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01.12.2012 | Research | Ausgabe 1/2012 Open Access

Malaria Journal 1/2012

Plasmodium falciparum parasitaemia in the first half of pregnancy, uterine and umbilical artery blood flow, and foetal growth: a longitudinal Doppler ultrasound study

Zeitschrift:
Malaria Journal > Ausgabe 1/2012
Autoren:
Jennifer B Griffin, Victor Lokomba, Sarah H Landis, John M Thorp Jr, Amy H Herring, Antoinette K Tshefu, Stephen J Rogerson, Steven R Meshnick
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1475-2875-11-319) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare there are no competing interests.

Authors’ contributions

JBG developed the objectives, analysed and interpreted the data, and drafted the manuscript. JBG was supported by the Infectious Disease Epidemiology Training Program grant (5-T32-AI070114-04). VL conducted all Doppler ultrasound measurements and interpreted the Doppler data. SHL designed and implemented the study while at the Department of Epidemiology, University of North Carolina – Chapel Hill and contributed to manuscript revision while at GlaxoSmithKline. AHH assisted with statistical analyses and helped prepare the Methods section of the manuscript. AKT supervised field activities, oversaw quality control at the University of Kinshasa and interpreted the data. JMT, SJR and SRM made substantial contributions to the interpretation of results and manuscript revision. All authors read and approved the final manuscript.

Abstract

Background

During early pregnancy, the placenta develops to meet the metabolic demands of the foetus. The objective of this analysis was to examine the effect of malaria parasitaemia prior to 20 weeks’ gestation on subsequent changes in uterine and umbilical artery blood flow and intrauterine growth restriction.

Methods

Data were analysed from 548 antenatal visits after 20 weeks’ gestation of 128 women, which included foetal biometric measures and interrogation of uterine and umbilical artery blood flow. Linear mixed effect models estimated the effect of early pregnancy malaria parasitaemia on uterine and umbilical artery resistance indices. Log-binomial models with generalized estimating equations estimated the effect of early pregnancy malaria parasitaemia on the risk of intrauterine growth restriction.

Results

There were differential effects of early pregnancy malaria parasitaemia on uterine artery resistance by nutritional status, with decreased uterine artery resistance among nourished women with early pregnancy malaria and increased uterine artery resistance among undernourished women with early pregnancy malaria. Among primigravidae, early pregnancy malaria parasitaemia decreased umbilical artery resistance in the late third trimester, likely reflecting adaptive villous angiogenesis. In fully adjusted models, primigravidae with early pregnancy malaria parasitaemia had 3.6 times the risk of subsequent intrauterine growth restriction (95% CI: 2.1, 6.2) compared to the referent group of multigravidae with no early pregnancy malaria parasitaemia.

Conclusions

Early pregnancy malaria parasitaemia affects uterine and umbilical artery blood flow, possibly due to alterations in placentation and angiogenesis, respectively. Among primigravidae, early pregnancy malaria parasitaemia increases the risk of intrauterine growth restriction. The findings support the initiation of malaria parasitaemia prevention and control efforts earlier in pregnancy.
Zusatzmaterial
Authors’ original file for figure 1
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Authors’ original file for figure 2
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Authors’ original file for figure 3
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