Fig 1.
Map showing the geographic location of Cruzeiro do Sul, Acre State, Brazilian Amazon.
Cruzeiro do Sul has an estimated population of 82,075 inhabitants. The map also indicates Rio Branco, the capital of Acre state.
Fig 2.
Flowchart detailing exclusion criteria applied to the evaluation of the enrolled maternal-child pairs.
P. vivax infected mothers—one or more infections only by P. vivax; P. falciparum infected mothers—one or more infections only by P. falciparum; Mixed infection—P. vivax- and P. falciparum-infection occurring at the same time and/or at different times during pregnancy.
Fig 3.
Time-series of gestational malaria cases between 2006–2014.
(A) Number of gestational malaria cases per species, (B) mean birth weight of newborns from non-infected and infected women during pregnancy.
Table 1.
Baseline characteristics of mothers at delivery.
Table 2.
Clinical outcomes of newborns at birth.
Fig 4.
Forest plot of the odds ratio for weight reduction in newborns from women infected during pregnancy compared to babies from non-infected women, according to Plasmodium species.
Each model adjusting for maternal age, gravidity and years of formal education (less than 4 years); mixed infection (P. vivax and P. falciparum-infection). p values were estimated through logistic regression methods. n, number of events; N, total number in each group; CI, confidence interval; SGA, small for gestational age; LBW, low birth weight.
Fig 5.
Impact of malaria on birth weight at term according to gravidity.
Tukey boxplots show the effect of gravidity on the weight of newborns from malaria-infected women (A), and on newborns from women infected according with Plasmodium species (B). The bottom and the top of the box are the first and third quartiles, the line inside the box is the median, and the whiskers represent the lowest and the highest data within 1.5 IQR of the first and upper quartiles. The line indicates the cut-off of low birth weight. Differences between each group were examined with Mann-Whitney or Kruskal-Wallis test with a Dunn’s post hoc test. (A) P—NI x Infec (p<0.0001); M—NI x Infec (p<0.0001); NI- P x M (p<0.0001); and Infec—P x M (p = 0.0004). (B) P—NI x Pv (p = 0.0001); NI x Pf (p = 0.0003); M—NI x Pv (p = 0.0009); NI x Pf (p<0.0001); NI x Mix (p = 0.003); Pv x Pf (p = 0.025); Pv—P x M (p = 0.0009). P, primigravida; M, multigravida; NI, non-infected pregnant women; Infec, infected pregnant women; Pv, P. vivax-infection; Pf, P. falciparum-infection; Mix, mixed-infection.
Fig 6.
Forest plot of the odds ratio for prematurity in newborns from women infected during pregnancy compared to babies from non-infected women, according to Plasmodium species.
Each model adjusting for maternal age, gravidity and years of formal education (less than 4 years). Mixed infection (P. vivax and P. falciparum-infection). p values were estimated through logistic regression methods. n, number of events; N, total number in each group; CI, confidence interval. Prematurity was defined as birth <37 weeks’ gestation; very preterm birth was defined as birth between ≥28 and <32 weeks’ gestation, and late preterm birth was defined as birth between ≥32 and <37 weeks’ gestation.