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OO Ayoola #** , OO Omotade * , I Gemmell, PE Clayton & JK Cruickshank

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,

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OO Ayoola #** , OO Omotade * , I Gemmell, PE Clayton & JK Cruickshank

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  1. 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

  2. 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)

  3. Bogalusa Heart Study: multiple regression on systolic BP at 15-17y(n= 182, Af.Am 92) NB. Ethnic difference in 15y BP ‘accounted for’ by b’weight etc. Cruickshank et al Circulation 2005;111:1932-37

  4. Falciparummalaria 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)

  5. Histological appearances of normal and malaria-infected placenta • normal and (B) malaria-infected • showing parasites and monocyte-macrophage infiltrates Rogersonet al, Lancet Infect Dis 2007

  6. LBW and catch up growth associated with increased risks of hypertension in later life…… Weight Gain from Birth to 3 months & Rise in Systolic BP Bansal et al, J Hypert 2008 March

  7. 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?

  8. Ibadan Maternal malaria, Infant Growth & Blood Pressure project ** **Wellcome Trust Research Training Fellowship awarded to Dr Ayoola

  9. 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

  10. Malaria parasite examination and definition Analysis: t-tests / multiple regression • 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.

  11. Infant recruitment and follow-up from birth till one year of age • 436 births – 399 at 3 months – 380 at 1 year 318 babies measured at all time-points = birth, 3 and 12 months

  12. Effect of Malaria on birth size and BP BIRTH

  13. Effect of Malaria on Growth and BP 3 months *p <0.03

  14. Effect of Malaria on Growth and BP 12 months *p <0.01

  15. Determinants of change in infant BP from birth to one year

  16. Comparison of Infant BP by Maternal malaria with 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)

  17. 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

  18. 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

  19. 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

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