PDF(Pubmed)
Abstract：
We aimed to measure the association between Trypanosoma cruzi infection in pregnancy and reduced fetal growth in the absence of T. cruzi congenital transmission. We conducted a cross-sectional study of secondary data of all singleton live births between 2011 and 2013 in five hospitals from Argentina, Honduras, and Mexico. We excluded newborns with T. cruzi infection. Noninfected pregnant people were those without any positive rapid tests. The main study outcomes were birth weight, head circumference, and length for gestational age and sex. Logistic regression models were adjusted for country, age, education level, and obstetric history. Of the 26,544 deliveries, 459 (1.7%) pregnant people were found by rapid tests to be positive for T. cruzi. Of these, 320 were positive by enzyme-linked immunosorbent assay and 231 had a positive polymerase chain reaction (PCR) test. Uninfected newborns from T. cruzi-infected pregnant people were more likely to have birth weights below the 5th and 10th percentiles and head circumferences below the 3rd and 10th percentiles. Among T. cruzi-infected pregnant people diagnosed by PCR, the odds ratios were 1.58 for birth weight below the 10th percentile (95% CI, 1.12-2.23) and 1.57 for birth weight below the 5th percentile (95% CI, 1.02-2.42). Higher T. cruzi parasitic loads in pregnancy had a stronger association with reduced fetal growth (both in birth weight and head circumference), with an odds ratio of 2.31 (95% CI, 1.36-3.91) for a birth weight below the 5th percentile. The association shows, irrespective of causality, that newborns of pregnancies with T. cruzi have an increased risk of reduced fetal growth. We recommend further studies to assess other potential confounders and the causality of these associations.
摘要：
我们旨在测量在没有克氏锥虫先天性传播的情况下，妊娠中克氏锥虫感染与胎儿生长减少之间的关联。我们对2011年至2013年阿根廷五家医院的所有单胎活产的次要数据进行了横断面研究，洪都拉斯,和墨西哥。我们排除了锥虫感染的新生儿。未感染的孕妇是那些没有任何阳性快速检测的人。主要研究结果是出生体重，头围,以及胎龄和性别的长度。Logistic回归模型针对国家/地区进行了调整，年龄,教育水平,和产科历史。在26,544次交付中，通过快速测试发现459名（1.7％）孕妇对T.cruzi呈阳性。其中,酶联免疫吸附试验阳性320例，聚合酶链反应（PCR）阳性231例。来自T.cruzi感染的孕妇的未感染新生儿更有可能的出生体重低于第5和第10百分位数，头围低于第3和第10百分位数。在通过PCR诊断的T.Cruzi感染的孕妇中，出生体重低于第10百分位数(95%CI,1.12~2.23)的比值比为1.58,出生体重低于第5百分位数(95%CI,1.02~2.42)的比值比为1.57.怀孕期间较高的克氏虫寄生负荷与胎儿生长减少（出生体重和头围）有更强的关联。出生体重低于第5百分位数的比值比为2.31（95％CI，1.36-3.91）。该协会显示，不管因果关系，患有T.Cruzi妊娠的新生儿胎儿生长减少的风险增加。我们建议进一步研究以评估其他潜在的混杂因素和这些关联的因果关系。
