Malaria in Pregnancy: Possible Cause for Metabolic Traits in the Offspring

There is a direct link between malaria during pregnancy and the later occurrence of metabolic traits in the offspring. These include impaired glucose metabolism and high blood pressure. This is the result of a health study in Ghana/West Africa, which was started in 2000 and in which 155 mother-child pairs participated.

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The international team of scientists led by Ina Danquah of the German Institute of Human Nutrition (DIfE), which also includes researchers from the Ghanaian Kwame Nkrumah University of Science and Technology and Charité – Universitätsmedizin Berlin, has now published its results in the Journal of Infection (G. Bedu-Addo et al., 2017; DOI: 10.1016/j. jinf. 2017.08
Sub-Saharan Africa has seen a significant increase in the number of people affected by noncommunicable metabolic diseases. In Ghana alone, about 10 percent of adults suffer from type 2 diabetes, 20 percent are pathologically overweight and 41 percent suffer from high blood pressure. At the same time, many Ghanaians are affected by malaria. This infectious disease transmitted by mosquitoes leads to life-threatening conditions, especially in infants. However, in areas where malaria is particularly prevalent, the disease occurs in many pregnant women without noticeable symptoms. However, it is often associated with maternal anemia, inflammation of the placenta, and a disturbed development of the unborn child. As a result, the newborns are often underweight and born premature.

The fact that a nutritional deficiency of unborn children can have a negative effect on their metabolic health in adulthood has been known at the latest since the effects of the Dutch Hunger Winter of 1944/45 on the next generation were scientifically investigated," said study leader Danquah. “Like famine, malaria during pregnancy can lead to undernutrition of the fetus. That is why we thought it was obvious that there could also be a connection between the state of health of mothers and the metabolic diseases that occur later on in children,” Danquah went on to say. Although malaria, type 2 diabetes and hypertension are widespread in West Africa, researchers say that possible links between the incidence of these diseases have been insufficiently studied.

To learn more about these relationships, the scientists evaluated the medical data from 155 mother-child pairs who participated in the health study in rural Ghana.
The data were collected from mothers and newborns shortly after childbirth and from teenagers 15 years later. At the time of birth, 45 percent of mothers were infected with malaria. 82 of the children were male and 73 female.

The analysis of the data reveals a direct relationship between the occurrence of malaria during pregnancy and an average 0.20 mmol/L increase in the fasting plasma glucose level of the offspring as teenagers. The systolic and diastolic blood pressure values of the adolescents whose mothers were infected at the time of birth exceeded the values of the other teenagers by an average of 5.4 and 3.7 mmHg, respectively. The observed relationships were independent of the maternal age at birth, the number of previous pregnancies and the familial socioeconomic status. The duration of the pregnancy, the birth weight of the children or the body mass index of the adolescents had only a minor impact on the observed relationships.

“The health systems in Ghana are doubly burdened by the simultaneous, massive occurrence of communicable and noncommunicable diseases. Alone the existing tropical infectious diseases and the prevailing malnutrition there have already pushed them to the limits of their capacity," said Danquah, who often visits the small rural town of Agogo due to her research work.

The scientists involved in the study agree that although the study is relatively small, it does reveal clear correlations. According to them, their findings have already provided a further argument for strengthening malaria prevention and therapy in order to also counteract the increasing incidence of diabetes and hypertension diseases in the population. In the future, further and more comprehensive studies will of course be necessary. These should also include molecular studies to identify the biochemical mechanisms that link diseases together.

Original publication:
George Bedu-Addo, Marie Alicke, Justice K. Boakye-Appiah, Inusah Abdul-Jalil, Markus van der Giet, Matthias B. Schulze, Frank P. Mockenhaupt, Ina Danquah: In utero exposure to malaria is associated with metabolic traits in adolescence: The Agogo 2000 birth cohort study,Journal of Infection 75, Published online: August 26, 2017.

Background Information:
According to the World Health Organization (WHO), in sub-Saharan Africa about a quarter of deaths are due to non-communicable diseases such as type 2 diabetes or cardiovascular disease. (Source: World Health Organization. Global status report on noncommunicable diseases 2010.