Generation of a malaria negative Ugandan birth weight standard for the diagnosis of small for gestational age.
<h4>Objective</h4>Placental malaria is a known risk factor for small for gestational age (SGA) neonates. However, currently utilized international and African birthweight standards have not controlled for placental malaria and/or lack obstetrical ultrasound dating. We developed a neonata...
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2020-01-01
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| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0240157 |
| _version_ | 1819128720065036288 |
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| author | Arthurine K Zakama Terik Weekes Richard Kajubi Abel Kakuru John Ategeka Moses Kamya Mary K Muhindo Diane Havlir Prasanna Jagannathan Grant Dorsey Stephanie L Gaw |
| author_facet | Arthurine K Zakama Terik Weekes Richard Kajubi Abel Kakuru John Ategeka Moses Kamya Mary K Muhindo Diane Havlir Prasanna Jagannathan Grant Dorsey Stephanie L Gaw |
| author_sort | Arthurine K Zakama |
| collection | DOAJ |
| description | <h4>Objective</h4>Placental malaria is a known risk factor for small for gestational age (SGA) neonates. However, currently utilized international and African birthweight standards have not controlled for placental malaria and/or lack obstetrical ultrasound dating. We developed a neonatal birthweight standard based on obstetrically dated pregnancies that excluded individuals with clinical malaria, asymptomatic parasitemia, and placental malaria infection. We hypothesized that current curves underestimate true ideal birthweight and the prevalence of SGA.<h4>Study design</h4>Participants were pooled from two double-blind randomized control trials of intermittent preventive therapy during pregnancy in Uganda. HIV-negative women without comorbidities were enrolled from 12-20 weeks gestation. Gestational age was confirmed by ultrasound dating. Women were followed through pregnancy and delivery for clinical malaria, asymptomatic parasitemia, and placental malaria. Women without malaria, asymptomatic parasitemia, or placental malaria formed the malaria negative cohort and generated the Ugandan birthweight standard. The Ugandan standard was then used to estimate the prevalence of SGA neonates in the malaria positive cohort. These findings were compared to international (Williams, World Health Organization (WHO), and INTERGROWTH-21st) and regional standards (Tanzanian and Malawi).<h4>Results</h4>926 women had complete delivery data; 393 (42.4%) met criteria for the malaria negative cohort and 533 (57.6%) were malaria positive. The Ugandan standard diagnosed SGA in 17.1% of malaria positive neonates; similar to the INTERGROWTH-21st and Schmiegelow curves. The WHO curve diagnosed SGA in significantly more neonates (32.1%, p = <0.001), and the Malawi curve diagnosed SGA in significantly fewer neonates (8.3%, p <0.001).<h4>Conclusion</h4>Exclusion of women with subclinical placental malaria in malaria-endemic areas created birth weight norms at higher values and increased the detection of SGA. Birth weight standards that fail to account for endemic illness may underestimate the true growth potential of healthy neonates. |
| first_indexed | 2024-12-22T08:32:18Z |
| format | Article |
| id | doaj.art-a7fb8e8f474a4a4c9a8b2f4da7616c0c |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-22T08:32:18Z |
| publishDate | 2020-01-01 |
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| series | PLoS ONE |
| spelling | doaj.art-a7fb8e8f474a4a4c9a8b2f4da7616c0c2022-12-21T18:32:28ZengPublic Library of Science (PLoS)PLoS ONE1932-62032020-01-011510e024015710.1371/journal.pone.0240157Generation of a malaria negative Ugandan birth weight standard for the diagnosis of small for gestational age.Arthurine K ZakamaTerik WeekesRichard KajubiAbel KakuruJohn AtegekaMoses KamyaMary K MuhindoDiane HavlirPrasanna JagannathanGrant DorseyStephanie L Gaw<h4>Objective</h4>Placental malaria is a known risk factor for small for gestational age (SGA) neonates. However, currently utilized international and African birthweight standards have not controlled for placental malaria and/or lack obstetrical ultrasound dating. We developed a neonatal birthweight standard based on obstetrically dated pregnancies that excluded individuals with clinical malaria, asymptomatic parasitemia, and placental malaria infection. We hypothesized that current curves underestimate true ideal birthweight and the prevalence of SGA.<h4>Study design</h4>Participants were pooled from two double-blind randomized control trials of intermittent preventive therapy during pregnancy in Uganda. HIV-negative women without comorbidities were enrolled from 12-20 weeks gestation. Gestational age was confirmed by ultrasound dating. Women were followed through pregnancy and delivery for clinical malaria, asymptomatic parasitemia, and placental malaria. Women without malaria, asymptomatic parasitemia, or placental malaria formed the malaria negative cohort and generated the Ugandan birthweight standard. The Ugandan standard was then used to estimate the prevalence of SGA neonates in the malaria positive cohort. These findings were compared to international (Williams, World Health Organization (WHO), and INTERGROWTH-21st) and regional standards (Tanzanian and Malawi).<h4>Results</h4>926 women had complete delivery data; 393 (42.4%) met criteria for the malaria negative cohort and 533 (57.6%) were malaria positive. The Ugandan standard diagnosed SGA in 17.1% of malaria positive neonates; similar to the INTERGROWTH-21st and Schmiegelow curves. The WHO curve diagnosed SGA in significantly more neonates (32.1%, p = <0.001), and the Malawi curve diagnosed SGA in significantly fewer neonates (8.3%, p <0.001).<h4>Conclusion</h4>Exclusion of women with subclinical placental malaria in malaria-endemic areas created birth weight norms at higher values and increased the detection of SGA. Birth weight standards that fail to account for endemic illness may underestimate the true growth potential of healthy neonates.https://doi.org/10.1371/journal.pone.0240157 |
| spellingShingle | Arthurine K Zakama Terik Weekes Richard Kajubi Abel Kakuru John Ategeka Moses Kamya Mary K Muhindo Diane Havlir Prasanna Jagannathan Grant Dorsey Stephanie L Gaw Generation of a malaria negative Ugandan birth weight standard for the diagnosis of small for gestational age. PLoS ONE |
| title | Generation of a malaria negative Ugandan birth weight standard for the diagnosis of small for gestational age. |
| title_full | Generation of a malaria negative Ugandan birth weight standard for the diagnosis of small for gestational age. |
| title_fullStr | Generation of a malaria negative Ugandan birth weight standard for the diagnosis of small for gestational age. |
| title_full_unstemmed | Generation of a malaria negative Ugandan birth weight standard for the diagnosis of small for gestational age. |
| title_short | Generation of a malaria negative Ugandan birth weight standard for the diagnosis of small for gestational age. |
| title_sort | generation of a malaria negative ugandan birth weight standard for the diagnosis of small for gestational age |
| url | https://doi.org/10.1371/journal.pone.0240157 |
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