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

    Research output: Contribution to journalArticleScientificpeer-review

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    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
    DOIs
    Publication statusPublished - 12 Oct 2022
    Publication typeA1 Journal article-refereed

    Keywords

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

    Publication forum classification

    • Publication forum level 1

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