Ayoola O.O., Omotade O.O., Gemmell I., Clayton P.E., Cruickshank J.K.
Cardiovascular Sciences and Paediatric Endocrinology Groups, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom; King's College and King's Health Partners, London, United Kingdom; Child Health, College of Medi
Ayoola, O.O., Cardiovascular Sciences and Paediatric Endocrinology Groups, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom, Child Health and Paediatric Endocrinology, University of Manchester, Manchester, United Kingdom; Omotade, O.O., Child Health, College of Medicine, University of Ibadan, Nigeria; Gemmell, I., Department of Primary Care and Biostatistics, University of Manchester, Manchester, United Kingdom; Clayton, P.E., Child Health and Paediatric Endocrinology, University of Manchester, Manchester, United Kingdom; Cruickshank, J.K., King's College and King's Health Partners, London, United Kingdom, Cardiovascular Medicine Group, Division of Diabetes and Nutrition, King's College and King's Health Partners, 150 Stamford St, London SE1 9RN, United Kingdom
We established a maternal birth cohort in Ibadan, Nigeria, where malaria is hyperendemic, to assess how intrauterine exposure to malaria affected infant blood pressure (BP) development. In a local maternity hospital, healthy pregnant women had regular blood films for malaria parasites from booking to delivery. Growth and BP were measured on 318 babies, all followed from birth to 3 and 12 months. Main outcomes were standardized measures of anthropometry and change in BP to 1 year. Babies exposed to maternal malaria were globally smaller at birth, and boys remained smaller at 3 months and 1 year. Change in systolic BP (SBP) during the year was greater in boys than in girls (20.9 versus 15.7 mm Hg; P=0.002) but greater in girls exposed to maternal malaria (18.7 versus 12.7 mm Hg; 95% confidence interval, 1-11 mm Hg; P=0.02). Eleven percent of boys (greater than twice than expected) had a SBP ≥95th percentile (hypertensive, US criteria), of whom 68% had maternal malaria exposure. On regression analysis (β coefficients, mm Hg), sex (boys>girls; β=4.4; 95% confidence interval, 1.1-7.7; P=0.01), maternal malaria exposure (3.64; 0.3-6.9; P=0.03), and weight change (2.4; 0.98-3.8/1 standard deviation score; P=0.001) all independently increased SBP change to 1 year, whereas increase in length decreased SBP (-1.98; -3.6 to -0.40). In conclusion, malaria-exposed boys had excess hypertension, whereas malaria-exposed girls a greater increase in SBP. Intrauterine exposure to malaria had sex-dependent effects on BP, independent of infant growth. Because infant-child-adult BP tracking is powerful, a malarial effect may contribute to the African burden of hypertension. © 2013 American Heart Association, Inc.
pyrimethamine plus sulfadoxine; adult; anthropometry; article; birth; blood; blood pressure; blood pressure measurement; child development; clinical assessment; cohort analysis; controlled study; delivery; environmental exposure; female; hospital; human; hypertension; infant; major clinical study; malaria; male; middle aged; Nigeria; outcome assessment; Plasmodium; Plasmodium falciparum; pregnant woman; prevalence; priority journal; sex difference; systolic blood pressure; weight change; young adult; child development; malaria; pregnancy; Anthropometry; Birth Weight; Blood Pressure; Child Development; Female; Humans; Hypertension; Infant; Malaria; Pregnancy; Prenatal Exposure Delayed Effects; Sex Factors