The online version of this article (doi:10.1186/1475-2875-11-222) contains supplementary material, which is available to authorized users.
Marcus J Rijken, Merel Charlotte de Wit contributed equally to this work.
The authors declare that they have no competing interests.
MJR designed the study, carried out the ultrasound scanning, performed the statistical analysis and drafted the manuscript. MCW performed the brain volume measurements and cortex grading, performed the statistical analysis and drafted the manuscript. EJHM carried out the statistical analysis and helped to draft the manuscript. SK, NK and TP performed the ultrasound scanning, organized and coordinated the study on site. GHV participated in the design of the study and revision of the manuscript. RMG participated in the design and coordination of the study, helped in the statistical analysis and revised the manuscript. FN conceived of the study and participated in the design and coordination of the study, and revised the manuscript. LRP participated in the design and analysis of the study, organized the image analysis and helped to draft and revised the manuscript. All authors read and approved the final manuscript.
Malaria in pregnancy has a negative impact on foetal growth, but it is not known whether this also affects the foetal nervous system. The aim of this study was to examine the effects of malaria on foetal cortex development by three-dimensional ultrasound.
Brain images were acquired using a portable ultrasound machine and a 3D ultrasound transducer. All recordings were analysed, blinded to clinical data, using the 4D view software package. The foetal supra-tentorial brain volume was determined and cortical development was qualitatively followed by scoring the appearance and development of six sulci. Multilevel analysis was used to study brain volume and cortical development in individual foetuses.
Cortical grading was possible in 161 out of 223 (72%) serial foetal brain images in pregnant women living in a malaria endemic area. There was no difference between foetal cortical development or brain volumes at any time in pregnancy between women with immediately treated malaria infections and non-infected pregnancies.
The percentage of images that could be graded was similar to other neuro-sonographic studies. Maternal malaria does not have a gross effect on foetal brain development, at least in this population, which had access to early detection and effective treatment of malaria.
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- Effect of malaria in pregnancy on foetal cortical brain development: a longitudinal observational study
Marcus J Rijken
Merel Charlotte de Wit
Eduard JH Mulder
Gerard HA Visser
François H Nosten
Lourens R Pistorius
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