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An individual participant data meta-analysis was conducted to assess the implications of using a local reference (STOPPAM) instead of a universal reference (Intergrowth-21) on the association between malaria in pregnancy and SGA.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Individual participant data of 6,236 newborns were pooled from seven conveniently identified studies conducted in Tanzania and Malawi from 2003\u20132018 with data on malaria in pregnancy, birthweight, and ultrasound estimated gestational age. Mixed-effects regression models were used to compare the association between malaria in pregnancy and SGA when using the STOPPAM and the Intergrowth-21 references, respectively.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>The 10th percentile for birthweights-for-gestational age was lower for STOPPAM than for Intergrowth-21, leading to a prevalence of SGA<jats:sub>STOPPAM<\/jats:sub> of 14.2% and SGA<jats:sub>IG21<\/jats:sub> of 18.0%, p\u2009&lt;\u20090.001. The association between malaria in pregnancy and SGA was stronger for STOPPAM (adjusted odds ratio (aOR) 1.30 [1.09\u20131.56], p\u2009&lt;\u20090.01) than for Intergrowth-21 (aOR 1.19 [1.00\u20131.40], p\u2009=\u20090.04), particularly among paucigravidae (SGA<jats:sub>STOPPAM<\/jats:sub> aOR 1.36 [1.09\u20131.71], p\u2009&lt;\u20090.01 vs SGA<jats:sub>IG21<\/jats:sub> aOR 1.21 [0.97\u20131.50], p\u2009=\u20090.08).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>The prevalence of SGA may be overestimated and the impact of malaria in pregnancy underestimated when using Intergrowth-21. Comparing local reference charts to global references when assessing and interpreting the impact of malaria in pregnancy may be appropriate.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12936-022-04307-2","type":"journal-article","created":{"date-parts":[[2022,10,12]],"date-time":"2022-10-12T12:05:50Z","timestamp":1665576350000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The choice of reference chart affects the strength of the association between malaria in pregnancy and small for gestational age: an individual participant data meta-analysis comparing the Intergrowth-21 with a Tanzanian birthweight chart"],"prefix":"10.1186","volume":"21","author":[{"given":"George","family":"Mtove","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel T. 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[] was approved by the College of Medicine Research and Ethics Committee, Malawi and the Ethical Committee of Pirkanmaa Hospital District, Finland. The study by Ashorn et al. [] was approved by the College of Medicine Research and Ethics Committee, University of Malawi and the Ethics Committee of Pirkanmaa Hospital District, Finland. The study by Madanitsa et al. [] obtained ethical approval from the Liverpool School of Tropical Medicine and the Malawian National Health Science Research Committee. The study by Divala et al. [] was approved by the University of Maryland, Baltimore Institutional Review Board, University of Malawi, College of Medicine Research and Ethics Committee, and the Malawi Pharmacy, Medicines and Poisons Board. The study by Schmiegelow et al. [] received ethical approval from the Tanzania Medical Research Coordinating Committee (reference number NIMR7HQ\/R.8a\/Vol. IX\/688). The study by Moeller et al. [] received ethical clearance from the Medical Research Coordinating Committee of the National Institute for Medical Research in Tanzania (reference NIMR\/HQ\/R.8a\/Vol. IX\/1717). The study by Gutman et al. was approved by the Centers for Disease Control and Prevention and University of Malawi College of Medicine.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval and consent to participate"}},{"value":"The included studies were performed according to Good Clinical Practice guidelines and the ethical standards of the Helsinki Declaration, and written informed consent was obtained from all participants prior to participation in the studies.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"292"}}