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The impact of malaria in pregnancy on changes in blood pressure in children over the first year of life. OO Ayoola #** , OO Omotade * , I Gemmell, PE Clayton & JK Cruickshank # Endocrine Sciences & Cardiovascular Medicine, - PowerPoint PPT Presentation
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The impact of malaria in pregnancy on changes in blood
pressure in children over the first year of life
OO Ayoola#**, OO Omotade*, I Gemmell, PE Clayton & JK Cruickshank
# Endocrine Sciences & Cardiovascular Medicine, University of Manchester, * College of Medicine, University of Ibadan
** Wellcome Trust Research Training Fellowship awarded to Dr Ayoola
Background
• Excess preponderance of hypertension and associated CV complications in African adults
• Hypertension and its complications in West Africa occur at younger ages; (Ezenwaka C, Atherosclerosis 1997;
Cruickshank et al J Hypert 2001)
• For normal weight boys, prevalence of systolic BP (>90th percentile, <95th percentile) higher in black than white boys aged 1-17 yrs
(Rosner et al Hypertension 2009)
Bogalusa Heart Study: multiple regression on systolic BP at 15-17y
(n= 182, Af.Am 92)
95 % CI Standard beta coefficients P value
Birth weight -8.6 to 4.1 - 0.36 <0.01
Height 0.27 to 0.57 0.38 <0.01
BMI 0.30 to 0.85 0.3 <0.01
DWT 0-4y -1.3 to –0.3 - 0.25 0.01
SBP at 4y 0.08 to 0.44 0.19 <0.01
NB. Ethnic difference in 15y BP ‘accounted for’ by b’weight etc.
Cruickshank et al Circulation 2005;111:1932-37
Falciparum malaria HYPER-endemic across (West) Africa
• co-exist with non-communicable diseases which are rapidly replacing traditional infections
• more frequent and severe in pregnancy causing maternal anaemia, and low birth weight (LBW) babies
• accounts for 5–12% of all LBW, 35% of preventable LBW and contributes to 75,000–200,000 infant deaths each year (Steketee, Am J Trop Med, 1996)
Histological appearances of normal and malaria-infected placenta
(A) normal and (B) malaria-infected showing parasites and monocyte-macrophage infiltrates
Rogerson et al, Lancet Infect Dis 2007
LBW and catch up growth associated with increased risks of hypertension in later life……
Bansal et al, J Hypert 2008 March
Weight Gain from Birth to 3 months & Rise in Systolic BP
Questions• Is early origins hypothesis relevant to
endemic High Blood Pressure (BP) in West Africa?
• Are the effects of malaria in pregnancy on birth size and early growth related to the pattern of BP change in the first year of life?
**Wellcome Trust Research Training Fellowship awarded to Dr Ayoola
Ibadan Maternal malaria, Infant Growth & Blood Pressure project **
Methods• Standardised anthropometry and BP measures
by Trained Nurses team with 2 monthly re-validation • in mothers through pregnancy, at delivery and
postnatally• in babies at birth, 3 and 12 months.
• BPs by ‘Datascope’ ,validated for mothers and infancy;
• 3 measures and mean of last 2 readings analysed
Malaria parasite examination and definition
• Thick blood smears for malaria parasites through pregnancy, at delivery, cord blood, 3 and 12 months
• Defined as: asexual blood stages of Plasmodium falciparum during any pregnancy visit or at delivery, in the placenta or cord blood
• Women grouped into 2:– a)‘No Malaria’ (MP No) - no parasites detected
throughout pregnancy or delivery– b) ‘Malaria present’ (MP Yes) - parasites present at
least once during pregnancy and/or at delivery.
Analysis: t-tests / multiple regression
Infant recruitment and follow-up from birth till one year of age
•
318 babies measured at all time-points = birth, 3 and 12 months
• 436 births – 399 at 3 months – 380 at 1 year
n = 318 BOYS
n = 173 GIRLS n = 145
Mean MP NO n = 86
MP YESn = 87
MP NO n = 72
MP YESn = 73
Weight (kg) 2.99 2.87 2.88 2.80Length (cm) 49.1 48.5 48.5 48.1BMI (kg/m2) 12.34 12.19 12.23 12.1
Effect of Malaria on birth size and BPBIRTH
SBP (mmHg) 70.9 68.6 75.8 70.4*
SBP/W 24.1 24.4 26.7 25.6SBP/L 1.45 1.42 1.56 1.47
n = 318 BOYS
n = 173 GIRLS n = 145
Mean MP NO n = 86
MP YESn = 87
MP NO n = 72
MP YESn = 73
Weight (kg) 6.14 5.84* 5.52 5.40Length (cm) 61.50 61.04 60.41 59.73BMI (kg/m2) 16.16 15.6* 15.12 15.1
SBP (mmHg) 90.1 90.2 89.5 89.6
SBP/W 15.0 15.7* 16.5 17.0SBP/L 1.46 1.48 1.49 1.50
Effect of Malaria on Growth and BP3 months
*p <0.03
n = 318 BOYS
n = 173 GIRLS n = 145
Mean MP NO n = 86
MP YESn = 87
MP NO n = 72
MP YESn = 73
Weight (kg) 8.79 8.40* 7.91 7.94Length (cm) 74.22 73.56 72.7 72.5BMI (kg/m2) 15.88 15.47 14.94 15.08
SBP (mmHg) 90.1 89.9 88.8 89.0
SBP/W 10.4 10.9* 11.4 11.4SBP/L 1.21 1.22 1.22 1.23
Effect of Malaria on Growth and BP12 months
*p <0.01
Variable SBP ß 95% CI P-value R2
0 - 12 months
Sex (boy/girl) -4.399 -7.72 to -1.08 0.01Malaria status 3.635 0.32 to 6.95 0.03
Length SDS 0-3 -1.984 -3.56 to -0.40 0.014Weight SDS 0-12 2.406 0.98 to 3.84 0.001Baby’s malarial status
at 3 months
-6.394 -15.6 to 2.81 0.17
Baby’s malarial status
at 12 months
-0.720 -7.38 to 5.94 0.83 0.10
Determinants of change in infant BP from birth to one year
12 MONTHS
n = 318 BOYS
n = 173BP Percentile
MP NO n = 86
MP YESn = 87
<95th 80 74
>95th 6 13
Comparison of Infant BP by Maternal malariawith US BP percentiles at age 1 year
(X2 = 5.53, p= 0.02)
OR of having hypertension in boys exposed to maternal malaria = 2.95, (X2 = 4.226, p=0.04)
GIRLS n = 145
MP NO n = 72
MP YESn = 73
67 66
5 7
(X2 =1.79, p= 0.2)
Conclusions• Babies exposed to maternal malaria were
smaller, shorter and thinner at birth and failed to catch up over their first year.
• Findings were more pronounced in boys.
• SBP adjusted for weight higher in boys exposed to maternal malaria
• Mean SBP change in infancy higher in exposed children particularly girls
Conclusions• Hence potentially important role for
intrauterine exposure to malaria in influencing early BP
• Follow-up continuing to elucidate contribution of these factors to their later BP profiles
Acknowledgements
• Professor JK Cruickshank• Professor PE Clayton• Professor O Omotade and
others at University of Ibadan
• Nursing Team of ICGV• Cardiovascular and
Endocrine Research Team at University of Manchester