量化孕期疟疾对低出生体重、早产和小于胎龄儿的影响：一项人群队列研究。
Quantifying low birth weight, preterm birth and small-for-gestational-age effects of malaria in pregnancy: a population cohort study.
作者信息
Rijken Marcus J, De Livera Alysha M, Lee Sue J, Boel Machteld E, Rungwilailaekhiri Suthatsana, Wiladphaingern Jacher, Paw Moo Kho, Pimanpanarak Mupawjay, Pukrittayakamee Sasithon, Simpson Julie A, Nosten François, McGready Rose
机构信息
Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand.
Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia.
出版信息
PLoS One. 2014 Jul 1;9(7):e100247. doi: 10.1371/journal.pone.0100247. eCollection 2014.
BACKGROUND
The association between malaria during pregnancy and low birth weight (LBW) is well described. This manuscript aims to quantify the relative contribution of malaria to small-for-gestational-age (SGA) infants and preterm birth (PTB) in pregnancies accurately dated by ultrasound on the Thai-Myanmar border at the Shoklo Malaria Research Unit.
METHODS AND FINDINGS
From 2001 to 2010 in a population cohort of prospectively followed pregnancies, we analyzed all singleton newborns who were live born, normal, weighed in the first hour of life and with a gestational age (GA) between 28+0 and 41+6 weeks. Fractional polynomial regression was used to determine the mean birthweight and standard deviation as functions of GA. Risk differences and factors of LBW and SGA were studied across the range of GA for malaria and non-malaria pregnancies. From 10,264 newborns records, population centiles were created. Women were screened for malaria by microscopy a median of 22 [range 1-38] times and it was detected and treated in 12.6% (1,292) of pregnancies. Malaria was associated with LBW, PTB, and SGA compared to those without malaria. Nearly two-thirds of PTB were classified as LBW (68% (539/789)), most of which 83% (447/539) were not SGA. After GA 39 weeks, 5% (298/5,966) of non-LBW births were identified as SGA. Low body mass index, primigravida, hypertension, smoking and female sex of the newborn were also significantly and independently associated with LBW and SGA consistent with previous publications.
CONCLUSIONS
Treated malaria in pregnancy was associated with an increased risk for LBW, PTB, and SGA, of which the latter are most important for infant survival. Using LBW as an endpoint without adjusting for GA incorrectly estimated the effects of malaria in pregnancy. Ultrasound should be used for dating pregnancies and birth weights should be expressed as a function (or adjusted for GA) of GA in future malaria in pregnancy studies.
背景
孕期疟疾与低出生体重（LBW）之间的关联已有详尽描述。本论文旨在量化在泰国-缅甸边境的索克洛疟疾研究单位通过超声准确确定孕周的妊娠中，疟疾对小于胎龄儿（SGA）和早产（PTB）的相对影响。
方法与结果
在2001年至2010年对一组前瞻性随访妊娠人群进行的队列研究中，我们分析了所有单胎活产、正常、出生后第一小时内称重且孕周（GA）在28⁺⁰至41⁺⁶周之间的新生儿。采用分数多项式回归来确定平均出生体重和标准差作为孕周的函数。研究了疟疾妊娠和非疟疾妊娠在整个孕周范围内低出生体重和小于胎龄儿的风险差异及相关因素。从10264条新生儿记录中创建了人群百分位数。通过显微镜检查对孕妇进行疟疾筛查，中位数为22次[范围1 - 38次]，在12.6%（1292例）的妊娠中检测到疟疾并进行了治疗。与未患疟疾的孕妇相比，疟疾与低出生体重、早产和小于胎龄儿有关。近三分之二的早产被归类为低出生体重（68%（539/789）），其中大部分83%（447/539）并非小于胎龄儿。在孕周39周后，5%（298/5966）的非低出生体重儿被确定为小于胎龄儿。低体重指数、初产妇、高血压、吸烟以及新生儿为女性也与低出生体重和小于胎龄儿显著且独立相关，这与以往研究结果一致。
结论
孕期经治疗的疟疾与低出生体重、早产和小于胎龄儿风险增加有关，其中后两者对婴儿生存最为重要。将低出生体重作为终点而不调整孕周会错误估计孕期疟疾的影响。在未来的孕期疟疾研究中，应使用超声确定孕周，且出生体重应以孕周的函数（或根据孕周进行调整）来表示。
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