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MP NO

The impact of malaria inpregnancy on changes in bloodpressure in children over the firstyear of lifeOO Ayoola#**, OO Omotade*, I Gemmell,PE Clayton & JK Cruickshank# Endocrine Sciences & Cardiovascular Medicine,University of Manchester, * College of Medicine, University of Ibadan** Wellcome Trust Research Training Fellowshipawarded to Dr Ayoola


Background• Excess preponderance of hypertension andassociated CV complications in African adults• Hypertension and its complications in West Africaoccur at younger ages;(Ezenwaka C, Atherosclerosis 1997;Cruickshank et al J Hypert 2001)• For normal weight boys, prevalence of systolic BP(>90 th percentile,


Bogalusa Heart Study: multipleregression on systolic BP at 15-17y(n= 182, Af.Am 92)95 % CIStandard betacoefficientsP valueBirth weight -8.6 to 4.1 - 0.36


Falciparum malaria HYPER-endemicacross (West) Africa• co-exist with non-communicable diseases whichare rapidly replacing traditional infections• more frequent and severe in pregnancy causingmaternal anaemia, and low birth weight (LBW)babies• accounts for 5–12% of all LBW, 35% ofpreventable LBW and contributes to 75,000–200,000 infant deaths each year (Steketee, Am JTrop Med, 1996)


Histological appearances ofnormal and malaria-infected placenta(A) normal and (B) malaria-infectedshowing parasites and monocyte-macrophage infiltratesRogerson et al, Lancet Infect Dis 2007


LBW and catch up growth associated withincreased risks of hypertension in later life……Weight Gain from Birth to 3 months & Risein Systolic BPBansal et al, J Hypert 2008 March


Questions• Is early origins hypothesis relevant toendemic High Blood Pressure (BP) inWest Africa?• Are the effects of malaria in pregnancyon birth size and early growth relatedto the pattern of BP change in the firstyear of life?


Ibadan Maternal malaria, Infant Growth& Blood Pressure project ****Wellcome Trust Research TrainingFellowship awarded to Dr Ayoola


Methods• Standardised anthropometry and BP measuresby Trained Nurses team with 2 monthly revalidation• in mothers through pregnancy, at delivery andpostnatally• in babies at birth, 3 and 12 months.• BPs by ‘Datascope’ ,validated for mothers andinfancy;• 3 measures and mean of last 2 readings analysed


Malaria parasite examination anddefinition• Thick blood smears for malaria parasites throughpregnancy, at delivery, cord blood, 3 and 12 months• Defined as: asexual blood stages of Plasmodiumfalciparum during any pregnancy visit or at delivery, inthe placenta or cord blood• Women grouped into 2:– a)‘No Malaria’ (MP No) - no parasites detectedthroughout pregnancy or delivery– b) ‘Malaria present’ (MP Yes) - parasites present atleast once during pregnancy and/or at delivery.Analysis: t-tests / multiple regression


Infant recruitment and follow-up frombirth till one year of age• 436 births – 399 at 3 months – 380 at 1 year318 babies measured at all time-points= birth, 3 and 12 months


Effect of Malaria on birth size and BPBIRTHn = 318BOYSn = 173GIRLSn = 145MeanMP NOn = 86MP YESn = 87MP NOn = 72MP YESn = 73Weight (kg) 2.99 2.87 2.88 2.80Length (cm) 49.1 48.5 48.5 48.1BMI (kg/m 2 ) 12.34 12.19 12.23 12.1SBP (mmHg) 70.9 68.6 75.8 70.4*SBP/W 24.1 24.4 26.7 25.6SBP/L 1.45 1.42 1.56 1.47


Effect of Malaria on Growth and BP3 monthsBOYSn = 173n = 318GIRLSn = 145MeanMP NOn = 86MP YESn = 87MP NOn = 72MP YESn = 73Weight (kg) 6.14 5.84* 5.52 5.40Length (cm) 61.50 61.04 60.41 59.73BMI (kg/m 2 ) 16.16 15.6* 15.12 15.1SBP (mmHg) 90.1 90.2 89.5 89.6SBP/W 15.0 15.7* 16.5 17.0SBP/L 1.46 1.48 1.49 1.50*p


Effect of Malaria on Growth and BP12 monthsBOYSn = 173n = 318GIRLSn = 145MeanMP NOn = 86MP YESn = 87MP NOn = 72MP YESn = 73Weight (kg) 8.79 8.40* 7.91 7.94Length (cm) 74.22 73.56 72.7 72.5BMI (kg/m 2 ) 15.88 15.47 14.94 15.08SBP (mmHg) 90.1 89.9 88.8 89.0SBP/W 10.4 10.9* 11.4 11.4SBP/L 1.21 1.22 1.22 1.23*p


Determinants of change in infant BP from birthto one yearVariable0 - 12 monthsSBPß 95% CI P-value R 2Sex (boy/girl) -4.399 -7.72 to -1.08 0.01Malaria status 3.635 0.32 to 6.95 0.03Length SDS 0-3 -1.984 -3.56 to -0.40 0.014Weight SDS 0-12 2.406 0.98 to 3.84 0.001Baby’s malarial statusat 3 monthsBaby’s malarial statusat 12 months-6.394 -15.6 to 2.81 0.17-0.720 -7.38 to 5.94 0.83 0.10


Comparison of Infant BP by Maternal malariawith US BP percentiles at age 1 yearBPPercentile12 MONTHSMP NOn = 86n = 318BOYSn = 173MP YESn = 8795th 6 13(X 2 = 5.53, p= 0.02)GIRLS n = 145MP NOn = 72OR of having hypertension in boys exposed tomaternal malaria = 2.95, (X 2 = 4.226, p=0.04)MP YESn = 7367 665 7(X 2 =1.79, p= 0.2)


Conclusions• Babies exposed to maternal malaria weresmaller, shorter and thinner at birth andfailed to catch up over their first year.• Findings were more pronounced in boys.• SBP adjusted for weight higher in boysexposed to maternal malaria• Mean SBP change in infancy higher inexposed children particularly girls


Conclusions• Hence potentially important role forintrauterine exposure to malaria ininfluencing early BP• Follow-up continuing to elucidatecontribution of these factors to theirlater BP profiles


Acknowledgements• Professor JK Cruickshank• Professor PE Clayton• Professor O Omotade andothers at University ofIbadan• Nursing Team of ICGV• Cardiovascular andEndocrine ResearchTeam at University ofManchester

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