Risk Factors for Maternal Chagas Disease and Vertical Transmission in a Bolivian Hospital.
Risk Factors for Maternal Chagas Disease and Vertical Transmission in a Bolivian Hospital.
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玻利维亚医院产妇恰加斯病和垂直传播的危险因素。
DOI：
10.1093/cid/ciaa1885
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发表时间：
2021
期刊：
影响因子：
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通讯作者：
Bowman,NatalieM
中科院分区：
文献类型：
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作者：
Klein,MelissaD;Tinajeros,Freddy;DelCarmenMenduiña,María;Málaga,Edith;Condori,BethJ;Verástegui,Manuela;Urquizu,Federico;Gilman,RobertH;Bowman,NatalieM
背景：克氏锥虫感染的垂直传播在恰加斯病新发病例中所占比例越来越大。需要更好的风险分层来预测哪些妇女更有可能传播感染。方法这项研究在玻利维亚圣克鲁斯的珀西博兰妇女医院招募了妇女和她们的婴儿。孕妇通过快速检测对恰加斯病进行筛查，并接受确认性血清学检查。结果在5828名登记在册的妇女中，有1271人(21.8%)查出恰加斯病筛查阳性。产妇年龄较大、恰加斯病家族史、家庭条件、教育水平较低以及居住在农村地区的历史与调整后的产妇感染几率显著相关。在血清阳性母亲的第1325名婴儿中，65名婴儿(4.9%)被诊断为先天性恰加斯病。预防传播的保护因素包括剖腹产(调整后的优势比[AOR]：.60；95%可信区间[CI]：.36-.99)和恰加斯病家族史(调整后的优势比：.58；95%可信区间：.34-.99)。双胞胎比单胎出生更容易受到先天性感染(OR：3.32；95%CI：1.60-6.90)。在先天感染的婴儿中，32.3%的婴儿出生体重较低，30.8%的婴儿出生后需要住院。结论尽管筛查和定量聚合酶链式反应增加了先天性恰加斯病的婴儿数量，但仍有许多婴儿没有得到诊断。更好地了解风险因素和更好地获得对先天性恰加斯病高度敏感和特殊的诊断技术，可能有助于改进区域倡议，以减少疾病负担。
BackgroundVertical transmission ofTrypanosoma cruziinfection accounts for a growing proportion of new cases of Chagas disease. Better risk stratification is needed to predict which women are more likely to transmit the infection.MethodsThis study enrolled women and their infants at the Percy Boland Women’s Hospital in Santa Cruz, Bolivia. Pregnant women were screened for Chagas disease by rapid test and received confirmatory serology. Infants of seropositive mothers underwent diagnostic testing with quantitative polymerase chain reaction (qPCR).ResultsAmong 5828 enrolled women, 1271 (21.8%) screened positive for Chagas disease. Older maternal age, family history of Chagas disease, home conditions, lower educational level, and history of living in a rural area were significantly associated with higher adjusted odds of maternal infection. Of the 1325 infants of seropositive mothers, 65 infants (4.9%) were diagnosed with congenital Chagas disease. Protective factors against transmission included cesarean delivery (adjusted odds ratio [aOR]: .60; 95% confidence interval [CI]: .36–.99) and family history of Chagas disease (aOR: .58; 95% CI: .34–.99). Twins were significantly more likely to be congenitally infected than singleton births (OR: 3.32; 95% CI: 1.60–6.90). Among congenitally infected infants, 32.3% had low birth weight, and 30.8% required hospitalization after birth.ConclusionsAlthough improved access to screening and qPCR increased the number of infants diagnosed with congenital Chagas disease, many infants remain undiagnosed. A better understanding of risk factors and improved access to highly sensitive and specific diagnostic techniques for congenital Chagas disease may help improve regional initiatives to reduce disease burden.