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Plasmodium falciparum and human immunodeficiency virus (HIV) are both risk factors for low birth weight (LBW) and maternal anemia, and they may interact to increase risk of adverse pregnancy outcomes. In 2005 and 2006, we followed 831 pregnant women attending antenatal care clinics in southern Malawi through delivery. HIV was associated with increased risk of LBW (adjusted prevalence ratio [PRadj] = 3.08, 95% confidence interval [CI] = 1.40, 6.79). Having greater than or equal to three episodes of peripheral parasitemia was also associated with increased risk of LBW (PRadj = 2.68, 95% CI = 1.06, 6.79). Among multigravidae, dual infection resulted in 9.59 (95% CI = 2.51, 36.6) times the risk of LBW compared with uninfected multigravidae. HIV infection and placental parasitemia were each associated with increased risk of anemia. Thus, HIV infection and parasitemia are important independent risk factors for adverse pregnancy outcomes. Among multigravidae, HIV infection and placental parasitemia may interact to produce an impact greater than the sum of their independent effects.
Financial support: This work was supported by Centers for Disease Control and Prevention Grant CDC/ASPH/ASTDR S1935-21/21. E.T.N. was funded through the Kenan Fellowship at the University of North Carolina at Chapel Hill.
Authors’ addresses: Ella T. Nkhoma, Safety and Epidemiology, HealthCore, Inc., Andover, MA, E-mail: firstname.lastname@example.org. Linda Kalilani-Phiri and Victor Mwapasa, Department of Community Health, College of Medicine, University of Malawi, Chichiri, Blantyre, Malawi, E-mails: email@example.com and firstname.lastname@example.org. Stephen J. Rogerson, Department of Medicine, University of Melbourne, Royal Melbourne Hospital, Melbourne, Victoria, Australia, E-mail: email@example.com. Steven R. Meshnick, Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, E-mail: firstname.lastname@example.org.