Adebami O Joseph, Owa J Aderinsola, Oyedeji G Ademola, Oyelami O Akibu, Omoniyi-Esan G Olutoyin
Department of Paediatrics and Child Health, Ladoke Akintola University of Technology Teaching Hospital, Osogbo 23401, Nigeria.
Am J Trop Med Hyg. 2007 Aug;77(2):209-13.
The objective of this study was to determine the role of malaria in the etiology of fetal malnutrition in Nigeria. This study took place at the Neonatal and Maternity Units of the Wesley Guild Hospital, Ilesa, Nigeria. This is a prospective study of 304 consecutive, singleton, term live births delivered between January and August 2002. Anthropometric and clinical data were recorded. Fetal malnutrition (FM; failure to acquire adequate quantum of fat and muscle mass during intrauterine growth) was diagnosed using clinical assessment of fetal nutritional status (CANS) and the score (CANSCORE) adapted by Metcoff. The placenta tissues were examined for malaria pigments and parasites, and placental and cord blood smears were examined for parasites. Babies were followed up in the neonatal period for clinical malaria. Babies were grouped into those with malaria-infected placental and cord blood specimens and those without. The two groups were compared with regard to the proportions with FM and complications of FM. Three hundred four placental and cord blood specimens were examined for malaria. Of the 304, 101 (33.2%) of the placental and 67 (22.0%) of the cord blood specimens were positive for malaria. Sixty-six (21.7%) of the 304 babies had FM. Forty-four (66.7%) of the 66 placental blood specimens of babies with FM were positive for malaria, whereas 57 (24.0%) of the 238 placentae of babies without FM had placental malaria (chi(2) =42.5, P < 0.0001). Similarly, 27 (40.9%) of 66 babies with FM compared with 40 (16.8%) among 238 babies without FM had malaria parasites in the cord blood (chi(2) =17.5, P < 0.001). The means of birth weight, ponderal index, and placenta weight were significantly lower among the babies of mothers with malaria-infected placentae than those without (P < 0.05 in all cases). Lack of antenatal care, primiparity, and failure to have chemoprophylaxis against malaria were the maternal factors found to be associated with placental malaria infection. Placental malaria is a major factor in the etiology of FM in Nigeria.
本研究的目的是确定疟疾在尼日利亚胎儿营养不良病因学中的作用。本研究在尼日利亚伊莱萨卫斯理公会医院的新生儿科和产科进行。这是一项对2002年1月至8月期间连续分娩的304例单胎足月活产进行的前瞻性研究。记录了人体测量和临床数据。胎儿营养不良（FM；在子宫内生长期间未能获得足够数量的脂肪和肌肉量）通过胎儿营养状况临床评估（CANS）和Metcoff改编的评分（CANSCORE）进行诊断。检查胎盘组织中的疟色素和寄生虫，并检查胎盘和脐带血涂片以查找寄生虫。在新生儿期对婴儿进行临床疟疾随访。将婴儿分为胎盘和脐带血标本感染疟疾的婴儿和未感染疟疾的婴儿。比较两组中FM的比例和FM的并发症。对304份胎盘和脐带血标本进行了疟疾检查。在这304份标本中，101份（33.2%）胎盘标本和67份（22.0%）脐带血标本疟疾检测呈阳性。304例婴儿中有66例（21.7%）患有FM。患有FM的婴儿的66份胎盘血标本中有44份（66.7%）疟疾检测呈阳性，而未患FM的238例婴儿的胎盘中有57份（24.0%）患有胎盘疟疾（χ²=42.5，P<0.0001）。同样，66例患有FM的婴儿中有27例（40.9%）脐带血中有疟原虫，而238例未患FM的婴儿中有40例（16.8%）脐带血中有疟原虫（χ²=17.5，P<0.001）。患有疟疾感染胎盘的母亲所生婴儿的出生体重、 ponderal指数和胎盘重量的均值显著低于未感染胎盘的母亲所生婴儿（所有情况下P<0.05）。发现缺乏产前护理、初产以及未进行疟疾化学预防是与胎盘疟疾感染相关的母亲因素。胎盘疟疾是尼日利亚FM病因学中的一个主要因素。
