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The Association among Malaria in Pregnancy, Neonatal inflammation, and Neurocognitive Development in a Cohort of Malawian Infants

Andrea G. BuchwaldCenter for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland;

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Sarah BoudovaCenter for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland;

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Ingrid PetersonCenter for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland;

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Titus DivalaBlantyre Malaria Project, University of Malawi College of Medicine, Blantyre, Malawi;

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Randy MungwiraBlantyre Malaria Project, University of Malawi College of Medicine, Blantyre, Malawi;

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Patricia MawindoBlantyre Malaria Project, University of Malawi College of Medicine, Blantyre, Malawi;

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Melissa GladstoneInstitute of Translational Research, University of Liverpool, Liverpool, United Kingdom;

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Cristiana CairoInstitute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland

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Miriam K. LauferCenter for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland;

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ABSTRACT.

Malaria in pregnancy (MIP) causes poor birth outcomes, but its impact on neurocognitive development has not been well characterized. Between 2012 and 2014, we enrolled 307 mother–infant pairs and monitored 286 infants for neurocognitive development using the Malawi Developmental Assessment Tool at 6, 12, and 24 months of age. MIP was diagnosed from peripheral blood and placental specimens. Cord blood cytokine levels were assessed for a subset of neonates. Predictors of neurodevelopment were examined using mixed-effect logistic regression for developmental delay. Among the participants, 78 mothers (25.4%) had MIP, and 45 infants (15.7%) experienced severe neurocognitive delay. MIP was not associated with differences in cord blood cytokine levels or neurocognitive development. Preterm birth, low birthweight, increasing maternal education level, and increasing interleukin 6 levels were associated significantly with delay. The results highlight the prevalence of severe delay and a need for broad access to early childhood support in this setting.

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Author Notes

Address correspondence to Andrea Buchwald, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, 685 W. Baltimore St., HSF-1 Rm. 480, Baltimore, MD 21201. E-mail: abuchwald@som.umaryland.edu

Financial support: This work was supported by the American Society of Tropical Medicine and Hygiene Benjamin H. Kean Travel Fellowship grant (to S. B.), the Infectious Diseases Society of America Medical Scholars Program (to S. B.), the National Institute of Allergy and Infectious Diseases (F30AI114195 to S.B., R01AI104702 to C. C., and U01AI087624 to M. K. L.), and the University of Maryland Baltimore, Institute for Clinical & Translational Research.

Authors’ addresses: Andrea Buchwald, Sarah Boudova, Ingrid Peterson, and Miriam K. Laufer, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, E-mails: andreabuchwald@umaryland.edu, sboudova@gmail.com, idpet2@gmail.com, and mlaufer@som.umaryland.edu. Titus Divala, Randy Mungwira, and Patricia Mawindo, Blantyre Malaria Project, University of Malawi College of Medicine, Blantyre, Malawi, E-mails: tdivala@kuhes.ac.mw, rmungwira@who.int, and patmawindo@gmail.com. Melissa Gladstone, Institute of Translational Research, University of Liverpool, Liverpool, UK, E-mail: melglad@liverpool.ac.uk. Cristiana Cairo, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, E-mail: ccairo@ihv.umaryland.edu.

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