Department of Pediatrics, Alpert Medical School of Brown University, Providence, Rhode Island.
Center for International Health Research, Rhode Island Hospital, Providence, Rhode Island.
Am J Trop Med Hyg. 2018 Aug;99(2):495-501. doi: 10.4269/ajtmh.17-0949. Epub 2018 Jun 28.
Low- and middle-income countries (LMICs) carry a high burden of infectious diseases associated with impaired gut integrity, leading to microbial translocation. Pregnancies in this setting are at high risk of fetal growth restriction (FGR). We examined the association among specific risk factors for impaired gut integrity (schistosomiasis, hookworm infection, and alcohol consumption), blood endotoxin levels, and FGR. Endotoxins, lipopolysaccharide-binding proteins (LBPs), and cytokines were measured in blood from women at 32 weeks gestation, the maternal-fetal interface (MFI) at delivery, and cord blood at delivery. Resolution of schistosomiasis had no impact on endotoxin levels; however, maternal hookworm infection and alcohol consumption were associated with modest increases in endotoxin at the MFI. Cytokines responses within the maternal peripheral blood and blood from the MFI were positively associated with endotoxins, but many cord blood cytokines were negatively associated with endotoxins. Newborns with FGR also had higher levels of endotoxins at the MFI. Risk factors for microbial translocation may lead to increased levels of endotoxins at the MFI, which may contribute to poor growth in utero.
中低收入国家（LMICs）承担着与肠道完整性受损相关的传染病的高负担，导致微生物易位。在这种情况下的妊娠有胎儿生长受限（FGR）的高风险。我们研究了特定的肠道完整性受损风险因素（血吸虫病、钩虫感染和饮酒）、血液内毒素水平和 FGR 之间的关联。在妊娠 32 周时、分娩时的母胎界面（MFI）和分娩时的脐血中测量了内毒素、脂多糖结合蛋白（LBPs）和细胞因子。血吸虫病的消退对内毒素水平没有影响；然而，母体钩虫感染和饮酒与 MFI 中的内毒素适度增加有关。母体外周血和 MFI 中的细胞因子反应与内毒素呈正相关，但许多脐血细胞因子与内毒素呈负相关。FGR 的新生儿在 MFI 中的内毒素水平也更高。微生物易位的危险因素可能导致 MFI 中的内毒素水平升高，这可能导致宫内生长不良。
