MALARIA DURING PREGNANCY IN AN AREA OF UNSTABLE ENDEMICITY
MALARIA DURING PREGNANCY IN AN AREA OF UNSTABLE ENDEMICITY
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DOI：
10.1016/0035-9203(91)90205-d
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发表时间：
1991-07-01
影响因子：
2.2
通讯作者：
WHITE, NJ
中科院分区：
文献类型：
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作者：
NOSTEN, F;TERKUILE, F;WHITE, NJ
1986年9月至1989年12月，在泰缅边境一个疟疾不稳定（中地方性）传播地区对怀孕期间疟疾进行了一项前瞻性研究。在克伦少数民族流离失所者营地设立了产前诊所，登记了1358名孕妇，平均估计胎龄为23周（标准偏差为5.7周），每周随访一次，直到分娩。505名妇女患疟疾（37.2%）；恶性疟原虫占80.2%，间日疟原虫占17.1%，混合感染占2.7%。初产妇感染发生率高于多产妇：153/322（47.5%）高于318/953 (33.3%)（P < 0.001）。疟疾发病率从妊娠第20周（12%）到足月（4.4%）下降。大多数感染是在出现症状之前发现的，没有与疟疾有关的死亡。尽管如此，疟疾与出生体重总体减少123克相关（95%置信区间[CI] 34-212克）。这种减少主要是由于受感染的原迁蝇所生婴儿的出生体重较低（平均减少151克，95%可信区间21-282克），以及第二次和第三次怀孕妇女的出生体重较低（平均减少185克，95%可信区间84-286克）。发展为疟疾的妇女需要治疗的贫血发生率较高，149/420（35.4%）比191/670（28.5%）高，且与寄生虫发作次数成正比。因此，尽管定期到产前诊所就诊并及时发现和治疗疟疾（目前在耐多药恶性疟原虫地区采用的抗疟疾战略），疟疾仍然对妊娠产生重大不利影响。在这些地区，有效预防或避免接触是唯一可能保护孕妇及其婴儿免受疟疾有害影响的抗疟疾措施。
A prospective study of malaria during pregnancy was conducted between September 1986 and December 1989 in an area of unstable (mesoendemic) malaria transmission on the Thai-Burmese border. Antenatal clinics were set up in camps for displaced persons of the Karen ethnic minority and 1358 pregnant women were enrolled at a mean estimated gestational age of 23 weeks (standard deviation 5.7 weeks) and were followed weekly until delivery. Malaria developed in 505 women (37.2%); 80.2% of infections were Plasmodium falciparum, 17.1% were P. vivax, and 2.7% were mixed. Primigravidae were infected more commonly than multigravidae: 153/322 (47.5%) compared with 318/953 (33.3%) (P < 0.001). The incidence of malaria declined from the 20th week of gestation (12%) towards term (4.4%). Most infections were detected before symptoms developed, and there were no deaths associated with malaria. Despite this, malaria was associated with an overall 123 g reduction in birthweight (95% confidence interval [CI] 34-212 g). This reduction was largely accounted for by lower birthweights of babies born to infected primigravidae (mean reduction 151 g, 95% CI 21-282 g) and women in their 2nd and 3rd pregnancies (mean reduction 185 g, 95% CI 84-286 g). The incidence of anaemia requiring treatment was higher in women who developed malaria, 149/420 (35.4%) compared with 191/670 (28.5%), and was proportional to the number of parasitaemic episodes. Thus, despite regular antenatal clinic attendance with prompt detection and treatment of malaria (the currently employed antimalarial strategy in areas with multidrug-resistant P. falciparum), malaria still had a significant adverse effect on pregnancy. Effective prophylaxis or avoidance of exposure are the only antimalarial measures likely to protect pregnant women and their babies from the harmful effects of malaria in these areas.