疟疾感染与胎盘血流：来自贝宁一个孕前队列的多普勒超声研究

Malaria Infections and Placental Blood Flow: A Doppler Ultrasound Study From a Preconception Cohort in Benin.

作者信息

Mondeilh Aude, Yovo Emmanuel, Accrombessi Manfred, Hounkonnou Cornelia, Agbota Gino, Atade William, Ladikpo Olaiitan T, Mehoba Murielle, Degbe Auguste, Vianou Bertin, Sossou Dariou, Ndam Nicaise Tuikue, Massougbodji Achille, McGready Rose, Fievet Nadine, Rijken Marcus J, Cottrell Gilles, Briand Valérie

机构信息

Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Centre, National Institute for Health and Medical Research (INSERM) UMR 1219, University of Bordeaux, Bordeaux, France.

Institut de Recherche Clinique du Bénin (IRCB), Abomey-Calavi, Benin.

出版信息

Open Forum Infect Dis. 2023 Aug 10;10(8):ofad376. doi: 10.1093/ofid/ofad376. eCollection 2023 Aug.

DOI:10.1093/ofid/ofad376

PMID:37577115

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10414806/

Abstract

BACKGROUND

Malaria in pregnancy (MiP) has been associated with fetal growth restriction, the underlying pathogenic mechanisms of which remain poorly understood. Malaria in pregnancy is suspected to induce abnormalities in placental vascularization, leading to impaired placental development. Our study evaluated MIP's effect on uterine artery (UtA) and umbilical artery (UA) blood flow.

METHODS

The analysis included 253 Beninese women followed throughout pregnancy and screened monthly for submicroscopic and microscopic malaria. Uterine artery Doppler measurement was performed once between 21 and 25 weeks' gestation (wg), and UA Doppler measurement was performed 1-3 times from 28 wg. Linear and logistic regression models were used to assess the effect of malaria infections on UtA Doppler indicators (pulsatility index and presence of a notch), whereas a logistic mixed model was used to assess the association between malaria infections and abnormal UA Doppler (defined as Z-score ≥2 standard deviation or absent/reversed UA end-diastolic flow).

RESULTS

Primigravidae represented 7.5% of the study population; 42.3% of women had at least 1 microscopic infection during pregnancy, and 29.6% had at least 1 submicroscopic infection (and no microscopic infection). Both microscopic and submicroscopic infections before Doppler measurement were associated with the presence of a notch (adjusted odds ratio [aOR] 4.5, 95% confidence interval [CI] = 1.2-16.3 and aOR 3.3, 95% CI = .9-11.9, respectively). No associations were found between malaria before the Doppler measurement and abnormal UA Doppler.

CONCLUSIONS

Malaria infections in the first half of pregnancy impair placental blood flow. This highlights the need to prevent malaria from the very beginning of pregnancy.

摘要

背景

妊娠疟疾（MiP）与胎儿生长受限有关，但其潜在的致病机制仍知之甚少。妊娠疟疾被怀疑会导致胎盘血管形成异常，从而导致胎盘发育受损。我们的研究评估了妊娠疟疾对子宫动脉（UtA）和脐动脉（UA）血流的影响。

方法

该分析纳入了253名贝宁女性，她们在整个孕期接受随访，并每月进行亚显微镜和显微镜下疟疾筛查。在妊娠21至25周（wg）期间进行一次子宫动脉多普勒测量，从28 wg开始进行1至3次UA多普勒测量。使用线性和逻辑回归模型评估疟疾感染对UtA多普勒指标（搏动指数和切迹的存在）的影响，而使用逻辑混合模型评估疟疾感染与异常UA多普勒（定义为Z评分≥2个标准差或UA舒张末期血流缺失/反向）之间的关联。

结果

初产妇占研究人群的7.5%；42.3%的女性在孕期至少有1次显微镜下感染，29.6%的女性至少有1次亚显微镜下感染（且无显微镜下感染）。在多普勒测量前，显微镜下和亚显微镜下感染均与切迹的存在相关（调整后的优势比[aOR]分别为4.5，95%置信区间[CI]=1.2 - 16.3和aOR 3.3，95% CI =.9 - 11.9）。在多普勒测量前的疟疾与异常UA多普勒之间未发现关联。