Predictors of plasmodium falciparum Infection in the First Trimester among nulliparous women from Kenya, Zambia, and the Democratic Republic of the Congo

Abstract

Background. Malaria can have deleterious effects early in pregnancy, during placentation. However, malaria testing and treatment are rarely initiated until the second trimester, leaving pregnancies unprotected in the frst trimester. To inform potential early intervention approaches, we sought to identify clinical and demographic predictors of frst-trimester malaria. Methods. We prospectively recruited women from sites in the Democratic Republic of the Congo (DRC), Kenya, and Zambia who participated in the ASPIRIN (Aspirin Supplementation for Pregnancy Indicated risk Reduction In Nulliparas) trial. Nulliparous women were tested for frst-trimester Plasmodium falciparum infection by quantitative polymerase chain reaction. We evaluated predictors using descriptive statistics. Results. First-trimester malaria prevalence among 1513 nulliparous pregnant women was 6.3% (95% confdence interval [CI], 3.7%–8.8%] in the Zambian site, 37.8% (95% CI, 34.2%–41.5%) in the Kenyan site, and 62.9% (95% CI, 58.6%–67.2%) in the DRC site. First-trimester malaria was associated with shorter height and younger age in Kenyan women in site-stratifed analyses, and with lower educational attainment in analyses combining all 3 sites. No other predictors were identifed. Conclusions. First-trimester malaria prevalence varied by study site in sub-Saharan Africa. Te absence of consistent predictors suggests that routine parasite screening in early pregnancy may be needed to mitigate frst-trimester malaria in high-prevalence settings.