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Case Report: Birth Outcome and Neurodevelopment in Placental Malaria Discordant Twins

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  • 1 Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana;
  • | 2 Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda;
  • | 3 Infectious Diseases Research Collaboration, Kampala, Uganda;
  • | 4 Division of Infectious Diseases and Geographical Medicine, Stanford University, Stanford, California;
  • | 5 Department of Paediatrics, Makerere University College of Health Sciences, Kampala, Uganda;
  • | 6 Department of Obstetrics and Gynecology, Makerere University College of Health Sciences, Kampala, Uganda;
  • | 7 School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda;
  • | 8 Department of Medicine, University of California San Francisco, San Francisco, California
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Maternal infection during pregnancy can have lasting effects on neurodevelopment, but the impact of malaria in pregnancy on child neurodevelopment is unknown. We present a case of a 24-year-old gravida three woman enrolled at 14 weeks 6 days of gestation in a clinical trial evaluating malaria prevention strategies in pregnancy. She had two blood samples test positive for Plasmodium falciparum using loop-mediated isothermal amplification before 20 weeks of gestation. At 31 weeks 4 days of gestation, the woman presented with preterm premature rupture of membranes, and the twins were delivered by cesarean section. Twin A was 1,920 g and Twin B was 1,320 g. Both placentas tested negative for malaria by microscopy, but the placenta of Twin B had evidence of past malaria by histology. The twins’ development was assessed using the Bayley Scales of Infant and Toddler Development–Third Edition. At 1 year chronologic age, Twin B had lower scores across all domains (composite scores: cognitive, Twin A [100], Twin B [70]; motor, Twin A [88], Twin B [73]; language, Twin A [109], Twin B [86]). This effect persisted at 2 years chronologic age (composite scores: cognitive, Twin A [80], Twin B [60]; motor, Twin A [76], Twin B [67]; language, Twin A [77], Twin B [59]). Infant health was similar over the first 2 years of life. We report differences in neurodevelopmental outcomes in placental malaria-discordant dizygotic twins. Additional research is needed to evaluate the impact of placental malaria on neurodevelopmental complications. Trial registration number: ClinicalTrials.gov number, NCT02163447. Registered: June 2014, https://clinicaltrials.gov/ct2/show/NCT02163447.

Author Notes

Address correspondence to Andrea L. Conroy, Department of Pediatrics, Indiana University School of Medicine, 1044 West Walnut St., R4 402D, Indianapolis, IN 46202. E-mail: conroya@iu.edu

Financial support: The clinical trial and neurocognitive follow-up were supported by grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (Clinical trial, Program Project grant, 5P01HD059454; neurodevelopmental assessment, R01HD086124).

Ethics approval and consent to participate: This study was approved by the Makerere University School of Biomedical Sciences, the Uganda National Council for Science and Technology, the National Drug Authority in Uganda, and the institutional review boards of the University of California, San Francisco, and Indiana University in the United States of America. All study participants provided written informed consent for participation in the parent clinical trial and provided separate written informed consent for neurocognitive evaluation of the children. The trial was registered: ClinicalTrials.gov number, NCT02163447.

Consent for publication: The mother provided written informed consent for publication of the case report using a translated version of the BioMed Central consent form.

Authors’ addresses: Andrea L. Conroy, Edward A. Liechty, and Chandy C. John, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, E-mails: conroya@iu.edu, eliecht@iu.edu, andchjohn@iu.edu. Paul Bangirana, Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda, E-mail: pbangirana@yahoo.com. Mary K. Muhindo and Abel Kakuru, Infectious Diseases Research Collaboration, Kampala, Uganda, E-mails: marymkakuru@gmail.com and akakuru@idrc-uganda.org. Prasanna Jagannathan, Division of Infectious Diseases and Geographical Medicine, Stanford University, Stanford, CA, E-mail: prasj@stanford.edu. Robert O. Opoka, Department of Paediatrics, Makerere University College of Health Sciences, Kampala, Uganda, E-mail: opokabob@yahoo.com. Miriam Nakalembe, Department of Obstetrics and Gynecology, Makerere University College of Health Sciences, Kampala, Uganda, E-mail: ivuds@yahoo.com. Moses R. Kamya, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda, E-mail: mkamya@idrc-uganda.org. Grant Dorsey, Department of Medicine, University of California San Francisco, San Francisco, CA, E-mail: grant.dorsey@ucsf.edu.

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