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Causes of preterm delivery and intrauterine growth retardation in a malaria endemic region of Papua New Guinea
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  1. S J Allena,
  2. A Raikob,
  3. A O’Donnella,
  4. N D E Alexanderb,
  5. J B Clegga
  1. aInstitute of Molecular Medicine, John Radcliffe Hospital, Headington, Oxford, OX3 9DS, bPapua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
  1. Dr Steve Allen. Email:sallen{at}hammer.imm.ox.ac.uk

Abstract

AIM To identify causes of preterm delivery and intrauterine growth retardation (IUGR) in a malaria endemic region of Papua New Guinea.

METHODS Independent predictors of preterm delivery and birthweight in term infants were identified using multiple regression analysis in a prospective study of 987 singleton live births delivered in Madang Hospital.

RESULTS Overall, Plasmodium falciparum infection of the placenta was associated with a reduction in birthweight of 130 g. Malaria was significantly more common in primigravidae than multigravidae and probably contributed to both preterm delivery and IUGR. Maternal haemoglobin concentrations were significantly lower in malaria infected than non-infected women and reduced haemoglobin was the main determinant of preterm delivery. Poorer maternal nutritional status and smoking were associated with both prematurity and IUGR. Greater antenatal clinic attendance predicted increased birthweight in term infants.

CONCLUSIONS Protection against malaria during pregnancy, especially in primigravidae, improved nutrition in women and discouragement of smoking would probably reduce both preterm delivery and IUGR. Greater use of existing antenatal clinics might increase birthweight in term infants.

  • In coastal Papua New Guinea, roughly a third of low birthweight infants were preterm and two thirds were growth retarded, term infants

  • Protection from malaria during pregnancy, especially in primigravidae, may prevent both IUGR and preterm delivery

  • A reduced maternal haemoglobin concentration was the main determinant of preterm birth

  • Prevention of smoking during pregnancy, improved nutrition in girls and women, and increased antenatal care may also prevent low birthweight in this region

  • malaria
  • intrauterine growth retardation
  • Papua New Guinea
  • antenatal care
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