Maternal Malaria Exposure & Preterm Birth Increase Infant Malaria Risk: A New Study
A recent study published in JAMA Network Open in September 2025 has revealed a significant link between maternal plasmodium falciparum (PM) infection during pregnancy and increased susceptibility to malaria in offspring, notably in early childhood. The research also suggests a parity-dependent association between preterm birth (PTD) and malaria risk.
The study, conducted between 2014 and 2019, followed 1687 mother-child dyads.Participants were women delivering their first, second, or subsequent children who did not have chronic or debilitating disease at enrollment. Researchers collected blood samples from mothers to screen for malaria and used transonographic examinations to determine gestational age. Children were followed for up to five years, with monitoring frequency varying based on malaria transmission season – monthly during transmission and bi-monthly during dry seasons.
Researchers diagnosed malaria in children through clinical examination and blood smear microscopy, with confirmation via nested polymerase chain reaction analysis for maternal infections.Severe malaria was defined as parasite detection alongside symptoms including coma, two or more convulsions within 24 hours, prostration, hemoglobin levels below 6 mg/dL, or respiratory distress. PTD was defined as viable birth before 37 weeks of gestation.
The study found that 66.9% of mothers experienced malaria infection during pregnancy, and 5.7% experienced PTD. A considerable proportion, 45.3%, of offspring were born during the malaria transmission season. By age one, 46% of children had been infected with P. falciparum, rising to 83% by age three.
Crucially, children born to mothers who tested positive for PM experienced infection substantially earlier. The median time to first infection was 49.9 weeks for offspring of PM-positive mothers, compared to 80.9 weeks for those born to PM-negative mothers. The risk of a child’s first P. falciparum infection was 1.56 times higher in those whose mothers had been infected.This increased risk persisted across all gravidity levels (first, second, and subsequent pregnancies).
Specifically, offspring of primigravid (first pregnancy) women with PM-positive mothers had an adjusted hazard ratio (aHR) of 1.86 for first malaria infection. Offspring of secundigravid (second pregnancy) and multigravida (subsequent pregnancies) women with PM-positive mothers showed increased risks with aHRs of 1.40 and 1.54, respectively.
While PTD was linked to a 1.12-fold increased risk of infection compared to full-term births, this association wasn’t statistically significant overall. Though, a significant increase in risk was observed in offspring of uninfected multigravid women who were born preterm, with a 1.76-fold increased risk compared to full-term births.
The study concludes that maternal malaria infection increases a child’s susceptibility to malaria in early life.the researchers noted that the relationship between PTD and susceptibility appears to be specifically relevant in offspring of uninfected multigravid women.
“The parity-dependent response to PTD remains to be further explored in a larger study sample with monitoring for immune cell profiles,” the investigators wrote. (Barry A, et al., 2025).
