Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana.
Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda.
Am J Trop Med Hyg. 2019 Mar;100(3):552-555. doi: 10.4269/ajtmh.18-0659.
Maternal infection during pregnancy can have lasting effects on neurodevelopment, but the impact of malaria in pregnancy on child neurodevelopment is unknown. We present a case of a 24-year-old gravida three woman enrolled at 14 weeks 6 days of gestation in a clinical trial evaluating malaria prevention strategies in pregnancy. She had two blood samples test positive for using loop-mediated isothermal amplification before 20 weeks of gestation. At 31 weeks 4 days of gestation, the woman presented with preterm premature rupture of membranes, and the twins were delivered by cesarean section. Twin A was 1,920 g and Twin B was 1,320 g. Both placentas tested negative for malaria by microscopy, but the placenta of Twin B had evidence of past malaria by histology. The twins' development was assessed using the -Third Edition. At 1 year chronologic age, Twin B had lower scores across all domains (composite scores: cognitive, Twin A [100], Twin B [70]; motor, Twin A [88], Twin B [73]; language, Twin A [109], Twin B [86]). This effect persisted at 2 years chronologic age (composite scores: cognitive, Twin A [80], Twin B [60]; motor, Twin A [76], Twin B [67]; language, Twin A [77], Twin B [59]). Infant health was similar over the first 2 years of life. We report differences in neurodevelopmental outcomes in placental malaria-discordant dizygotic twins. Additional research is needed to evaluate the impact of placental malaria on neurodevelopmental complications. Trial registration number: ClinicalTrials.gov number, NCT02163447. Registered: June 2014, https://clinicaltrials.gov/ct2/show/NCT02163447.
母体妊娠期间感染可能对神经发育产生持久影响，但妊娠期间疟疾对儿童神经发育的影响尚不清楚。我们报告了一例 24 岁的孕妇，她在妊娠 14 周 6 天时入组了一项评估妊娠期间疟疾预防策略的临床试验。在妊娠 20 周之前，她有两份血样通过环介导等温扩增检测呈阳性。在妊娠 31 周 4 天时，该孕妇发生早产胎膜早破，通过剖宫产娩出双胞胎。双胞胎 A 的体重为 1920 克，双胞胎 B 的体重为 1320 克。两个胎盘均通过显微镜检查检测不到疟疾，但双胞胎 B 的胎盘组织学有过去疟疾的证据。使用《第三版》评估双胞胎的发育情况。在 1 岁时，双胞胎 B 在所有领域的评分都较低（综合评分：认知，双胞胎 A[100]，双胞胎 B[70]；运动，双胞胎 A[88]，双胞胎 B[73]；语言，双胞胎 A[109]，双胞胎 B[86]）。这种影响持续到 2 岁时（综合评分：认知，双胞胎 A[80]，双胞胎 B[60]；运动，双胞胎 A[76]，双胞胎 B[67]；语言，双胞胎 A[77]，双胞胎 B[59]）。在生命的头 2 年里，婴儿的健康状况相似。我们报告了胎盘疟疾不一致的双卵双胞胎在神经发育结果上的差异。需要进一步研究来评估胎盘疟疾对神经发育并发症的影响。试验注册编号：ClinicalTrials.gov 编号，NCT02163447。注册时间：2014 年 6 月，https://clinicaltrials.gov/ct2/show/NCT02163447。
