Factors associated with ultrasound-aided detection of suboptimal fetal growth in a malaria-endemic area in Papua New Guinea
Identifieur interne : 002E07 ( Main/Exploration ); précédent : 002E06; suivant : 002E08Factors associated with ultrasound-aided detection of suboptimal fetal growth in a malaria-endemic area in Papua New Guinea
Auteurs : Holger Werner Unger [Australie] ; Maria Ome-Kaius ; Stephan Karl [Australie] ; Dupain Singirok ; Peter Siba ; Jane Walker ; Regina Alice Wangnapi [Australie] ; Ivo Mueller [Australie, Espagne] ; Stephen John Rogerson [Australie]Source :
- BMC Pregnancy and Childbirth [ 1471-2393 ] ; 2015.
Descripteurs français
- KwdFr :
- Adolescent, Adulte, Anémie (épidémiologie), Complications de la grossesse et hémopathies (épidémiologie), Complications parasitaires de la grossesse (épidémiologie), Facteurs de risque, Femelle, Grossesse, Humains, Jeune adulte, Maladies endémiques, Malnutrition (épidémiologie), Modèles linéaires, Mâle, Nourrisson petit pour son âge gestationnel, Nourrisson à faible poids de naissance, Nouveau-né, Paludisme (épidémiologie), Papouasie - Nouvelle-Guinée (épidémiologie), Pays en voie de développement, Poids de naissance, Poids foetal, Population rurale, Retard de croissance intra-utérin (imagerie diagnostique), Retard de croissance intra-utérin (épidémiologie), Âge gestationnel, Échographie prénatale, Études de cohortes, Études prospectives.
- MESH :
- imagerie diagnostique : Retard de croissance intra-utérin.
- épidémiologie : Anémie, Complications de la grossesse et hémopathies, Complications parasitaires de la grossesse, Malnutrition, Paludisme, Papouasie - Nouvelle-Guinée, Retard de croissance intra-utérin.
- Adolescent, Adulte, Facteurs de risque, Femelle, Grossesse, Humains, Jeune adulte, Maladies endémiques, Modèles linéaires, Mâle, Nourrisson petit pour son âge gestationnel, Nourrisson à faible poids de naissance, Nouveau-né, Pays en voie de développement, Poids de naissance, Poids foetal, Population rurale, Âge gestationnel, Échographie prénatale, Études de cohortes, Études prospectives.
English descriptors
- KwdEn :
- Adolescent, Adult, Anemia (epidemiology), Birth Weight, Cohort Studies, Developing Countries, Endemic Diseases, Female, Fetal Growth Retardation (diagnostic imaging), Fetal Growth Retardation (epidemiology), Fetal Weight, Gestational Age, Humans, Infant, Low Birth Weight, Infant, Newborn, Infant, Small for Gestational Age, Linear Models, Malaria (epidemiology), Male, Malnutrition (epidemiology), Papua New Guinea (epidemiology), Pregnancy, Pregnancy Complications, Hematologic (epidemiology), Pregnancy Complications, Parasitic (epidemiology), Prospective Studies, Risk Factors, Rural Population, Ultrasonography, Prenatal, Young Adult.
- MESH :
- diagnostic imaging : Fetal Growth Retardation.
- epidemiology : Anemia, Fetal Growth Retardation, Malaria, Malnutrition, Papua New Guinea, Pregnancy Complications, Hematologic, Pregnancy Complications, Parasitic.
- Adolescent, Adult, Birth Weight, Cohort Studies, Developing Countries, Endemic Diseases, Female, Fetal Weight, Gestational Age, Humans, Infant, Low Birth Weight, Infant, Newborn, Infant, Small for Gestational Age, Linear Models, Male, Pregnancy, Prospective Studies, Risk Factors, Rural Population, Ultrasonography, Prenatal, Young Adult.
Abstract
Fetal growth restriction (FGR) is associated with increased infant mortality rates and ill-health in adulthood. Evaluation of fetal growth requires ultrasound. As a result, ultrasound-assisted evaluations of causes of FGR in malaria-endemic developing countries are rare. We aimed to determine factors associated with indicators of abnormal fetal growth in rural lowland Papua New Guinea (PNG).
Weights and growth of 671 ultrasound-dated singleton pregnancies (<25 gestational weeks) were prospectively monitored using estimated fetal weights and birthweights. Maternal nutritional status and haemoglobin levels were assessed at enrolment, and participants were screened for malaria on several occasions. FGR was suspected upon detection of an estimated fetal weight or birthweight <10th centile (small-for-gestational age) and/or low fetal weight gain, defined as a change in weight z-score in the first quartile. Factors associated with fetal weight and fetal weight gain were additionally assessed by evaluating differences in weight z-scores and change in weight z-scores. Log-binomial and linear mixed effect models were used to determine factors associated with indicators of FGR.
SGA and low weight gain were detected in 48.3% and 37.0% of pregnancies, respectively. Of participants, 13.8%, 21.2%, and 22.8% had a low mid-upper arm circumference (MUAC, <22 cms), short stature (<150 cms) and anaemia (haemoglobin <90 g/L) at first antenatal visit. 24.0% (161/671) of women had at least one malaria infection detected in peripheral blood. A low MUAC (adjusted risk ratio [aRR] 1.51, 95% CI 1.29, 1.76,
Macronutrient undernutrition and anaemia increased the risk of FGR. Antenatal nutritional interventions and malaria prevention could improve fetal growth in PNG.
Url:
DOI: 10.1186/s12884-015-0511-6
PubMed: 25881316
PubMed Central: 4404558
Affiliations:
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H" first="Holger Werner" last="Unger">Holger Werner Unger</name><affiliation><nlm:aff id="Aff1">Papua New Guinea Institute of Medical Research (PNG IMR), 60, Goroka, Eastern Highlands Province 411 Papua New Guinea</nlm:aff><wicri:noCountry code="subfield">Eastern Highlands Province 411 Papua New Guinea</wicri:noCountry></affiliation><affiliation wicri:level="4"><nlm:aff id="Aff2">Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Post Office Royal Melbourne Hospital, Parkville, VIC 3050 Melbourne, Australia</nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Post Office Royal Melbourne Hospital, Parkville, VIC 3050 Melbourne</wicri:regionArea><orgName type="university">Université de Melbourne</orgName><placeName><settlement type="city">Melbourne</settlement><region type="état">Victoria (État)</region></placeName></affiliation></author><author><name sortKey="Ome Kaius, Maria" sort="Ome Kaius, Maria" uniqKey="Ome Kaius M" first="Maria" last="Ome-Kaius">Maria Ome-Kaius</name><affiliation><nlm:aff id="Aff1">Papua New Guinea Institute of Medical Research (PNG IMR), 60, Goroka, Eastern Highlands Province 411 Papua New Guinea</nlm:aff><wicri:noCountry code="subfield">Eastern Highlands Province 411 Papua New Guinea</wicri:noCountry></affiliation></author><author><name sortKey="Karl, Stephan" sort="Karl, Stephan" uniqKey="Karl S" first="Stephan" last="Karl">Stephan Karl</name><affiliation wicri:level="3"><nlm:aff id="Aff3">Walter and Eliza Hall Institute of Medical Research (WEHI), 1G Royal Parade, Parkville 3052, Melbourne, Australia</nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>Walter and Eliza Hall Institute of Medical Research (WEHI), 1G Royal Parade, Parkville 3052, Melbourne</wicri:regionArea><placeName><settlement type="city">Melbourne</settlement><region type="état">Victoria (État)</region></placeName></affiliation></author><author><name sortKey="Singirok, Dupain" sort="Singirok, Dupain" uniqKey="Singirok D" first="Dupain" last="Singirok">Dupain Singirok</name><affiliation><nlm:aff id="Aff1">Papua New Guinea Institute of Medical Research (PNG IMR), 60, Goroka, Eastern Highlands Province 411 Papua New Guinea</nlm:aff><wicri:noCountry code="subfield">Eastern Highlands Province 411 Papua New Guinea</wicri:noCountry></affiliation></author><author><name sortKey="Siba, Peter" sort="Siba, Peter" uniqKey="Siba P" first="Peter" last="Siba">Peter Siba</name><affiliation><nlm:aff id="Aff1">Papua New Guinea Institute of Medical Research (PNG IMR), 60, Goroka, Eastern Highlands Province 411 Papua New Guinea</nlm:aff><wicri:noCountry code="subfield">Eastern Highlands Province 411 Papua New Guinea</wicri:noCountry></affiliation></author><author><name sortKey="Walker, Jane" sort="Walker, Jane" uniqKey="Walker J" first="Jane" last="Walker">Jane Walker</name><affiliation><nlm:aff id="Aff4">Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA UK</nlm:aff><wicri:noCountry code="subfield">EH16 4SA UK</wicri:noCountry></affiliation></author><author><name sortKey="Wangnapi, Regina Alice" sort="Wangnapi, Regina Alice" uniqKey="Wangnapi R" first="Regina Alice" last="Wangnapi">Regina Alice Wangnapi</name><affiliation wicri:level="4"><nlm:aff id="Aff2">Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Post Office Royal Melbourne Hospital, Parkville, VIC 3050 Melbourne, Australia</nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Post Office Royal Melbourne Hospital, Parkville, VIC 3050 Melbourne</wicri:regionArea><orgName type="university">Université de Melbourne</orgName><placeName><settlement type="city">Melbourne</settlement><region type="état">Victoria (État)</region></placeName></affiliation></author><author><name sortKey="Mueller, Ivo" sort="Mueller, Ivo" uniqKey="Mueller I" first="Ivo" last="Mueller">Ivo Mueller</name><affiliation wicri:level="3"><nlm:aff id="Aff3">Walter and Eliza Hall Institute of Medical Research (WEHI), 1G Royal Parade, Parkville 3052, Melbourne, Australia</nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>Walter and Eliza Hall Institute of Medical Research (WEHI), 1G Royal Parade, Parkville 3052, Melbourne</wicri:regionArea><placeName><settlement type="city">Melbourne</settlement><region type="état">Victoria (État)</region></placeName></affiliation><affiliation wicri:level="1"><nlm:aff id="Aff5">Barcelona Centre for International Health Research (CRESIB), Rosselo 132, 08036 Barcelona, Spain</nlm:aff><country xml:lang="fr">Espagne</country><wicri:regionArea>Barcelona Centre for International Health Research (CRESIB), Rosselo 132, 08036 Barcelona</wicri:regionArea><placeName><settlement type="city">Barcelone</settlement><region nuts="2" type="region">Catalogne</region></placeName></affiliation></author><author><name sortKey="Rogerson, Stephen John" sort="Rogerson, Stephen John" uniqKey="Rogerson S" first="Stephen John" last="Rogerson">Stephen John Rogerson</name><affiliation wicri:level="4"><nlm:aff id="Aff2">Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Post Office Royal Melbourne Hospital, Parkville, VIC 3050 Melbourne, Australia</nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Post Office Royal Melbourne Hospital, Parkville, VIC 3050 Melbourne</wicri:regionArea><orgName type="university">Université de Melbourne</orgName><placeName><settlement type="city">Melbourne</settlement><region type="état">Victoria (État)</region></placeName></affiliation></author></analytic><series><title level="j">BMC Pregnancy and Childbirth</title><idno type="eISSN">1471-2393</idno><imprint><date when="2015">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adolescent</term><term>Adult</term><term>Anemia (epidemiology)</term><term>Birth Weight</term><term>Cohort Studies</term><term>Developing Countries</term><term>Endemic Diseases</term><term>Female</term><term>Fetal Growth Retardation (diagnostic imaging)</term><term>Fetal Growth Retardation (epidemiology)</term><term>Fetal Weight</term><term>Gestational Age</term><term>Humans</term><term>Infant, Low Birth Weight</term><term>Infant, Newborn</term><term>Infant, Small for Gestational Age</term><term>Linear Models</term><term>Malaria (epidemiology)</term><term>Male</term><term>Malnutrition (epidemiology)</term><term>Papua New Guinea (epidemiology)</term><term>Pregnancy</term><term>Pregnancy Complications, Hematologic (epidemiology)</term><term>Pregnancy Complications, Parasitic (epidemiology)</term><term>Prospective Studies</term><term>Risk Factors</term><term>Rural Population</term><term>Ultrasonography, Prenatal</term><term>Young Adult</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Adolescent</term><term>Adulte</term><term>Anémie (épidémiologie)</term><term>Complications de la grossesse et hémopathies (épidémiologie)</term><term>Complications parasitaires de la grossesse (épidémiologie)</term><term>Facteurs de risque</term><term>Femelle</term><term>Grossesse</term><term>Humains</term><term>Jeune adulte</term><term>Maladies endémiques</term><term>Malnutrition (épidémiologie)</term><term>Modèles linéaires</term><term>Mâle</term><term>Nourrisson petit pour son âge gestationnel</term><term>Nourrisson à faible poids de naissance</term><term>Nouveau-né</term><term>Paludisme (épidémiologie)</term><term>Papouasie - Nouvelle-Guinée (épidémiologie)</term><term>Pays en voie de développement</term><term>Poids de naissance</term><term>Poids foetal</term><term>Population rurale</term><term>Retard de croissance intra-utérin (imagerie diagnostique)</term><term>Retard de croissance intra-utérin (épidémiologie)</term><term>Âge gestationnel</term><term>Échographie prénatale</term><term>Études de cohortes</term><term>Études prospectives</term></keywords><keywords scheme="MESH" qualifier="diagnostic imaging" xml:lang="en"><term>Fetal Growth Retardation</term></keywords><keywords scheme="MESH" qualifier="epidemiology" xml:lang="en"><term>Anemia</term><term>Fetal Growth Retardation</term><term>Malaria</term><term>Malnutrition</term><term>Papua New Guinea</term><term>Pregnancy Complications, Hematologic</term><term>Pregnancy Complications, Parasitic</term></keywords><keywords scheme="MESH" qualifier="imagerie diagnostique" xml:lang="fr"><term>Retard de croissance intra-utérin</term></keywords><keywords scheme="MESH" qualifier="épidémiologie" xml:lang="fr"><term>Anémie</term><term>Complications de la grossesse et hémopathies</term><term>Complications parasitaires de la grossesse</term><term>Malnutrition</term><term>Paludisme</term><term>Papouasie - Nouvelle-Guinée</term><term>Retard de croissance intra-utérin</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adolescent</term><term>Adult</term><term>Birth Weight</term><term>Cohort Studies</term><term>Developing Countries</term><term>Endemic Diseases</term><term>Female</term><term>Fetal Weight</term><term>Gestational Age</term><term>Humans</term><term>Infant, Low Birth Weight</term><term>Infant, Newborn</term><term>Infant, Small for Gestational Age</term><term>Linear Models</term><term>Male</term><term>Pregnancy</term><term>Prospective Studies</term><term>Risk Factors</term><term>Rural Population</term><term>Ultrasonography, Prenatal</term><term>Young Adult</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Adolescent</term><term>Adulte</term><term>Facteurs de risque</term><term>Femelle</term><term>Grossesse</term><term>Humains</term><term>Jeune adulte</term><term>Maladies endémiques</term><term>Modèles linéaires</term><term>Mâle</term><term>Nourrisson petit pour son âge gestationnel</term><term>Nourrisson à faible poids de naissance</term><term>Nouveau-né</term><term>Pays en voie de développement</term><term>Poids de naissance</term><term>Poids foetal</term><term>Population rurale</term><term>Âge gestationnel</term><term>Échographie prénatale</term><term>Études de cohortes</term><term>Études prospectives</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Fetal growth restriction (FGR) is associated with increased infant mortality rates and ill-health in adulthood. Evaluation of fetal growth requires ultrasound. As a result, ultrasound-assisted evaluations of causes of FGR in malaria-endemic developing countries are rare. We aimed to determine factors associated with indicators of abnormal fetal growth in rural lowland Papua New Guinea (PNG).</p></sec><sec><title>Methods</title><p>Weights and growth of 671 ultrasound-dated singleton pregnancies (<25 gestational weeks) were prospectively monitored using estimated fetal weights and birthweights. Maternal nutritional status and haemoglobin levels were assessed at enrolment, and participants were screened for malaria on several occasions. FGR was suspected upon detection of an estimated fetal weight or birthweight <10<sup>th</sup> centile (small-for-gestational age) and/or low fetal weight gain, defined as a change in weight z-score in the first quartile. Factors associated with fetal weight and fetal weight gain were additionally assessed by evaluating differences in weight z-scores and change in weight z-scores. Log-binomial and linear mixed effect models were used to determine factors associated with indicators of FGR.</p></sec><sec><title>Results</title><p>SGA and low weight gain were detected in 48.3% and 37.0% of pregnancies, respectively. Of participants, 13.8%, 21.2%, and 22.8% had a low mid-upper arm circumference (MUAC, <22 cms), short stature (<150 cms) and anaemia (haemoglobin <90 g/L) at first antenatal visit. 24.0% (161/671) of women had at least one malaria infection detected in peripheral blood. A low MUAC (adjusted risk ratio [aRR] 1.51, 95% CI 1.29, 1.76, <italic>P</italic> < 0.001), short stature (aRR 1.27, 95% CI 1.04, 1.55, <italic>P</italic> = 0.009), and anaemia (aRR 1.27, 95% CI 1.06, 1.51, <italic>P</italic> = 0.009) were associated with SGA, and a low body mass index was associated with low fetal weight gain (aRR 2.10, 95% CI 1.62, 2.71, <italic>P</italic> < 0.001). Additionally, recent receipt of intermittent preventive treatment in pregnancy was associated with increased weight z-scores, and anaemia with reduced change in weight z-scores. Malaria infection was associated with SGA on crude but not adjusted analyses (aRR 1.13, 95% CI 0.95, 1.34, <italic>P</italic> = 0.172).</p></sec><sec><title>Conclusion</title><p>Macronutrient undernutrition and anaemia increased the risk of FGR. 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Ome-Kaius</name><name sortKey="Siba, Peter" sort="Siba, Peter" uniqKey="Siba P" first="Peter" last="Siba">Peter Siba</name><name sortKey="Singirok, Dupain" sort="Singirok, Dupain" uniqKey="Singirok D" first="Dupain" last="Singirok">Dupain Singirok</name><name sortKey="Walker, Jane" sort="Walker, Jane" uniqKey="Walker J" first="Jane" last="Walker">Jane Walker</name></noCountry><country name="Australie"><region name="Victoria (État)"><name sortKey="Unger, Holger Werner" sort="Unger, Holger Werner" uniqKey="Unger H" first="Holger Werner" last="Unger">Holger Werner Unger</name></region><name sortKey="Karl, Stephan" sort="Karl, Stephan" uniqKey="Karl S" first="Stephan" last="Karl">Stephan Karl</name><name sortKey="Mueller, Ivo" sort="Mueller, Ivo" uniqKey="Mueller I" first="Ivo" last="Mueller">Ivo Mueller</name><name sortKey="Rogerson, Stephen John" sort="Rogerson, Stephen John" uniqKey="Rogerson S" first="Stephen John" last="Rogerson">Stephen John Rogerson</name><name sortKey="Wangnapi, Regina Alice" sort="Wangnapi, Regina Alice" uniqKey="Wangnapi R" first="Regina Alice" last="Wangnapi">Regina Alice Wangnapi</name></country><country name="Espagne"><region name="Catalogne"><name sortKey="Mueller, Ivo" sort="Mueller, Ivo" uniqKey="Mueller I" first="Ivo" last="Mueller">Ivo Mueller</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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