CONSEQUENCES OF MATERNAL ANEMIA ON OUTCOME OF PREGNANCY IN A MALARIA ENDEMIC AREA IN PAPUA-NEW-GUINEA
CONSEQUENCES OF MATERNAL ANEMIA ON OUTCOME OF PREGNANCY IN A MALARIA ENDEMIC AREA IN PAPUA-NEW-GUINEA
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DOI：
10.1080/00034983.1990.11812429
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发表时间：
1990-02-01
影响因子：
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通讯作者：
PAINO, J
中科院分区：
文献类型：
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作者：
BRABIN, BJ;GINNY, M;PAINO, J
对居住在巴布亚新几内亚马当农村特定研究区域的孕妇在孕期贫血患病率与寄生虫率和脾脏发病率的关系进行了调查。探讨孕期贫血、缺铁、疟疾对胎儿的影响。在这一人群中贫血的患病率很高，44%的初孕科和29%的多孕科在怀孕28周后患有严重贫血[Hb(Hb)<；8gdl-1]。妊娠0-16周重度贫血的优势比为4.7%(P<；0.0001)。47%的初产妇和32%的多胎孕妇在产前预约时有铁缺乏的证据，并有较高的红细胞原卟啉值(35微克dl-1全血)。严重贫血的风险与所有孕妇的脾肿大和缺铁显著相关(脾肿大，P<；0.05；缺铁，P<；0.0002)。分娩时Hb值高于初诊时，预订时疟疾阳性组和分娩时疟疾阴性组之间差异最大(原虫1.5gdl-1，P<0.01；多胎科0.7g dl-1，P<；0.01)，表明疟疾预防是控制贫血的重要因素。根据8g dl-1的截止值定义了两个Hb组，这对应于预订和交付时较低的四分位数。小于8gdl-1的初产妇低出生体重的风险显著增加(65%vs27%，P<；0.025)，但早产率并未显著增加，表明大多数婴儿发育迟缓。早孕期贫血和缺铁与初生儿低出生体重的风险有关。目前分娩时的寄生虫血症似乎是一个不太重要的因素，尽管出生时有严重贫血和寄生虫血症的初产妇出生体重最低。通过药物治疗和化学预防控制疟疾可在多大程度上降低低出生体重的风险，这与妇女贫血的流行率和原因有关。
The prevalence of anemia during pregnancy was investigated in relation to parasite and spleen rates of pregnant women living in a defined study area in rural Madang, Papua New Guinea. The effects in pregnancy of anemia, iron deficiency and malaria on the foetus were investigated. There is a high prevalence of anemia in this population, with 44% of primigravidae and 29% of multigravidae having severe anaemia [hemoglobin (Hb) < 8 g dl-1] after 28 weeks gestation. The odds ratio for severe anemia at 0-16 weeks gestation in pregnant compared to non-pregnant women was 4.7 (P < 0.0001). Forty-seven per cent of primigravidae and 32% of multigravidae had evidence of iron deficiency with high free erythrocyte protoporphyrin values (> 35 .mu.g dl-1 whole blood) at antenatal booking. The risk of severe anemia was significantly associated with splenomegaly and iron deficiency for all gravidae (splenomegaly P < 0.05; iron deficiency, P < 0.0002). Hb values at delivery were higher than at first attendance, with the greatest difference between groups malaria-positive at booking and malaria-negative at delivery (primigravidae 1.5 g dl-1, P < 0.01; multigravidae, 0.7 g dl-1, P < 0.01), indicating that malaria prophylaxis was an important factor in controlling anemia. Two Hb groups were defined on the basis of the cut-off at 8 g dl-1, which corresponded to the lower quartile value at booking and delivery. A significantly increased risk of low birthweight was shown for primigravidae with values below 8 g dl-1 (65% v. 27%, P < 0.025), but the prematurity rate was not significantly increased, indicating that the majority of babies were growth-retarded. Early pregnancy anemia and iron deficiency were related to the risk of low birthweight in primigravidae. Current parasitemia at delivery appeared a less important factor, although primigravidae with severe anemia and parasitemia at delivery had the lowest birthweights. The extent to which malaria control, using drug treatment and chemoprophylaxis, can reduce the risk of low birthweight will vary in relation to the prevalence and causes of anemia in women.