Submicroscopic Plasmodium falciparum Infections Are Associated With Maternal Anemia, Premature Births, and Low Birth Weight
Submicroscopic Plasmodium falciparum Infections Are Associated With Maternal Anemia, Premature Births, and Low Birth Weight
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DOI：
10.1093/cid/civ122
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发表时间：
2015-05-15
影响因子：
11.8
通讯作者：
Ndam, Nicaise Tuikue
中科院分区：
文献类型：
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作者：
Cottrell, Gilles;Moussiliou, Azizath;Ndam, Nicaise Tuikue
背景。相对于显微镜，分子检测测量的是恶性疟原虫感染的真实流行程度。这种隐性感染在怀孕期间很常见，但其对妊娠结局的影响尚不清楚。我们进行了一项纵向研究来描述这种影响。在一组1037名贝宁孕妇中，我们使用超声准确估计胎龄。记录妊娠期间恶性疟原虫感染、血红蛋白浓度、妊娠期间疟疾间歇预防治疗（IPTp）使用情况及其他参数。通过多变量分析，我们评估了亚显微感染对产妇贫血、早产和低出生体重的影响。在纳入时，聚合酶链反应（PCR）和显微镜检查分别检测到40%和16%的女性感染。2剂IPTp后感染比例明显下降，但在分娩时反弹至34% （PCR）。怀孕期间的亚显微镜感染与低平均血红蛋白相关，而与妊娠无关，并且与原鸟贫血风险增加相关（优势比[OR]， 2.23； 95%可信区间[CI]， 0.98 -5.07）。前瞻性地，纳入时的亚显微镜感染与初孕科低出生体重（OR, 6.09; 95% CI, 1.16-31.95）和多孕科早产（OR, 2.25; 95% CI, 1.13-4.46）的风险显著增加相关。在这项详细的纵向研究中，我们记录了亚显微恶性疟原虫在怀孕期间对多胎妊娠结局的有害影响。寄生虫病在怀孕期间经常发生，但常规的显微镜和快速诊断测试无法检测到绝大多数发作。我们的研究结果表明，对当前预防妊娠相关疟疾战略的任何修订都要谨慎。
Background. Molecular, as opposed to microscopic, detection measures the real prevalence of Plasmodium falciparum infections. Such occult infections are common during pregnancy but their impact on pregnancy outcomes is unclear. We performed a longitudinal study to describe that impact.Methods. In a cohort of 1037 Beninese pregnant women, we used ultrasound to accurately estimate gestational ages. Infection with P. falciparum, hemoglobin concentration, use of intermittent preventive treatment during pregnancy (IPTp) for malaria, and other parameters were recorded during pregnancy. Using multivariate analyses, we evaluated the impact of submicroscopic infections on maternal anemia, premature birth, and low birth weight.Results. At inclusion, polymerase chain reaction (PCR) and microscopy detected infection in 40% and 16% of women, respectively. The proportion infected declined markedly after 2 doses of IPTp but rebounded to 34% (by PCR) at delivery. Submicroscopic infections during pregnancy were associated with lower mean hemoglobin irrespective of gravidity, and with increased anemia risk in primigravidae (odds ratio [OR], 2.23; 95% confidence interval [CI], .98-5.07). Prospectively, submicroscopic infections at inclusion were associated with significantly increased risks of low birth weight in primigravidae (OR, 6.09; 95% CI, 1.16-31.95) and premature births in multigravidae (OR, 2.25; 95% CI, 1.13-4.46).Conclusions. In this detailed longitudinal study, we document the deleterious impact of submicroscopic P. falciparum parasitemia during pregnancy on multiple pregnancy outcomes. Parasitemia occurs frequently during pregnancy, but routine microscopic and rapid diagnostic tests fail to detect the vast majority of episodes. Our findings imply caution in any revision of the current strategies for prevention of pregnancy-associated malaria.