Malaria Infections and Placental Blood Flow: A Doppler Ultrasound Study From a Preconception Cohort in Benin.

Autor: Mondeilh A; Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Centre, National Institute for Health and Medical Research (INSERM) UMR 1219, University of Bordeaux, Bordeaux, France., Yovo E; Institut de Recherche Clinique du Bénin (IRCB), Abomey-Calavi, Benin.; Montpellier Interdisciplinary Center on Sustainable Agri-food Systems (MoISA), Université de Montpellier, Montpellier, France., Accrombessi M; Institut de Recherche Clinique du Bénin (IRCB), Abomey-Calavi, Benin.; Faculty of Infectious and Tropical Diseases, Disease Control Department, London School of Hygiene and Tropical Medicine London, United Kingdom., Hounkonnou C; Centre d'investigation clinique, module épidémiologie clinique (CIC-EC 1425), Université Paris Cité and Université Sorbonne Paris Nord, Paris, France.; Département d'Épidémiologie, Biostatistique et Recherche Clinique, AP-HP, Hôpital Bichat Paris, France., Agbota G; Institut de Recherche Clinique du Bénin (IRCB), Abomey-Calavi, Benin., Atade W; Institut de Recherche Clinique du Bénin (IRCB), Abomey-Calavi, Benin., Ladikpo OT; Institut de Recherche Clinique du Bénin (IRCB), Abomey-Calavi, Benin., Mehoba M; Institut de Recherche Clinique du Bénin (IRCB), Abomey-Calavi, Benin., Degbe A; Institut de Recherche Clinique du Bénin (IRCB), Abomey-Calavi, Benin., Vianou B; Institut de Recherche Clinique du Bénin (IRCB), Abomey-Calavi, Benin., Sossou D; Institut de Recherche Clinique du Bénin (IRCB), Abomey-Calavi, Benin., Ndam NT; Research Institute for Sustainable Development (IRD), UMR 261 MERIT, Université Paris Cité, Paris, France., Massougbodji A; Institut de Recherche Clinique du Bénin (IRCB), Abomey-Calavi, Benin., McGready R; Shoklo Malaria Research Unit, Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand.; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom., Fievet N; Research Institute for Sustainable Development (IRD), UMR 261 MERIT, Université Paris Cité, Paris, France., Rijken MJ; Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.; Department of Obstetrics and Gynecology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands., Cottrell G; Research Institute for Sustainable Development (IRD), UMR 261 MERIT, Université Paris Cité, Paris, France., Briand V; Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Centre, National Institute for Health and Medical Research (INSERM) UMR 1219, University of Bordeaux, Bordeaux, France.
Jazyk: angličtina
Zdroj: Open forum infectious diseases [Open Forum Infect Dis] 2023 Aug 10; Vol. 10 (8), pp. ofad376. Date of Electronic Publication: 2023 Aug 10 (Print Publication: 2023).
DOI: 10.1093/ofid/ofad376
Abstrakt: Background: Malaria in pregnancy (MiP) has been associated with fetal growth restriction, the underlying pathogenic mechanisms of which remain poorly understood. Malaria in pregnancy is suspected to induce abnormalities in placental vascularization, leading to impaired placental development. Our study evaluated MIP's effect on uterine artery (UtA) and umbilical artery (UA) blood flow.
Methods: The analysis included 253 Beninese women followed throughout pregnancy and screened monthly for submicroscopic and microscopic malaria. Uterine artery Doppler measurement was performed once between 21 and 25 weeks' gestation (wg), and UA Doppler measurement was performed 1-3 times from 28 wg. Linear and logistic regression models were used to assess the effect of malaria infections on UtA Doppler indicators (pulsatility index and presence of a notch), whereas a logistic mixed model was used to assess the association between malaria infections and abnormal UA Doppler (defined as Z-score ≥2 standard deviation or absent/reversed UA end-diastolic flow).
Results: Primigravidae represented 7.5% of the study population; 42.3% of women had at least 1 microscopic infection during pregnancy, and 29.6% had at least 1 submicroscopic infection (and no microscopic infection). Both microscopic and submicroscopic infections before Doppler measurement were associated with the presence of a notch (adjusted odds ratio [aOR] 4.5, 95% confidence interval [CI] = 1.2-16.3 and aOR 3.3, 95% CI = .9-11.9, respectively). No associations were found between malaria before the Doppler measurement and abnormal UA Doppler.
Conclusions: Malaria infections in the first half of pregnancy impair placental blood flow. This highlights the need to prevent malaria from the very beginning of pregnancy.
Competing Interests: Potential conflicts of interest. All authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest.
(© The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)
Databáze: MEDLINE
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