The choice of reference chart affects the strength of the association between malaria in pregnancy and small for gestational age: an individual participant data meta-analysis comparing the Intergrowth-21 with a Tanzanian birthweight chart

George Mtove*, Daniel T R Minja, Omari Abdul, Samwel Gesase, Kenneth Maleta, Titus H Divala, Noel Patson, Ulla Ashorn, Miriam K Laufer, Mwayiwawo Madanitsa, Per Ashorn, Don Mathanga, Jobiba Chinkhumba, Julie R Gutman, Feiko O Ter Kuile, Sofie Lykke Møller, Ib C Bygbjerg, Michael Alifrangis, Thor Theander, John P A LusinguChristentze Schmiegelow

*Corresponding author for this work

Abstract

BACKGROUND: The prevalence of small for gestational age (SGA) may vary depending on the chosen weight-for-gestational-age reference chart. An individual participant data meta-analysis was conducted to assess the implications of using a local reference (STOPPAM) instead of a universal reference (Intergrowth-21) on the association between malaria in pregnancy and SGA.

METHODS: Individual participant data of 6,236 newborns were pooled from seven conveniently identified studies conducted in Tanzania and Malawi from 2003-2018 with data on malaria in pregnancy, birthweight, and ultrasound estimated gestational age. Mixed-effects regression models were used to compare the association between malaria in pregnancy and SGA when using the STOPPAM and the Intergrowth-21 references, respectively.

RESULTS: The 10th percentile for birthweights-for-gestational age was lower for STOPPAM than for Intergrowth-21, leading to a prevalence of SGASTOPPAM of 14.2% and SGAIG21 of 18.0%, p < 0.001. The association between malaria in pregnancy and SGA was stronger for STOPPAM (adjusted odds ratio (aOR) 1.30 [1.09-1.56], p < 0.01) than for Intergrowth-21 (aOR 1.19 [1.00-1.40], p = 0.04), particularly among paucigravidae (SGASTOPPAM aOR 1.36 [1.09-1.71], p < 0.01 vs SGAIG21 aOR 1.21 [0.97-1.50], p = 0.08).

CONCLUSIONS: The prevalence of SGA may be overestimated and the impact of malaria in pregnancy underestimated when using Intergrowth-21. Comparing local reference charts to global references when assessing and interpreting the impact of malaria in pregnancy may be appropriate.

Original languageEnglish
Article number292
JournalMalaria Journal
Volume21
Issue number1
ISSN1475-2875
DOIs
Publication statusPublished - 12 Oct 2022

Keywords

  • Birth Weight
  • Female
  • Fetal Growth Retardation
  • Gestational Age
  • Humans
  • Infant, Newborn
  • Infant, Small for Gestational Age
  • Malaria/epidemiology
  • Pregnancy
  • Tanzania/epidemiology

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