Bilbo SD, Schwarz JM, 2009. Early-life programming of later-life brain and behavior: a critical role for the immune system. Front Behav Neurosci 3: 14.
Knuesel I, Chicha L, Britschgi M, Schobel SA, Bodmer M, Hellings JA, Toovey S, Prinssen EP, 2014. Maternal immune activation and abnormal brain development across CNS disorders. Nat Rev Neurol 10: 643.
Dellicour S, Tatem AJ, Guerra CA, Snow RW, Kuile FO, 2010. Quantifying the number of pregnancies at risk of malaria in 2007: a demographic study. PLoS Med 7: e1000221.
McDonald CR et al. 2015. Experimental malaria in pregnancy induces neurocognitive injury in uninfected offspring via a C5a-C5a receptor dependent pathway. PLoS Pathog 11: e1005140.
Kakuru A, Jagannathan P, Muhindo MK, Natureeba P, Awori P, Nakalembe M, 2016. Dihydroartemisinin–piperaquine for the prevention of malaria in pregnancy. N Engl J Med 374: 928–939.
Kamya MR et al. 2015. Malaria transmission, infection, and disease at three sites with varied transmission intensity in Uganda: implications for malaria control. Am J Trop Med Hyg 92: 903–912.
Villar J et al. International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st), 2014. International standards for newborn weight, length, and head circumference by gestational age and sex: the newborn cross-sectional study of the INTERGROWTH-21st project. Lancet 384: 857–868.
Society for Maternal-Fetal Medicine Simpson LL, 2013. Twin-twin transfusion syndrome. Am J Obstet Gynecol 208: 3–18.
Zaman SS, Khan NZ, Islam S, Banu S, Dixit S, Shrout P, Durkin M, 1990. Validity of the ‘ten questions’ for screening serious childhood disability: results from urban Bangladesh. Int J Epidemiol 19: 613–620.
Bayley N, 2006. Bayley Scales of Infant and Toddler Development, 3rd edition. San Antonio, TX.
Halling C, Malone FD, Breathnach FM, Stewart MC, McAuliffe FM, Morrison JJ, Dicker P, Manning F, Corcoran JD, Perinatal Ireland Research Consortium, 2016. Neuro-developmental outcome of a large cohort of growth discordant twins. Eur J Pediatr 175: 381–389.
Goyen T-A, Veddovi M, Lui K, 2003. Developmental outcome of discordant premature twins at 3 years. Early Hum Dev 73: 27–37.
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Maternal infection during pregnancy can have lasting effects on neurodevelopment, but the impact of malaria in pregnancy on child neurodevelopment is unknown. We present a case of a 24-year-old gravida three woman enrolled at 14 weeks 6 days of gestation in a clinical trial evaluating malaria prevention strategies in pregnancy. She had two blood samples test positive for Plasmodium falciparum using loop-mediated isothermal amplification before 20 weeks of gestation. At 31 weeks 4 days of gestation, the woman presented with preterm premature rupture of membranes, and the twins were delivered by cesarean section. Twin A was 1,920 g and Twin B was 1,320 g. Both placentas tested negative for malaria by microscopy, but the placenta of Twin B had evidence of past malaria by histology. The twins’ development was assessed using the Bayley Scales of Infant and Toddler Development–Third Edition. At 1 year chronologic age, Twin B had lower scores across all domains (composite scores: cognitive, Twin A [100], Twin B [70]; motor, Twin A [88], Twin B [73]; language, Twin A [109], Twin B [86]). This effect persisted at 2 years chronologic age (composite scores: cognitive, Twin A [80], Twin B [60]; motor, Twin A [76], Twin B [67]; language, Twin A [77], Twin B [59]). Infant health was similar over the first 2 years of life. We report differences in neurodevelopmental outcomes in placental malaria-discordant dizygotic twins. Additional research is needed to evaluate the impact of placental malaria on neurodevelopmental complications. Trial registration number: ClinicalTrials.gov number, NCT02163447. Registered: June 2014, https://clinicaltrials.gov/ct2/show/NCT02163447.
Financial support: The clinical trial and neurocognitive follow-up were supported by grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (Clinical trial, Program Project grant, 5P01HD059454; neurodevelopmental assessment, R01HD086124).
Ethics approval and consent to participate: This study was approved by the Makerere University School of Biomedical Sciences, the Uganda National Council for Science and Technology, the National Drug Authority in Uganda, and the institutional review boards of the University of California, San Francisco, and Indiana University in the United States of America. All study participants provided written informed consent for participation in the parent clinical trial and provided separate written informed consent for neurocognitive evaluation of the children. The trial was registered: ClinicalTrials.gov number, NCT02163447.
Consent for publication: The mother provided written informed consent for publication of the case report using a translated version of the BioMed Central consent form.
Authors’ addresses: Andrea L. Conroy, Edward A. Liechty, and Chandy C. John, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, E-mails: conroya@iu.edu, eliecht@iu.edu, andchjohn@iu.edu. Paul Bangirana, Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda, E-mail: pbangirana@yahoo.com. Mary K. Muhindo and Abel Kakuru, Infectious Diseases Research Collaboration, Kampala, Uganda, E-mails: marymkakuru@gmail.com and akakuru@idrc-uganda.org. Prasanna Jagannathan, Division of Infectious Diseases and Geographical Medicine, Stanford University, Stanford, CA, E-mail: prasj@stanford.edu. Robert O. Opoka, Department of Paediatrics, Makerere University College of Health Sciences, Kampala, Uganda, E-mail: opokabob@yahoo.com. Miriam Nakalembe, Department of Obstetrics and Gynecology, Makerere University College of Health Sciences, Kampala, Uganda, E-mail: ivuds@yahoo.com. Moses R. Kamya, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda, E-mail: mkamya@idrc-uganda.org. Grant Dorsey, Department of Medicine, University of California San Francisco, San Francisco, CA, E-mail: grant.dorsey@ucsf.edu.
Bilbo SD, Schwarz JM, 2009. Early-life programming of later-life brain and behavior: a critical role for the immune system. Front Behav Neurosci 3: 14.
Knuesel I, Chicha L, Britschgi M, Schobel SA, Bodmer M, Hellings JA, Toovey S, Prinssen EP, 2014. Maternal immune activation and abnormal brain development across CNS disorders. Nat Rev Neurol 10: 643.
Dellicour S, Tatem AJ, Guerra CA, Snow RW, Kuile FO, 2010. Quantifying the number of pregnancies at risk of malaria in 2007: a demographic study. PLoS Med 7: e1000221.
McDonald CR et al. 2015. Experimental malaria in pregnancy induces neurocognitive injury in uninfected offspring via a C5a-C5a receptor dependent pathway. PLoS Pathog 11: e1005140.
Kakuru A, Jagannathan P, Muhindo MK, Natureeba P, Awori P, Nakalembe M, 2016. Dihydroartemisinin–piperaquine for the prevention of malaria in pregnancy. N Engl J Med 374: 928–939.
Kamya MR et al. 2015. Malaria transmission, infection, and disease at three sites with varied transmission intensity in Uganda: implications for malaria control. Am J Trop Med Hyg 92: 903–912.
Villar J et al. International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st), 2014. International standards for newborn weight, length, and head circumference by gestational age and sex: the newborn cross-sectional study of the INTERGROWTH-21st project. Lancet 384: 857–868.
Society for Maternal-Fetal Medicine Simpson LL, 2013. Twin-twin transfusion syndrome. Am J Obstet Gynecol 208: 3–18.
Zaman SS, Khan NZ, Islam S, Banu S, Dixit S, Shrout P, Durkin M, 1990. Validity of the ‘ten questions’ for screening serious childhood disability: results from urban Bangladesh. Int J Epidemiol 19: 613–620.
Bayley N, 2006. Bayley Scales of Infant and Toddler Development, 3rd edition. San Antonio, TX.
Halling C, Malone FD, Breathnach FM, Stewart MC, McAuliffe FM, Morrison JJ, Dicker P, Manning F, Corcoran JD, Perinatal Ireland Research Consortium, 2016. Neuro-developmental outcome of a large cohort of growth discordant twins. Eur J Pediatr 175: 381–389.
Goyen T-A, Veddovi M, Lui K, 2003. Developmental outcome of discordant premature twins at 3 years. Early Hum Dev 73: 27–37.
Past two years | Past Year | Past 30 Days | |
---|---|---|---|
Abstract Views | 489 | 404 | 27 |
Full Text Views | 612 | 14 | 0 |
PDF Downloads | 281 | 16 | 0 |