A NEW cohort study finds children born preterm face increased risk of malaria infection during early childhood, even when mothers had no malaria during pregnancy.
Malaria Vaccine Insights from Preterm Birth Risks
Pregnancy malaria (PM) has long been linked to adverse birth outcomes, including preterm delivery (PTD) and low birthweight, which in turn elevate infant susceptibility to malaria. Researchers in Mali enrolled 1,679 mother-child pairs to investigate whether PTD independently modifies malaria risk in early childhood. Children were followed for up to 5 years, with clinical and parasitaemia data collected throughout both malaria transmission and dry seasons. The study highlights that preterm birth, even among children of mothers with prior immunity, may increase vulnerability to Plasmodium falciparum infection, emphasising a potential target group for malaria vaccine and chemoprevention strategies.
Trial Design Highlights Malaria Vaccine Relevance
The observational longitudinal cohort in Ouélessébougou tracked children born between 2011 and 2016, monitoring malaria infections monthly during peak seasons. Analyses accounted for maternal gravidity and infection history. Using Cox proportional hazards and negative binomial models, researchers evaluated whether PTD affected first malaria infections, clinical malaria episodes, and parasitaemia incidence. Stratified analyses revealed that preterm birth increased infection hazards specifically among offspring of multigravid or secundigravid women who were uninfected during pregnancy, demonstrating a nuanced interplay between maternal immunity, birth timing, and malaria susceptibility.
Preterm Children Face Higher Malaria Incidence
Results showed that preterm children had a 1.76-fold higher hazard of first malaria infection in multigravid pregnancies and up to 3.63-fold higher risk in certain uninfected maternal subgroups. The incidence rate of parasitaemia was nearly three times higher in preterm offspring of uninfected multigravida women. These findings suggest that preterm birth should be considered a key factor in early-life malaria prevention, including prioritisation for vaccination and chemoprophylaxis, particularly in regions with seasonal malaria transmission.
Overall, the study emphasises that preterm birth amplifies malaria risk in early childhood, highlighting the need for targeted prevention strategies. Ongoing research may inform vaccine deployment and monitoring for high-risk paediatric populations.
Reference
Barry A et al. Preterm birth and malaria susceptibility in offspring of uninfected multigravid women. JAMA Netw Open. 2025;8(9):e2532179.
