Dorman E K, Shulman C E, Kingdom J, Bulmer J N, Mwendwa J, Peshu N, Marsh K
Kenya Medical Research Institute, Centre for Geographical Medicine Research, Coast, Kilifi, Kenya.
Ultrasound Obstet Gynecol. 2002 Feb;19(2):165-70. doi: 10.1046/j.0960-7692.2001.00545.x.
In endemic areas, maternal malaria infection is usually asymptomatic. However, it is known that infected maternal erythrocytes sequester in the intervillous space of the placenta. There is a strong association between placental malaria infection and both low birth weight (LBW) and severe maternal anemia. We aimed to determine whether impaired uteroplacental blood flow might account for the low infant birth weight associated with maternal falciparum malaria infection.
This observational study was carried out during a large double-blind, randomized, controlled trial of an antimalarial drug intervention for primigravidae. Nine hundred and ninety-five women were recruited from the antenatal clinic at a district hospital on the Kenya coast and had at least one Doppler ultrasound scan. Uterine artery resistance index and the presence or absence of a diastolic notch were recorded. In the third trimester, blood was taken for hemoglobin and malaria film.
Malaria infection at 32-35 weeks of gestation was associated with abnormal uterine artery flow velocity waveforms on the day of blood testing (relative risk (RR) 2.11, 95% confidence interval (CI) 1.24-3.59, P = 0.006). This association persisted after controlling for pre-eclampsia. Impaired uteroplacental blood flow in the women studied was also predictive of poor perinatal outcome, including low birth weight, preterm delivery and perinatal death. The risk of preterm delivery in women with histological evidence of past placental malaria infection was more than twice that of women without infection (RR 2.33, 95% CI 1.31-4.13, P = 0.004).
Uteroplacental hemodynamics are altered in the presence of maternal falciparum malaria infection. This may account for some of the excess of LBW babies observed in malaria endemic areas. Strategies that prevent or clear placental malaria may confer perinatal benefit through preservation of placental function.
在疟疾流行地区，孕产妇疟疾感染通常没有症状。然而，已知受感染的孕产妇红细胞会滞留在胎盘的绒毛间隙。胎盘疟疾感染与低出生体重（LBW）和严重孕产妇贫血之间存在密切关联。我们旨在确定子宫胎盘血流受损是否可能是孕产妇恶性疟原虫感染所致低出生体重的原因。
本观察性研究是在一项针对初产妇的抗疟药物干预大型双盲、随机、对照试验期间进行的。从肯尼亚海岸一家地区医院的产前诊所招募了995名妇女，她们至少接受了一次多普勒超声扫描。记录子宫动脉阻力指数以及是否存在舒张期切迹。在孕晚期，采集血液检测血红蛋白和疟原虫涂片。
妊娠32 - 35周时的疟疾感染与血液检测当天子宫动脉血流速度波形异常相关（相对风险（RR）2.11，95%置信区间（CI）1.24 - 3.59，P = 0.006）。在控制子痫前期后，这种关联仍然存在。所研究妇女的子宫胎盘血流受损也可预测不良围产期结局，包括低出生体重、早产和围产期死亡。有既往胎盘疟疾感染组织学证据的妇女早产风险是未感染妇女的两倍多（RR 2.33，95% CI 1.31 - 4.13，P = 0.004）。
孕产妇恶性疟原虫感染会改变子宫胎盘血流动力学。这可能是疟疾流行地区观察到低出生体重婴儿过多的部分原因。预防或清除胎盘疟疾的策略可能通过保护胎盘功能带来围产期益处。
