ArticlePLoS medicine2025
Submicroscopic malaria in pregnancy and associated adverse pregnancy events: A case-cohort study of 4,352 women on the Thailand-Myanmar border.
Article in PLoS medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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Who cites it
8 citing papers in PubMed.
- Clinical, parasitological, and hematologic profile of pregnant women with malaria in Colombia: a retrospective cross-sectional study.IJID regions · 2026Article
- Malaria Epidemiology andTropical medicine and infectious disease · 2026Article
- Epidemiology of malaria and leishmaniasis in Thailand (2004-2025): A systematic review.Current research in parasitology & vector-borne diseases · 2026Review
- Hidden burden of malaria in pregnancy in hard-to-reach areas of Odisha, India: challenges to elimination and the case for integrating molecular surveillance.Frontiers in public health · 2026Article
- Cohort Profile: the SMRU Refugee and Migrant Pregnancy Study in Western Thailand and Eastern Myanmar.Wellcome open research · 2026Article
- Prevalence of submicroscopic congenital malaria and associated risk factors in an area of low endemicity of Guatemala.Malaria journal · 2025Article
- A need for new tools for prevention of malaria in pregnancy.PLoS medicine · 2025Article
- Detrimental infant and maternal outcomes of undiagnosed asymptomatic malaria in pregnancy.PLoS medicine · 2025Article
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Abstract
backgroundMalaria in pregnancy detected by microscopy is associated with maternal anaemia, reduced fetal growth, and preterm birth, but the effects of lower density (i.e., submicroscopic) malaria infections are poorly characterised. This analysis was undertaken to investigate associations between submicroscopic malaria at the first antenatal care (ANC) visit and these adverse pregnancy events on the Thailand-Myanmar border.
methodsBlood samples taken from refugee and migrant pregnant women presenting for their first ANC visit were analysed retrospectively for malaria using ultrasensitive PCR (uPCR, limit of detection 22 parasites/mL). The relationships between submicroscopic malaria and subsequent microscopically detectable malaria, anaemia, birth weight, and preterm birth were evaluated using inverse probability weighting for stratified random sampling.
resultsFirst ANC visit samples from 4,352 asymptomatic women (median gestational age 16.5 weeks) attending between October 1st 2012 and December 31st 2015 were analysed. The weighted proportion of women with submicroscopic malaria infection was 4.6% (95% CI 3.9-5.6), comprising 59.8% (49.5-69.4) Plasmodium vivax, 6.5% (4.0-10.5) Plasmodium falciparum, 1.8% (0.9-3.6) mixed, and 31.9% (22.2-43.5) infections which could not be speciated. Submicroscopic parasitaemia at first ANC visit was associated with subsequent microscopically detected malaria (adjusted hazard ratio [HR] 12.9, 95% CI 8.8-18.8, p < 0.001) and lower birth weight (adjusted predicted mean difference -275 g, 95% CI -510 to -40, p = 0.022). There was no association with preterm birth. Submicroscopic P. falciparum mono-infection (adjusted HR 2.8, 95% CI 1.2-6.6, p = 0.023) and coinfection with P. falciparum and P. vivax (adjusted HR 10.3, 95% CI 2.6-40.4, p = 0.001) was associated with increased risk of maternal anaemia, but submicroscopic P. vivax mono-infection was not. That uPCR was conducted for only a part of the cohort due to cost constraints is a limitation.
conclusionsIn low transmission settings, uPCR identifies substantially more malaria infections at antenatal screening than conventional diagnostic methods. On the Thailand-Myanmar border, submicroscopic malaria at first antenatal consultation was associated with higher risks of microscopically diagnosed malaria later in pregnancy, anaemia, and reduced birth weight.
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