Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California, United States of America.
Infectious Diseases Research Collaboration, Kampala, Uganda.
PLoS One. 2020 Oct 2;15(10):e0240157. doi: 10.1371/journal.pone.0240157. eCollection 2020.
Placental malaria is a known risk factor for small for gestational age (SGA) neonates. However, currently utilized international and African birthweight standards have not controlled for placental malaria and/or lack obstetrical ultrasound dating. We developed a neonatal birthweight standard based on obstetrically dated pregnancies that excluded individuals with clinical malaria, asymptomatic parasitemia, and placental malaria infection. We hypothesized that current curves underestimate true ideal birthweight and the prevalence of SGA.
Participants were pooled from two double-blind randomized control trials of intermittent preventive therapy during pregnancy in Uganda. HIV-negative women without comorbidities were enrolled from 12-20 weeks gestation. Gestational age was confirmed by ultrasound dating. Women were followed through pregnancy and delivery for clinical malaria, asymptomatic parasitemia, and placental malaria. Women without malaria, asymptomatic parasitemia, or placental malaria formed the malaria negative cohort and generated the Ugandan birthweight standard. The Ugandan standard was then used to estimate the prevalence of SGA neonates in the malaria positive cohort. These findings were compared to international (Williams, World Health Organization (WHO), and INTERGROWTH-21st) and regional standards (Tanzanian and Malawi).
926 women had complete delivery data; 393 (42.4%) met criteria for the malaria negative cohort and 533 (57.6%) were malaria positive. The Ugandan standard diagnosed SGA in 17.1% of malaria positive neonates; similar to the INTERGROWTH-21st and Schmiegelow curves. The WHO curve diagnosed SGA in significantly more neonates (32.1%, p = <0.001), and the Malawi curve diagnosed SGA in significantly fewer neonates (8.3%, p <0.001).
Exclusion of women with subclinical placental malaria in malaria-endemic areas created birth weight norms at higher values and increased the detection of SGA. Birth weight standards that fail to account for endemic illness may underestimate the true growth potential of healthy neonates.
胎盘疟疾是胎儿生长受限（SGA）新生儿的已知危险因素。然而，目前使用的国际和非洲出生体重标准并未控制胎盘疟疾和/或缺乏产科超声日期。我们开发了一种基于产科日期妊娠的新生儿出生体重标准，排除了患有临床疟疾、无症状寄生虫血症和胎盘疟疾感染的个体。我们假设目前的曲线低估了真正的理想出生体重和 SGA 的患病率。
参与者来自乌干达两项关于妊娠期间间歇性预防治疗的双盲随机对照试验。从 12-20 周妊娠时招募无合并症的 HIV 阴性妇女。通过超声日期确认胎龄。对妇女进行妊娠和分娩的临床疟疾、无症状寄生虫血症和胎盘疟疾随访。没有疟疾、无症状寄生虫血症或胎盘疟疾的妇女形成疟疾阴性队列，并生成乌干达出生体重标准。然后，使用乌干达标准来估计疟疾阳性队列中 SGA 新生儿的患病率。将这些发现与国际（Williams、世界卫生组织（WHO）和 INTERGROWTH-21st）和区域标准（坦桑尼亚和马拉维）进行比较。
926 名妇女有完整的分娩数据；393 名（42.4%）符合疟疾阴性队列标准，533 名（57.6%）为疟疾阳性。乌干达标准诊断出 17.1%的疟疾阳性新生儿为 SGA；与 INTERGROWTH-21st 和 Schmiegelow 曲线相似。WHO 曲线诊断出 SGA 的新生儿明显更多（32.1%，p<0.001），而马拉维曲线诊断出 SGA 的新生儿明显更少（8.3%，p<0.001）。
在疟疾流行地区排除患有亚临床胎盘疟疾的妇女，创造了更高数值的出生体重标准，并增加了 SGA 的检出率。未能考虑地方性疾病的出生体重标准可能会低估健康新生儿的真实生长潜力。
