Centre for Medical Parasitology, Institute of International Health, Immunology, and Microbiology, University of Copenhagen, Copenhagen, Denmark.
PLoS One. 2013;8(1):e53794. doi: 10.1371/journal.pone.0053794. Epub 2013 Jan 11.
Pregnancy associated malaria is associated with decreased birth weight, but in-utero evaluation of fetal growth alterations is rarely performed. The objective of this study was to investigate malaria induced changes in fetal growth during the 3(rd) trimester using trans-abdominal ultrasound.
An observational study of 876 pregnant women (398 primi- and secundigravidae and 478 multigravidae) was conducted in Tanzania. Fetal growth was monitored with ultrasound and screening for malaria was performed regularly. Birth weight and fetal weight were converted to z-scores, and fetal growth evaluated as fetal weight gain from the 26th week of pregnancy.
Malaria infection only affected birth weight and fetal growth among primi- and secundigravid women. Forty-eight of the 398 primi- and secundigravid women had malaria during pregnancy causing a reduction in the newborns z-score of -0.50 (95% CI: -0.86, -0.13, P = 0.008, multiple linear regression). Fifty-eight percent (28/48) of the primi- and secundigravidae had malaria in the first half of pregnancy, but an effect on fetal growth was observed in the 3(rd) trimester with an OR of 4.89 for the fetal growth rate belonging to the lowest 25% in the population (95%CI: 2.03-11.79, P<0.001, multiple logistic regression). At an individual level, among the primi- and secundigravidae, 27% experienced alterations of fetal growth immediately after exposure but only for a short interval, 27% only late in pregnancy, 16.2% persistently from exposure until the end of pregnancy, and 29.7% had no alterations of fetal growth.
The effect of malaria infections was observed during the 3(rd) trimester, despite infections occurring much earlier in pregnancy, and different mechanisms might operate leading to different patterns of growth alterations. This study highlights the need for protection against malaria throughout pregnancy and the recognition that observed changes in fetal growth might be a consequence of an infection much earlier in pregnancy.
妊娠相关疟疾与出生体重降低有关，但很少对胎儿生长发育的宫内变化进行评估。本研究旨在通过经腹超声检查，研究妊娠晚期疟疾对胎儿生长的影响。
在坦桑尼亚进行了一项对 876 名孕妇（398 名初产妇和经产妇及 478 名经产妇）的观察性研究。使用超声监测胎儿生长情况，并定期进行疟疾筛查。将出生体重和胎儿体重转换为 z 分数，并将胎儿生长评估为从妊娠第 26 周开始的胎儿体重增加。
疟疾感染仅影响初产妇和经产妇的出生体重和胎儿生长。398 名初产妇和经产妇中有 48 名在怀孕期间感染疟疾，导致新生儿 z 分数降低 0.50（95%CI：-0.86，-0.13，P=0.008，多元线性回归）。58%（28/48）的初产妇和经产妇在妊娠前半期感染疟疾，但在妊娠晚期观察到对胎儿生长的影响，属于人群中最低 25%的胎儿生长率的比值比为 4.89（95%CI：2.03-11.79，P<0.001，多元逻辑回归）。在个体水平上，在初产妇和经产妇中，27%的人在接触后立即出现胎儿生长变化，但仅持续短暂时间，27%的人仅在妊娠晚期出现，16.2%的人从接触到妊娠结束持续存在，29.7%的人胎儿生长无变化。
尽管疟疾感染发生在妊娠早期，但在妊娠晚期仍观察到感染的影响，可能存在不同的机制导致不同的生长发育改变模式。本研究强调了整个孕期需要预防疟疾，并认识到观察到的胎儿生长变化可能是妊娠早期感染的结果。
