Pathways through which intermittent preventive treatment for malaria in pregnancy influences child growth faltering: a mediation analysis.

Autor:	Tong Y; Department of Statistics, Stanford University, Stanford, United States., Ratnasiri K; Department of Epidemiology and Population Health, Stanford University, Stanford, United States.; Department of Microbiology and Immunology, Stanford University, Stanford, United States., Hanif S; Department of Epidemiology and Population Health, Stanford University, Stanford, United States., Nguyen AT; Department of Epidemiology and Population Health, Stanford University, Stanford, United States., Roh ME; Institute for Global Health Sciences, University of California San Francisco, San Francisco, United States.; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, United States., Dorsey G; Department of Medicine, Division of HIV, ID, and Global Medicine, University of California San Francisco, San Francisco., Kakuru A; Infectious Diseases Research Collaboration, Kampala, Uganda., Jagannathan P; Department of Medicine, Stanford University, Stanford, United States., Benjamin-Chung J; Department of Epidemiology and Population Health, Stanford University, Stanford, United States.; Chan Zuckerberg Biohub, San Francisco, United States.
Jazyk:	angličtina
Zdroj:	MedRxiv : the preprint server for health sciences [medRxiv] 2024 Jun 10. Date of Electronic Publication: 2024 Jun 10.
DOI:	10.1101/2024.06.09.24308656
Abstrakt:	Background: Intermittent preventive treatment for malaria in pregnancy (IPTp) can improve birth outcomes, but whether it confers benefits to postnatal growth is unclear. We investigated the effect of IPTp on infant growth in Uganda and its pathways of effects using causal mediation analyses. Methods: We analyzed data from 633 infants born to mothers enrolled in a randomized trial of monthly IPTp with dihydroartemisinin-piperaquine (DP) vs sulfadoxine-pyrimethamine (SP) (NCT02793622). Weight and length were measured from 0-12 months of age. Using generalized linear models, we estimated effects of DP vs. SP on gravidity-stratified mean length-for-age (LAZ) and weight-for-length Z-scores (WLZ). We investigated mediation by placental malaria, gestational weight change, maternal anemia, maternal inflammation-related proteins, preterm birth, birth length, and birth weight. Mediation models adjusted for infant sex, gravidity, gestational age at enrollment, maternal age, maternal parasitemia at enrollment, education, and wealth. Findings: SP increased LAZ by 0.18-0.28 Z from birth through age 4 months compared to DP, while DP increased WLZ by 0.11-0.28 Z from 2-8 months compared to SP among infants of multigravidae. We did not observe these differences among primigravida. Mediators of SP included increased birth weight and length and maternal stem cell factor at delivery. Mediators of DP included placental malaria and birth length, maternal IL-18, CDCP1, and CD6 at delivery. Interpretation: In high malaria transmission settings, different IPTp regimens influenced infant growth among multigravidae through distinct pathways in the period of exclusive breastfeeding, when few other interventions are available. Funding: Stanford Center for Innovation and Global Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bill & Melinda Gates Foundation.
Databáze:	MEDLINE
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