Open Access Highly Accessed Open Badges Research

Effect of malaria in pregnancy on foetal cortical brain development: a longitudinal observational study

Marcus J Rijken1*, Merel Charlotte de Wit2, Eduard JH Mulder2, Suporn Kiricharoen1, Noaeni Karunkonkowit1, Tamalar Paw1, Gerard HA Visser2, Rose McGready134, François H Nosten134 and Lourens R Pistorius2

Author Affiliations

1 Shoklo Malaria Research Unit, PO Box 46, Mae Sot, Tak 63110, Thailand

2 Department of Obstetrics, University Medical Center Utrecht, Utrecht, Netherlands

3 Centre for Tropical Medicine, Churchill Hospital, Oxford, UK

4 Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand

For all author emails, please log on.

Malaria Journal 2012, 11:222  doi:10.1186/1475-2875-11-222

Published: 2 July 2012



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.

Malaria; Pregnancy; Ultrasonography; Prenatal; Brain; Foetus; Cerebral cortex