The effects of malaria in pregnancy on neurocognitive development in children at one and six years of age in Benin: a prospective mother-child cohort


Background: Malaria in pregnancy (MiP) contributes significantly to infant mortality rates in Sub-Saharan Africa and has consequences on survivors, such as pre-term birth and low birth weight. However, its impact on long-term neurocognitive development in children remains unknown.

Methods: Our prospective cohort included pregnant women and their live-born singletons from the Malaria in Pregnancy Preventive Alternative Drugs clinical trial. MiP was assessed using microscopy and real-time quantitative polymerase chain-reactions (qPCR). Neurocognitive development in children was assessed using the Mullen Scales of Early Learning and the Kaufman Assessment Battery for Children 2 nd edition (KABC-II) at one and six years of age, respectively.

Results: Of 493 pregnant women, 196 (40%) were infected with malaria at least once; 121 (31%) with placental malaria diagnosed by qPCR. Multiple linear regression beta coefficients showed that impaired gross motor scores were associated with MiP at least once [-2.55 Confidence Interval (CI) (-5.15, 0.05)], placental malaria by qPCR [-4.95 CI (-7.65, -2.24)], and high parasite density at delivery [-1.92 CI (-3.86, 0.02)] after adjustment. Malaria and high parasite density at the 2 nd ANV were associated with lower KABC-II Non-Verbal Index scores at six years [-2.57 CI (-4.86, -0.28)] and [-1.91 CI (-3.51, -0.32)], respectively.

Conclusions: This prospective cohort study provides evidence that MiP, particularly late-term, could have important negative consequences on child development at one and six years of age. Mechanisms behind this association must be further investigated and diagnostic methods in low-income countries should be strengthened to provide adequate treatment.