_mv |
AT andreamweckman neurocognitiveoutcomesinmalawianchildrenexposedtomalariaduringpregnancyanobservationalbirthcohortstudy AT andrealconroy neurocognitiveoutcomesinmalawianchildrenexposedtomalariaduringpregnancyanobservationalbirthcohortstudy AT mwayiwawomadanitsa neurocognitiveoutcomesinmalawianchildrenexposedtomalariaduringpregnancyanobservationalbirthcohortstudy AT brunognaneswaran neurocognitiveoutcomesinmalawianchildrenexposedtomalariaduringpregnancyanobservationalbirthcohortstudy AT chloermcdonald neurocognitiveoutcomesinmalawianchildrenexposedtomalariaduringpregnancyanobservationalbirthcohortstudy AT lindakalilaniphiri neurocognitiveoutcomesinmalawianchildrenexposedtomalariaduringpregnancyanobservationalbirthcohortstudy AT jayachandna neurocognitiveoutcomesinmalawianchildrenexposedtomalariaduringpregnancyanobservationalbirthcohortstudy AT doreenali neurocognitiveoutcomesinmalawianchildrenexposedtomalariaduringpregnancyanobservationalbirthcohortstudy AT victormwapasa neurocognitiveoutcomesinmalawianchildrenexposedtomalariaduringpregnancyanobservationalbirthcohortstudy AT carolekhairallah neurocognitiveoutcomesinmalawianchildrenexposedtomalariaduringpregnancyanobservationalbirthcohortstudy AT kyawlaythwai neurocognitiveoutcomesinmalawianchildrenexposedtomalariaduringpregnancyanobservationalbirthcohortstudy AT stevenrmeshnick neurocognitiveoutcomesinmalawianchildrenexposedtomalariaduringpregnancyanobservationalbirthcohortstudy AT stevemtaylor neurocognitiveoutcomesinmalawianchildrenexposedtomalariaduringpregnancyanobservationalbirthcohortstudy AT feikooterkuile neurocognitiveoutcomesinmalawianchildrenexposedtomalariaduringpregnancyanobservationalbirthcohortstudy AT kevinckain neurocognitiveoutcomesinmalawianchildrenexposedtomalariaduringpregnancyanobservationalbirthcohortstudy AT melissagladstone neurocognitiveoutcomesinmalawianchildrenexposedtomalariaduringpregnancyanobservationalbirthcohortstudy |
| _version_ |
1718375858624790528 |