巴布亚新几内亚高疟疾传播地区孕妇前瞻性队列中疟疾和不良出生结局的危险因素
Risk factors for malaria and adverse birth outcomes in a prospective cohort of pregnant women resident in a high malaria transmission area of Papua New Guinea.
作者信息
Stanisic Danielle I, Moore Kerryn A, Baiwog Francesca, Ura Alice, Clapham Caroline, King Christopher L, Siba Peter M, Beeson James G, Mueller Ivo, Fowkes Freya J, Rogerson Stephen J
机构信息
Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria 3050, Australia Institute of Glycomics, Griffith University, Southport, Queensland 4215, Australia.
Burnet Institute, Melbourne, Victoria, Australia Centre for Epidemiology and Biostatistics, University of Melbourne, Parkville, Victoria, Australia.
出版信息
Trans R Soc Trop Med Hyg. 2015 May;109(5):313-24. doi: 10.1093/trstmh/trv019. Epub 2015 Mar 10.
BACKGROUND
Low birth weight (LBW), anaemia and malaria are common in Papua New Guinean women.
METHODS
To identify risk factors for LBW, anaemia and preterm delivery (PTD), pregnant women recruited into a cohort study in Madang, Papua New Guinea, were followed to delivery.
RESULTS
Of 470 women enrolled, delivery data were available for 328 (69.7%). By microscopy, 34.4% (113/328) of women had malaria parasitaemia at enrolment and 12.5% (41/328) at delivery; at each time point, PCR detected sub-microscopic parasitaemia in substantially more. Most infections were with Plasmodium falciparum; the remainder being predominantly P. vivax. Anaemia and smoking were associated with lower birth weight, and LBW (16.7%; 51/305) and PTD (21.8%; 63/290) were common. Histopathologically diagnosed chronic placental malaria was associated with LBW (adjusted odds ratio [aOR] 3.3; p=0.048) and PTD (aOR 4.2; p=0.01). Lack of maternal education predisposed to PTD. Sub-microscopic parasitaemia at delivery appeared to increase the risk of LBW. Of the genetic polymorphisms, Southeast Asian ovalocytosis, α(+)-thalassaemia and complement receptor 1 (CR1) deficiency, a CR1 heterozygous genotype was associated with decreased risk of anaemia and substantial but non-significant effects were noted in other comparisons.
CONCLUSIONS
In coastal Papua New Guinea, malaria and anaemia are important causes of adverse pregnancy outcomes.
背景
低出生体重、贫血和疟疾在巴布亚新几内亚女性中很常见。
方法
为了确定低出生体重、贫血和早产的风险因素，在巴布亚新几内亚马当招募进入队列研究的孕妇被随访至分娩。
结果
在登记的470名女性中，有328名（69.7%）有分娩数据。通过显微镜检查，34.4%（113/328）的女性在登记时患有疟疾寄生虫血症，12.5%（41/328）在分娩时患有；在每个时间点，聚合酶链反应检测到的亚显微镜下寄生虫血症更多。大多数感染是由恶性疟原虫引起的；其余主要是间日疟原虫。贫血和吸烟与较低的出生体重有关，低出生体重（16.7%；51/305）和早产（21.8%；63/290）很常见。组织病理学诊断的慢性胎盘疟疾与低出生体重（调整优势比[aOR]3.3；p = 0.048）和早产（aOR 4.2；p = 0.01）有关。母亲缺乏教育易导致早产。分娩时的亚显微镜下寄生虫血症似乎会增加低出生体重的风险。在基因多态性方面，东南亚椭圆形红细胞增多症、α（+）-地中海贫血和补体受体1（CR1）缺乏症中，CR1杂合基因型与贫血风险降低有关，在其他比较中观察到显著但不显著的影响。
结论
在巴布亚新几内亚沿海地区，疟疾和贫血是不良妊娠结局的重要原因。
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