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dc.contributor.authorCates, Jordan E.
dc.contributor.authorUnger, Holger W.
dc.contributor.authorBriand, Valerie
dc.contributor.authorFievet, Nadine
dc.contributor.authorValea, Innocent
dc.contributor.authorTinto, Halidou
dc.contributor.authord'Alessandro, Umberto
dc.contributor.authorLandis, Sarah H.
dc.contributor.authorAdu-Afarwuah, Seth
dc.contributor.authorDewey, Kathryn G.
dc.contributor.authorO. ter Kuile, Feiko
dc.contributor.authorDesai, Meghna
dc.contributor.authorDellicour, Stephanie
dc.contributor.authorOuma, Peter
dc.contributor.authorGutman, Julie
dc.contributor.authorOneko, Martina
dc.contributor.authorSlutsker, Laurence
dc.contributor.authorTerlouw, Dianne J.
dc.contributor.authorKariuki, Simon
dc.contributor.authorAyisi, John
dc.contributor.authorMadanitsa, Mwayiwawo
dc.contributor.authorMwapasa, Victor
dc.contributor.authorAshorn, Per
dc.contributor.authorMaleta, Kenneth
dc.contributor.authorMueller, Ivo
dc.contributor.authorStanisic, Danielle
dc.contributor.authorSchmiegelow, Christentze
dc.contributor.authorLusingu, John
dc.contributor.authorvan Eijk, Anna Maria
dc.contributor.authoret al.
dc.date.accessioned2018-01-10T23:30:51Z
dc.date.available2018-01-10T23:30:51Z
dc.date.issued2017
dc.identifier.issn1549-1277
dc.identifier.doi10.1371/journal.pmed.1002373
dc.identifier.urihttp://hdl.handle.net/10072/360993
dc.description.abstractBackground Four studies previously indicated that the effect of malaria infection during pregnancy on the risk of low birthweight (LBW; <2,500 g) may depend upon maternal nutritional status. We investigated this dependence further using a large, diverse study population. Methods and findings We evaluated the interaction between maternal malaria infection and maternal anthropometric status on the risk of LBW using pooled data from 14,633 pregnancies from 13 studies (6 cohort studies and 7 randomized controlled trials) conducted in Africa and the Western Pacific from 1996–2015. Studies were identified by the Maternal Malaria and Malnutrition (M3) initiative using a convenience sampling approach and were eligible for pooling given adequate ethical approval and availability of essential variables. Study-specific adjusted effect estimates were calculated using inverse probability of treatment-weighted linear and log-binomial regression models and pooled using a random-effects model. The adjusted risk of delivering a baby with LBW was 8.8% among women with malaria infection at antenatal enrollment compared to 7.7% among uninfected women (adjusted risk ratio [aRR] 1.14 [95% confidence interval (CI): 0.91, 1.42]; N = 13,613), 10.5% among women with malaria infection at delivery compared to 7.9% among uninfected women (aRR 1.32 [95% CI: 1.08, 1.62]; N = 11,826), and 15.3% among women with low mid-upper arm circumference (MUAC <23 cm) at enrollment compared to 9.5% among women with MUAC ≥ 23 cm (aRR 1.60 [95% CI: 1.36, 1.87]; N = 9,008). The risk of delivering a baby with LBW was 17.8% among women with both malaria infection and low MUAC at enrollment compared to 8.4% among uninfected women with MUAC ≥ 23 cm (joint aRR 2.13 [95% CI: 1.21, 3.73]; N = 8,152). There was no evidence of synergism (i.e., excess risk due to interaction) between malaria infection and MUAC on the multiplicative (p = 0.5) or additive scale (p = 0.9). Results were similar using body mass index (BMI) as an anthropometric indicator of nutritional status. Meta-regression results indicated that there may be multiplicative interaction between malaria infection at enrollment and low MUAC within studies conducted in Africa; however, this finding was not consistent on the additive scale, when accounting for multiple comparisons, or when using other definitions of malaria and malnutrition. The major limitations of the study included availability of only 2 cross-sectional measurements of malaria and the limited availability of ultrasound-based pregnancy dating to assess impacts on preterm birth and fetal growth in all studies. Conclusions Pregnant women with malnutrition and malaria infection are at increased risk of LBW compared to women with only 1 risk factor or none, but malaria and malnutrition do not act synergistically
dc.description.peerreviewedYes
dc.languageEnglish
dc.publisherPublic Library of Sciences
dc.relation.ispartofpagefrome1002373-1
dc.relation.ispartofpagetoe1002373-20
dc.relation.ispartofissue8
dc.relation.ispartofjournalPLos Medicine
dc.relation.ispartofvolume14
dc.subject.fieldofresearchClinical Sciences not elsewhere classified
dc.subject.fieldofresearchMedical and Health Sciences
dc.subject.fieldofresearchcode110399
dc.subject.fieldofresearchcode11
dc.titleMalaria, malnutrition, and birthweight: A meta-analysis using individual participant data
dc.typeJournal article
dc.type.descriptionC1 - Articles
dc.type.codeC - Journal Articles
dcterms.licensehttps://creativecommons.org/publicdomain/zero/1.0/
dc.description.versionVersion of Record (VoR)
gro.rights.copyright2017. This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication
gro.hasfulltextFull Text
gro.griffith.authorStanisic, Danielle


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