Placental malaria increases malaria risk in the first 30 months of life
Placental malaria increases malaria risk in the first 30 months of life
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DOI：
10.1086/591968
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发表时间：
2008-10-15
影响因子：
11.8
通讯作者：
Grobusch, Martin P.
中科院分区：
文献类型：
--
作者：
Schwarz, Norbert G.;Adegnika, Ayola A.;Grobusch, Martin P.
背景妊娠期恶性疟原虫感染与死胎、胎儿生长受限和低出生体重有关。另一个后果可能是在生命早期患疟疾的风险增加，尽管这种后果的流行病学证据是有限的。对527名儿童进行了为期30个月的观察。分娩时显微镜下可检测到胎盘恶性疟原虫感染的母亲的后代被定义为暴露。结果指标为疟疾（寄生虫血症和发热）。采用考克斯比例风险模型进行分析，并按妊娠分层。总的来说，感染胎盘恶性疟原虫的母亲的后代在出生后的前30个月内患临床疟疾的风险显著较高（校正风险比，2.1; 95%置信区间[CI]，1.2-3.7）。经产妇后代的校正风险比为2.6（95%CI，1.3-5.3），经产妇后代的校正风险比为1.5（95%CI，0.6-3.8）。胎盘感染的孕鼠的后代在出生后的第一年内没有疟疾发作。我们的研究结果表明，在分娩时检测到的活动性胎盘恶性疟原虫感染与生命早期患疟疾的风险相似，与未感染者相比，其风险高出2倍。经产妇感染疟疾的风险似乎高于经产妇感染疟疾的风险，这一事实强调了在所有孕妇中预防疟疾的重要性。
Background. Plasmodium falciparum infection during pregnancy is associated with stillbirth, fetal growth restriction, and low birth weight. An additional consequence may be increased risk of malaria in early life, although the epidemiological evidence of this consequence is limited.Methods. A cohort of 527 children were observed actively every month for 30 months after delivery. Offspring of mothers with microscopically detectable placental P. falciparum infection at the time of delivery were defined as exposed. The outcome measure was malaria (parasitemia and fever). Analyses were performed using Cox proportional hazard models and were stratified by gravidity.Results. Overall, offspring of mothers with placental P. falciparum infection had a significantly higher risk of clinical malaria during the first 30 months of life (adjusted hazard ratio, 2.1; 95% confidence interval [CI], 1.2-3.7). The adjusted hazard ratio for offspring of multigravidae was 2.6 (95% CI, 1.3-5.3), and that for primigravidae was 1.5 (95% CI, 0.6-3.8). The offspring of placenta-infected primigravidae had no episodes of malaria during the first year of life.Conclusions. Our findings show that active placental P. falciparum infection detected at delivery is associated with an similar to 2-fold greater risk of malaria during early life, compared with noninfection. The fact that persons born to infected multigravidae rather than primigravidae appear to be at greater risk emphasizes the importance of preventing malaria in mothers of all gravidities.