Associations Between Malaria in Pregnancy and Neonatal Neurological Outcomes: Malaria in Pregnancy and Neonatal Neurological Outcomes.

Abstract Objective: To compare neurological functioning of neonates born to mothers with and without malaria in pregnancy. Methods: Pregnant women presenting at Korle Bu Teaching Hospital, Ghana were recruited into this prospective observational study. Malaria exposure was determined by clinically-documented antenatal malaria infection; parasitemia in maternal, placental, or umbilical cord blood; or placental histology. Neurological functioning was assessed using the Hammersmith Neonatal Neurological Examination within 48 hours of birth. Performance was classified as “optimal” or “suboptimal” by subdomain and overall. Results: Between 21st November 2018 and 10th February 2019, 211 term-born neonates, of whom 27 (13%) were exposed to malaria, were included. In the reflexes subdomain, exposed neonates tended to score lower (adjusted mean difference: -0.34, 95% CI: -0.70–0.03) with increased risk (adjusted risk ratio: 1.63, 95% CI: 1.09–2.44) of suboptimal performance compared to unexposed neonates. There were no significant between-group differences in scores or optimality classification for the remaining subdomains and overall. Conclusion: Malaria-exposed neonates had similar neurological functioning relative to unexposed neonates, with differences confined to the reflexes subdomain, suggesting potential underlying neurological immaturity or injury. Further studies are needed to confirm these findings and determine the significance of malaria in pregnancy on long-term neurological outcomes.