Impaired uteroplacental blood flow in pregnancies complicated by falciparum malaria

被引:96
作者
Dorman, EK
Shulman, CE
Kingdom, J
Bulmer, JN
Mwendwa, J
Peshu, N
Marsh, K
机构
[1] Homerton Hosp, Dept Obstet & Gynecol, London E9 6SR, England
[2] KEMRI, Ctr Geog Med Res, Kilifi, Kenya
[3] London Sch Hyg & Trop Med, London WC1, England
[4] Univ Oxford, John Radcliffe Hosp, Inst Mol Med, Oxford OX3 9DU, England
[5] Univ Newcastle, Royal Victoria Infirm, Dept Pathol, Newcastle Upon Tyne, Tyne & Wear, England
[6] Univ Toronto, Mt Sinai Hosp, Dept Maternal Fetal Med, Toronto, ON M5G 1X5, Canada
关键词
birth weight; Doppler; malaria; placenta; uterine artery;
D O I
10.1046/j.0960-7692.2001.00545.x
中图分类号
O42 [声学];
学科分类号
070206 ; 082403 ;
摘要
Objective In endemic areas, maternal malaria infection is usually asymptomatic. However, it is known that infected maternal erythrocytes sequester in the intervillous space of the placenta. There is a strong association between placental malaria infection and both low birth weight (LBW) and severe maternal anemia. We aimed to determine whether impaired uteroplacental blood flow might account or the low infant birth weight associated with maternal falciparum malaria infection. Methods This observational study was carried out during a large double-blind, randomized, controlled trial of an antimalarial drug intervention for primigravidae. Nine hundred and ninety-five women were recruited from the antenatal clinic at a district hospital on the Kenya coast and had at least one Doppler ultrasound scan. Uterine artery resistance index and the presence or absence of a diastolic notch were recorded, In the third trimester, blood was taken fur hemoglobin and malaria film. Results Malaria infection at 32-35 weeks of gestation was associated with abnormal uterine artery flow velocity waveforms on the day of blood testing (relative risk (RR) 2.11, 95% confidence interval (CI) 1.24-3.59, P = 0.006). This association persisted after controlling for pre-eclampsia. Impaired uteroplacental blood flow in the women studied was also predictive of poor perinatal outcome, including low birth weight, preterm delivery and perinatal death. The risk of preterm delivery in women with histological evidence of past placental malaria infection was more than twice that of women without infection (RR 2.33, 95% CI 1.31-4.13, P = 0.004). Conclusions Uteroplacental hemodynamics are altered in the presence of maternal falciparum malaria infection. This may account for some of the excess of LBW babies observed in malaria endemic areas. Strategies that prevent or clear placental malaria may confer perinatal benefit through preservation of placental function.
引用
收藏
页码:165 / 170
页数:6
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