Treatment of uncomplicated and severe malaria during pregnancy.
Treatment of uncomplicated and severe malaria during pregnancy.
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DOI：
10.1016/s1473-3099(18)30065-3
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发表时间：
2018-04
期刊：
影响因子：
--
通讯作者：
Sevene E
中科院分区：
文献类型：
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作者：
D'Alessandro U;Hill J;Tarning J;Pell C;Webster J;Gutman J;Sevene E
在过去10年中，关于治疗妊娠期疟疾的现有证据大幅增加。由于其相对易于使用，良好的灵敏度和特异性，基于富组氨酸蛋白2的快速诊断测试适用于有症状的孕妇;然而，此类测试不太适合系统筛查，因为它们不会检测到无症状妇女中的重要比例的感染。妊娠对抗疟药物药代动力学的影响在不同研究和抗疟药物类别之间差异很大，强调需要在妊娠和非妊娠妇女中进行前瞻性研究。关于头三个月的疟疾治疗，世卫组织正在审查国际准则。对于妊娠中期和晚期，几项试验的结果证实，青蒿素类复方治疗是安全有效的，尽管耐受性和疗效可能因治疗而异。现在必须将这些证据转化为有利于疟疾流行国家孕妇的政策和临床实践。在许多国家和区域，获得寄生虫学诊断或适当抗疟治疗的机会仍然很少。因此，迫切需要进行研究，以确定针对孕妇和保健提供者的质量改进干预措施。此外，还需要建立有效和实用的药物警戒系统，以进一步扩大抗疟药物安全性方面的知识，特别是在怀孕的头三个月。
Over the past 10 years, the available evidence on the treatment of malaria during pregnancy has increased substantially. Owing to their relative ease of use, good sensitivity and specificity, histidine rich protein 2 based rapid diagnostic tests are appropriate for symptomatic pregnant women; however, such tests are less appropriate for systematic screening because they will not detect an important proportion of infections among asymptomatic women. The effect of pregnancy on the pharmacokinetics of antimalarial drugs varies greatly between studies and class of antimalarial drugs, emphasising the need for prospective studies in pregnant and non-pregnant women. For the treatment of malaria during the first trimester, international guidelines are being reviewed by WHO. For the second and third trimester of pregnancy, results from several trials have confirmed that artemisinin-based combination treatments are safe and efficacious, although tolerability and efficacy might vary by treatment. It is now essential to translate such evidence into policies and clinical practice that benefit pregnant women in countries where malaria is endemic. Access to parasitological diagnosis or appropriate antimalarial treatment remains low in many countries and regions. Therefore, there is a pressing need for research to identify quality improvement interventions targeting pregnant women and health providers. In addition, efficient and practical systems for pharmacovigilance are needed to further expand knowledge on the safety of antimalarial drugs, particularly in the first trimester of pregnancy.