Infectious Diseases Research Collaboration, Kampala, Uganda.
Division of High-Consequence Pathogens and Pathology, National Center for Emergin and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
PLoS One. 2019 Apr 11;14(4):e0215058. doi: 10.1371/journal.pone.0215058. eCollection 2019.
Preterm birth (PTB) is a leading cause of neonatal mortality and longer-term morbidity. Acute chorioamnionitis (ACA) is a common cause of PTB, however, there are limited data on the prevalence of ACA and its association with PTB in resource limited settings.
Data and samples came from a clinical trial evaluating novel strategies for the prevention of malaria in HIV infected pregnant women in Uganda. Women were enrolled between 12-28 weeks of gestation and followed through delivery. For each placenta delivered, three placental tissue types (membrane roll, umbilical cord and chorionic plate/villous parenchyma) were collected. Slides were assessed for diagnosis of maternal and fetal ACA by microscopic evaluation of neutrophilic infiltration using a standardized grading scale. The primary outcomes were PTB (<37 weeks), low birth weight (LBW, <2500 grams), and small-for-gestational age (SGA, birth weight <10th percentile for age). Univariate and multivariate logistic regression were used to estimate associations between 1) maternal characteristics (age, education, wealth, gravidity, gestational age at enrollment, placental malaria, anti-malarial prophylaxis treatment regimen, HIV disease parameters) and ACA, and 2) associations between ACA and adverse birth outcomes.
A total of 193 placentas were included in the analysis. The prevalence of maternal and fetal ACA was 44.5% and 28.0%, respectively. HIV infected women between 28-43 years of age had a higher risk of maternal ACA compared to those between 17-21 years of age (50.9% vs. 19.1%; aOR = 4.00 (1.10-14.5), p = 0.04) and the diagnosis of severe maternal ACA was associated with a significantly higher risk of PTB (28.6% vs. 6.0%; aOR = 6.04 (1.87-19.5), p = 0.003), LBW (33.3% vs. 9.4%; aOR = 4.86 (1.65-14.3); p = 0.004), and SGA (28.6% vs. 10.1%; aOR = 3.70 (1.20-11.4), p = 0.02). No maternal characteristics were significantly associated with fetal ACA and the diagnosis of fetal ACA was not associated with adverse birth outcomes.
Histological evidence of severe maternal ACA was associated with an increased risk of PTB, LBW, and SGA in HIV infected, pregnant Ugandan women.
早产（PTB）是新生儿死亡和长期发病的主要原因。急性绒毛膜羊膜炎（ACA）是早产的常见原因，但在资源有限的环境中，关于 ACA 的患病率及其与 PTB 的关系的数据有限。
数据和样本来自于一项在乌干达评估预防 HIV 感染孕妇疟疾的新策略的临床试验。在妊娠 12-28 周之间招募了妇女，并在分娩时进行随访。对于每个分娩的胎盘，采集了三种胎盘组织类型（胎膜卷、脐带和绒毛板/绒毛实质）。通过使用标准化分级量表评估中性粒细胞浸润的显微镜评估来评估胎盘的母体和胎儿 ACA 的诊断。主要结局是 PTB（<37 周）、低出生体重（LBW，<2500 克）和小于胎龄儿（SGA，出生体重<年龄第 10 百分位）。使用单变量和多变量逻辑回归来估计 1）母体特征（年龄、教育、财富、孕次、入组时的妊娠周数、胎盘疟疾、抗疟预防治疗方案、HIV 疾病参数）与 ACA 之间的关联，以及 2）ACA 与不良出生结局之间的关联。
共纳入 193 例胎盘进行分析。母体和胎儿 ACA 的患病率分别为 44.5%和 28.0%。28-43 岁的 HIV 感染妇女发生母体 ACA 的风险高于 17-21 岁的妇女（50.9%比 19.1%；aOR=4.00（1.10-14.5），p=0.04），严重母体 ACA 的诊断与 PTB（28.6%比 6.0%；aOR=6.04（1.87-19.5），p=0.003）、LBW（33.3%比 9.4%；aOR=4.86（1.65-14.3）；p=0.004）和 SGA（28.6%比 10.1%；aOR=3.70（1.20-11.4），p=0.02）的风险显著增加。没有母体特征与胎儿 ACA 显著相关，胎儿 ACA 的诊断与不良出生结局无关。
在 HIV 感染的乌干达孕妇中，严重的母体 ACA 的组织学证据与 PTB、LBW 和 SGA 的风险增加有关。
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