PROJECT SUMMARY / ABSTRACT
Since the emergence of SARS-CoV-2 in 2020, millions of pregnancies in malaria-endemic sub-Saharan Africa
have been impacted by SARS-CoV-2 infection. High rates of SARS-CoV-2 and malaria co-infections during
pregnancy will continue as new SARS-CoV-2 variants emerge and cause re-infections in subsequent waves.
SARS-CoV-2 and malaria in pregnancy are both associated with adverse birth and infant outcomes – including
preterm birth, low birth weight, and impaired growth and neurodevelopment – possibly mediated through
maternal inflammation. Data on long-term developmental effects of gestational SARS-CoV-2 in highly malaria
exposed populations are lacking. To address this gap, I will leverage samples and data from mother-infant dyads
enrolled in two complementary ongoing NIH-funded antimalarial chemoprevention trials in Busia, Uganda. In the
pregnancy trial, pregnant women are randomized to one of three antimalarial chemoprevention regimens and
followed through delivery; infants born to these women are being randomized in a separate clinical trial to receive
antimalarial chemoprevention or placebo and followed to age 4 years. These trials have coincided with Uganda’s
early SARS-CoV-2 surges, and preliminary data indicate high incidence of both SARS-CoV-2 and malaria during
pregnancy. Using clinical data and samples collected as part of the ongoing trials, I will test the hypothesis that
infants exposed to gestational SARS-CoV-2 will have impaired growth and neurodevelopment in early childhood
when compared with unexposed infants, and that this is mediated by maternal inflammation. I further hypothesize
that exposure to both SARS-CoV-2 and malaria in pregnancy increases adverse infant outcomes due to the
synergistic inflammatory effects of both pathogens. In Aim 1, I will use serologic testing of stored plasma samples
to retrospectively identify mothers who experienced SARS-CoV-2 during pregnancy and compare the growth of
infants with and without gestational SARS-CoV-2 exposure through age 4 years. In Aim 2, I will compare
neurocognitive test scores at ages 24 and 42 months among infants with and without gestational SARS-CoV-2.
In Aim 3, I will explore maternal proteomic immune signatures of SARS-CoV-2 in pregnancy and determine if
the effect of gestational SARS-CoV-2 on infant growth and neurodevelopment is mediated by specific
inflammatory pathways. This cohort is uniquely poised to address the impact of SARS-CoV-2 in pregnancy in a
malaria endemic setting, with longitudinal data and samples collected before widespread baseline SARS-CoV-
2 immunity. To accomplish these aims and become an independent translational researcher in tropical perinatal
infections, I have assembled an interdisciplinary mentorship team of experts in in infectious diseases, obstetrics,
pediatrics, neuropsychology, immunology, and global health. Results from this proposed study have immediate
implications for improving care of at-risk infants, and could identify diagnostic or therapeutic targets for future
clinical interventions.
