Observational studyPLoS medicine2021
Neurocognitive outcomes in Malawian children exposed to malaria during pregnancy: An observational birth cohort study.
Observational study in PLoS medicine, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 2 of them syntheses that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
17 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Placental malaria: a systematic review and meta-analysis of global burden, risk factors, and maternal and foetal outcomes.Journal of global health · 2025Pooled it
- Malaria in pregnancy and its potential impact on neurodevelopment in children: a systematic review.Pediatric research · 2025Pooled it
- Understanding modifiable caregiver factors contributing to child development among young children in rural Malawi.Maternal & child nutrition · 2024Trial
- Effect of Malaria and Malaria Chemoprevention Regimens in Pregnancy and Childhood on Neurodevelopmental and Behavioral Outcomes in Children at 12, 24, and 36 Months: A Randomized Clinical Trial.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2023Trial
- Developmental Toxicity Study for the Antimalarial Drug Combination Cabamiquine-Pyronaridine Using a Translational Approach.Birth defects research · 2026Article
- Uncomplicated Malaria in Infancy and Neurodevelopment at 1 and 6 Years: Evidence From the MiPPAD Birth Cohort Study of Benin.Tropical medicine & international health : TM & IH · 2026Article
- PRECISE-DYAD: a prospective cohort study linking maternal and infant health trajectories in sub-Saharan Africa.BMJ open · 2026Observational
- Cohort Profile: PRECISE-DYAD: a prospective cohort study linking maternal and infant health trajectories in sub-Saharan Africa.medRxiv : the preprint server for health sciences · 2025Article
- Placental malaria induces a unique methylation profile associated with fetal growth restriction.Epigenetics · 2025Article
- Adverse pregnancy outcomes in maternal malarial infection: A systematic review and meta-analysis.New microbes and new infections · 2024Review
- Uptake and Effectiveness of Intermittent Preventive Treatment with Sulfadoxine-Pyrimethamine during Pregnancy in Africa: A Scoping Review.Diseases (Basel, Switzerland) · 2024Article
- Intercontinental insights into autism spectrum disorder: a synthesis of environmental influences and DNA methylation.Environmental epigenetics · 2024Review
- Exploring the hidden mental health consequences of malaria beyond the fever.Frontiers in human neuroscience · 2024Review
- Beyond TORCH: A narrative review of the impact of antenatal and perinatal infections on the risk of disability.Neuroscience and biobehavioral reviews · 2023Review
- The Association among Malaria in Pregnancy, Neonatal inflammation, and Neurocognitive Development in a Cohort of Malawian Infants.The American journal of tropical medicine and hygiene · 2022Article
- The PRECISE-DYAD protocol: linking maternal and infant health trajectories in sub-Saharan Africa.Wellcome open research · 2022Article
- Developmental origins of disease highlight the immediate need for expanded access to comprehensive prenatal care.Frontiers in public health · 2022Article
Corrections and comments
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Authors and funding
16 authors.
Funding
Abstract
backgroundAnnually 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. METHODS AND
findingsBetween 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.
conclusionsThis 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.
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