{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T16:49:51Z","timestamp":1790786991311,"version":"4.1.0"},"update-to":[{"DOI":"10.12688\/wellcomeopenres.25582.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T00:00:00Z","timestamp":1774569600000}}],"reference-count":247,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T00:00:00Z","timestamp":1774569600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["093956"],"award-info":[{"award-number":["093956"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]},{"name":"SMRU (part of the MORU) i.e. Oxford Tropical Network: Wellcome","award":["220211"],"award-info":[{"award-number":["220211"]}]}],"content-domain":{"domain":["wellcomeopenresearch.org"],"crossmark-restriction":false},"short-container-title":["Wellcome Open Res"],"abstract":"<ns3:p>\n                    Background Marginalised populations face significant health risks in pregnancy with reduced access to preventive and life-saving services due to conflict and migration. Infectious disease risk is high and the double burden of malnutrition increases risk from non-communicable disease although only weak epidemiological data supports this in refugees and migrant communities. This manuscript describes the SMRU Refugee and Migrant Pregnancy Cohort commencing nearly 40\u00a0years ago, established in response to the very high rate of\n                    <ns3:italic>Plasmodium falciparum<\/ns3:italic>\n                    maternal mortality in refugee camps on the Thailand Myanmar border Methods Pregnant women who registered to antenatal care clinics of the Shoklo Malaria Research Unit from 1986 to 2024 living in marginalised communities of refugee and migrants were the eligible population. Pregnancies were prospectively followed from enrolment through to childbirth. Types of data include: 1) medical and obstetric records including patient characteristics, pregnancy progress and birth outcomes and 2) investigations (such as HIV). Results Among 94,645 pregnancies maternal mortality was 176 per 100,000 livebirths (120\/68,024). Embedded cohorts included observational and clinical trials, providing evidence on the optimisation of treatment of malaria in pregnancy and on the rapid changes towards non-communicable diseases in refugees and migrants. Low mean height (151.4\u00a0cm), well below European and American populations from which the majority of guidelines have been created, questions appropriateness, such as gestational weight gain in pregnancy. A broad scope of research findings including tropical infections impacting pregnancy outcomes, mental health and suicide, a shared platform of \u201c-omics\u201d of Karen and Burmese women from first trimester, and practice of care in low-income settings have emerged and been shared. Conclusions The SMRU Refugee and Migrant Pregnancy Cohort findings have had significant local and international impact including changing the World Health Organisation Malaria Treatment Guidelines in pregnancy; and establishing a range of guidelines and tools improving maternal-child health practices.\n                  <\/ns3:p>","DOI":"10.12688\/wellcomeopenres.25582.2","type":"journal-article","created":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T16:24:10Z","timestamp":1774628650000},"page":"21","update-policy":"https:\/\/doi.org\/10.12688\/wellcomeopenres.crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Cohort Profile: the SMRU Refugee and Migrant Pregnancy Study in Western Thailand and Eastern Myanmar"],"prefix":"10.12688","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1621-3257","authenticated-orcid":false,"given":"Rose","family":"McGready","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1897-1978","authenticated-orcid":false,"given":"Nicholas","family":"J White","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7951-0745","authenticated-orcid":false,"given":"Fran\u00e7ois H","family":"Nosten","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"SMRU Refugee and Migrant Pregnancy Study Collaborators","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2560","published-online":{"date-parts":[[2026,3,27]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"227-39","DOI":"10.1016\/j.actatropica.2011.02.016","article-title":"Malaria in the Greater Mekong Subregion: heterogeneity and complexity.","volume":"121","author":"L Cui","year":"2012","journal-title":"Acta Trop."},{"key":"ref2","doi-asserted-by":"publisher","first-page":"153-158","DOI":"10.1177\/004947558301300405","article-title":"Clinical management of chloroquine-resistant Plasmodium falciparum malaria in Southeast Asia.","volume":"13","author":"N White","year":"1983","journal-title":"Trop Doct."},{"key":"ref3","article-title":"Camp population Thailand. 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In response to the comments we have amended the manuscript. A point by point response follows: It is not the main aim of the report which is why it may not be included in detail, however, in figure 3 and its descriptions, it would be interesting to know 1. what the authors think has stalled maternal mortality and We are analysing and writing an individual case analysis for maternal mortality. \n<b>The main aim of figure 3 was to highlight the overwhelming efficiency of <i>P. falciparum <\/i>as a single lethal agent in non\/pauci-immune women. <\/b>2. any more information about trends of malaria mortality to be highlighted (though aware some of the authors' existing academic publications capture this, it is challenging in a mobile population, and&nbsp;the authors acknowledge the more than 100 women who passed away.) A\n<b>s above and thank you for point this out \u2013 we have added text to better emphasize this<\/b>. Lastly, a short conclusion after 'What are the main strengths and weaknesses of the study?' would be useful for the reader to provide the key messages the authors would like reader to take away.&nbsp; \n<b>Thank you \u2013 added.<\/b>  This report describes a remarkable and unique project which has had significant impacts on the understanding of malaria in pregnancy, related comorbidities and has changed practice. It captures its evolution, key time points and highlights the impacts and outputs from this work. Thank you \n<b>Is the rationale for, and objectives of, the study clearly described?<\/b> Yes \n<b>Is the study design appropriate for the research question?<\/b> Yes \n<b>Are sufficient details of the methods provided to allow replication by others?<\/b> Yes \n<b>Are the datasets clearly presented in a useable and accessible format?<\/b> No We checked the links in the online version and they seen ok.","URL":"https:\/\/wellcomeopenresearch.org\/articles\/11-21\/v2#referee-comment-6452","order":1,"name":"referee-comment-6452","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.21956\/wellcomeopenres.28177.r144721, Muhammad H Zaman, Boston University, Boston, Massachusetts, 19 Feb 2026, version 1, indexed","URL":"https:\/\/wellcomeopenresearch.org\/articles\/11-21\/v1#referee-response-144721","order":2,"name":"referee-response-144721","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Rose McGready<\/b>; \n<i>Posted: 01 Mar 2026<\/i>; We sincerely appreciate the useful suggestions from Reviewer 2. Along with the comments from Reviewer 1 the manuscript has improved from the considerable time devoted to review. This is an excellent cohort report, and describes the nature of the cohort, the study, and the results in crisp detail. I learned a lot from this report. I do not have any concerns, but have a few (relatively minor) recommendations. 1. The notion of migrant and refugee can, at times, be arbitrary in a complex setting. There are people who may fall into both, or neither. How did the researchers deal with various categories and their overlapping nature? and those who did not clearly fit into any group? This is a good point. Refugees and migrants were registered based on \n<u>where<\/u> they first attended antenatal care, and in the majority (&gt;99%), women completed care (camp or migrant site) and delivered under the same banner. Documentation of birth for marginalised populations is difficult. Refugees know they need to birth in the camp if they want the child\u2019s birth is registered in the camp\u2026which likely explains why registration and delivery place are usually the same. 2. Were there community members who were pendular migrants (i.e. moved back and forth between locations)? Few. All pregnant women receive a unique identifier. If they move between locations it is picked up through the coding and it is very infrequent. 3. How have issues around climate change in the region impacted the study, or its results?&nbsp; &nbsp;This is an area we are currently working on. 4. Finally - as this study developed further and strengthened, over the years, how have the perceptions of access to care, knowledge among the cohort, or practices changed?&nbsp; &nbsp; This is a gap\/limitation and text to include this has been added prior to the conclusion and referenced (Am. J. Trop. Med. Hyg., 108(3), 2023, pp. 465\u2013469 doi:10.4269\/ajtmh.22-0624). Measuring changes in perceptions in pregnancy care has to be captured around the change time and be appropriately timed; at the beginning of change there is frequently resistance e.g. masks for COVID-19. A manuscript currently under review includes perceptions of a new model of ANC care but it was not possible to isolate women who used both models of care. However there have been changes in perception, care and knowledge observed but not captured in publications. For example in the first 10 years of the camp the mortality of infants was 1 in 4 in the first year of life; uptake of family planning was low; but this has changed significantly with family planning now an item of demand. &nbsp; Overall, this is an extraordinary study and I learned a lot. Thank you.","URL":"https:\/\/wellcomeopenresearch.org\/articles\/11-21\/v2#referee-comment-6453","order":3,"name":"referee-comment-6453","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"The SMRU Refugee and Migrant Pregnancy Cohort has relied on a patchwork of funds including at times, personal donations. SMRU Wellcome Trust (WT) of UK, via Mahidol-Oxford Research Unit, has supported consistent partial support under the following grant codes: 2010-2015 WT Reference 077166, 2015-2020 WT Reference 106698, 2020-2025 WT Reference 220211, and earlier 2000-2005, 2005-2010 (Reference unavailable). Additional support from various sources such as the European Union, DFID, The Global Fund, the Bill & Melinda Gates Foundation, and Expertise France. Cohort studies such as the INTERGROWTH-21st Study, the SIDRA Medicine Qatar Foundation for the Molecular Signature of Pregnancy Study have also provided support particular to that study. Personal donations have helped support the SMRU Refugee and Migrant Pregnancy Cohort in hard times.\r\nFor the purpose of Open Access, the author has applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.","order":4,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}