Université Sorbonne Paris Cité, Université Paris Diderot, Inserm, INTS, Unité Biologie Intégrée du Globule Rouge, Laboratoire d'Excellence GR-Ex, Paris, France.
Institut de Recherche pour le Développement, UMR 216, Mère et Enfant face aux Infections Tropicales, Paris, France.
Sci Rep. 2017 May 3;7(1):1414. doi: 10.1038/s41598-017-01495-9.
Pregnancy-associated malaria (PAM) is associated with poor pregnancy outcomes. Hemoglobin S (HbS) and hemoglobin C (HbC) mutations are frequently encountered in malaria-endemic areas of Africa, where they protect children from severe and uncomplicated Plasmodium falciparum malaria. However, scant epidemiological data exist on the impact of these Hb variants on PAM. A prospective cohort of 635 Beninese pregnant women was recruited before 24 weeks of gestational age and followed until the end of pregnancy. HbAA, HbAC, and HbAS genotypes were determined and tested for association with pregnancy outcomes and PAM indicators using linear and logistic multivariate models. Newborns from HbAC mothers had higher birthweights than those from HbAA mothers among women infected at any time during pregnancy (mean difference 182.9 g, p = 0.08), or during the first half of pregnancy (654.3 g, p = 0.0006). No such birthweight differences were observed between newborns from HbAS and HbAA mothers. HbAC and HbAS were not associated with other pregnancy outcomes or PAM indicators. In conclusion, HbAC but not HbAS is associated with an improved birth outcome in pregnant women with documented PAM. Higher-birthweight newborns from HbAC mothers may have a survival advantage that contributes to the natural selection of HbC in malaria-endemic areas.
妊娠合并疟疾（PAM）与不良妊娠结局有关。血红蛋白 S（HbS）和血红蛋白 C（HbC）突变在非洲疟疾流行地区很常见，它们可保护儿童免受严重和无并发症的恶性疟原虫疟疾的影响。然而，关于这些 Hb 变体对 PAM 的影响的流行病学数据很少。在妊娠 24 周前，前瞻性招募了 635 名贝宁孕妇，并随访至妊娠结束。确定 HbAA、HbAC 和 HbAS 基因型，并使用线性和逻辑多元模型检测其与妊娠结局和 PAM 指标的关联。在妊娠期间任何时间或妊娠前半期感染的妇女中，HbAC 母亲的新生儿出生体重高于 HbAA 母亲（平均差异 182.9g，p=0.08）。在 HbAS 母亲的新生儿中未观察到这种出生体重差异。HbAC 和 HbAS 与其他妊娠结局或 PAM 指标无关。总之，在有记录的 PAM 孕妇中，HbAC 而不是 HbAS 与改善的出生结局相关。HbAC 母亲的新生儿出生体重较高，可能具有生存优势，这有助于 HbC 在疟疾流行地区的自然选择。
