Effects of malaria parasitaemia on foetal middle cerebral artery doppler indices in a cohort of pregnant Nigerian women

Objectives: Malaria in pregnancy (MiP) increases maternal and perinatal complications including maternal anaemia and foetal growth restriction (FGR). Middle cerebral artery (MCA) indices obtained using Doppler ultrasound are an important tool in predicting the onset of FGR and perinatal mortality in MiP since ultrasound is cheap, readily available, noninvasive and radiation free. We aimed at comparing foetal MCA Doppler indices in pregnant women with and without malaria. The effect of parasitaemia level on these indices was also evaluated. Methods: Fifty-eight foetuses of women with MiP and 100 foetuses of age and gestational age matched apparently healthy controls between 24 and 40 weeks were consecutively recruited from the antenatal clinic of our hospital between January and December 2018. Venous blood was taken for peripheral blood film to diagnose and quantify malaria parasitaemia. Foetal MCA Doppler indices of both MiP subjects and controls were determined using real time 2.5–5.5 MHz diagnostic ultrasound machine with Doppler facility. Results: Mean foetal MCA resistive index, pulsatility index, peak systolic velocity (PSV), end-diastolic velocity, and systolic-diastolic ratio for MiP subjects were 0.81 ± 0.05, 1.65 ± 0.24, 48.31 ± 14.16, 9.72 ± 4.18 and 5.53 ± 1.34 while those for controls were 0.84 ± 0.04, 1.88 ± 0.19, 51.43 ± 11.41, 8.24 ± 2.51 and 6.51 ± 1.02, respectively. Apart from PSV (P = 0.132), other indices evaluated showed statistically significant difference between the two groups (P > 0.01). None of the parameters showed significance association with the level of parasitaemia. Conclusion: MiP causes detectable changes in the foetal MCA Doppler indices which may indicate foetal distress and also suggest FGR.