Maternal malaria status and metabolic profiles in pregnancy and in cord blood: relationships with birth size in Nigerian infants

During pregnancy, anthropometric measurements, blood film for malaria parasites and assays for lipids, glucose, insulin and TNF were obtained from 467 mothers and these analytes and insulin-like growth factor-I (IGF-I) were obtained from cord blood of 187 babies.Overall prevalence of maternal malaria was 52%, associated with younger age, anaemia and smaller infant birth size. Mothers with malaria had significantly lower cholesterol (total, HDL and LDL) and higher TNF, but no difference in triglyceride. In contrast, there was no effect of maternal malaria on cord blood lipids, but the median (range) cord IGF-I was significantly lower in babies whose mothers had malaria: 60.4 (24,145)μg/L, versus no malaria: 76.5 (24, 150)μg/L, p = 0.03. On regression analysis, the key determinants of birth weight included maternal total cholesterol, malarial status and cord insulin and IGF-I.Malaria in pregnancy was common and associated with reduced birth size, lower maternal lipids and higher TNF. In the setting of endemic malaria, maternal total cholesterol during pregnancy and cord blood insulin and IGF-I levels are potential biomarkers of foetal growth and birth size.In Nigeria, increasing mortality from stroke and end-stage renal failure is associated with a high prevalence of hypertension, obesity, diabetes and high serum triglycerides especially in women [1]. Numerous studies have established associations between reduced birth weight and increased risk of coronary heart disease, diabetes, hypertension and stroke in adulthood [2,3]. Malaria remains endemic in Nigeria and is more common among pregnant women, with prevalence ranging from 20% to 44%. It leads to significant consequences for maternal and infant health, such as maternal anemia, responsible for 11% of maternal deaths, and low birth weight (LBW), responsible for 5-12% of all LBW, 43% of preventable LBW babies and contributes to 75,000-200,000 infant deaths each year in Nigeria [4-9]. Therefore, malaria in pregnancy m