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

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  • Griffin, Jennifer B
    • Affiliation: Gillings School of Global Public Health, Department of Epidemiology
  • Lokomba, Victor
    • Other Affiliation: Ecole de Santé Publique, Faculté de Medecine, Université de Kinshasa, Kinshasa, Republique Démocratique du Congo
  • Landis, Sarah H
    • Other Affiliation: Oncology Research and Development, GlaxoSmithKline
  • Thorp, John M
    • Affiliation: School of Medicine, Department of Obstetrics and Gynecology
  • Herring, Amy
    • Affiliation: Gillings School of Global Public Health, Department of Biostatistics
  • Tshefu, Antoinette K
    • Other Affiliation: Ecole de Santé Publique, Faculté de Medecine, Université de Kinshasa, Kinshasa, Republique Démocratique du Congo
  • Rogerson, Stephen J
    • Other Affiliation: Department of Medicine (RMH/WH), The University of Melbourne, Royal Melbourne Hospital
  • Meshnick, Steven R.
    • Affiliation: Gillings School of Global Public Health, Department of Epidemiology
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.
Date of publication
DOI
Identifier
  • 22963509
  • doi:10.1186/1475-2875-11-319
Resource type
  • Article
Rights statement
  • In Copyright
Rights holder
  • Jennifer B Griffin et al.; licensee BioMed Central Ltd.
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Journal title
  • Malaria Journal
Journal volume
  • 11
Journal issue
  • 1
Page start
  • 319
Language
  • English
Is the article or chapter peer-reviewed?
  • Yes
ISSN
  • 1475-2875
Bibliographic citation
  • Malaria Journal. 2012 Sep 10;11(1):319
Publisher
  • BioMed Central Ltd
Access right
  • Open Access
Date uploaded
  • November 13, 2012

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