Malaria during pregnancy constitutes a large health problem in endemic areas. WHO recommends that interventions are initiated at the first antenatal visit, and these improve pregnancy outcomes. This study evaluated foetal growth by ultrasound and birth outcomes in women who were infected prior to the first antenatal visit (gestational age, GA<120 days) and not later in pregnancy. Compared to uninfected controls, women with early P. falciparumexposure had retarded intrauterine growth between a GA of 212 and 253 days (mean weight gain reduction: 107g [26;188], P=0.0099) and shorter pregnancy length (mean reduction 6.6 days [1.0;112.5], P=0.0087). The birth weight (mean reduction 221g [6;436], P=0.044) and the placental weight (mean reduction 84g ([18; 150], P=0.013) at term were also reduced. The study suggests that early exposure to P. falciparum, which are not prevented by current control strategies, has profound impact on foetal growth, pregnancy length and the placental weight at term.