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in the third trimester. All programs using active case-finding methods had higher prevalence among mothers with P. falciparum malaria infection at enrollment. The pooled prevalence of microcephaly among neonates with congenital infection was 3.5 per 10,000 live births. Differences in prevalence of congenital infection were not statistically significant among programs using active and passive methods, except among non-Hispanic Blacks, for which prevalence was higher among programs using passive methods. Prevalence of congenital infection did not differ significantly by maternal age, trimester of first prenatal visit, and gestational age or birth weight.
Commentary: Microcephaly is a rare birth defect that is caused by infections of the brain during pregnancy. The prevalence of congenital infection with P. falciparum among Malian mothers was high and P. falciparum infection in late pregnancy was associated with a 12-fold increase in the prevalence of microcephaly. If P. falciparum infection of the mother during pregnancy were associated with an increased risk of microcephaly, a marked reduction in the prevalence of microcephaly would be expected if malaria was prevented among pregnant women. If P. falciparum infection in late pregnancy did not increase the risk of congenital infection, then P. falciparum infection in late pregnancy may not be associated with an increased risk of microcephaly. The pooled prevalence estimates of congenital P. falciparum infection in this study were similar to the prevalence of P. falciparum infection in adults in Mali, suggesting a high rate of asymptomatic carriage of P. falciparum in this population. Malaria prevention activities should include strategies to prevent P. falciparum infection among pregnant women in this area.
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