Reducing childhood mortality in poor countries - Importance and prevention of malaria in pregnancy
Reducing childhood mortality in poor countries - Importance and prevention of malaria in pregnancy
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DOI：
10.1016/s0035-9203(03)90012-5
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发表时间：
2003-01-01
影响因子：
2.2
通讯作者：
Dorman, EK
中科院分区：
文献类型：
--
作者：
Shulman, CE;Dorman, EK
妊娠期疟疾是世界范围内低出生体重分娩最重要的可预防原因之一。它也是造成产妇严重贫血的一个主要原因，造成产妇死亡。据估计，全世界40%的孕妇在怀孕期间暴露于疟疾感染。妊娠期恶性疟原虫疟疾的临床特征在很大程度上取决于妇女的免疫状况，而这又取决于她以前接触疟疾的情况。对于事先很少或没有免疫力的孕妇，例如来自非流行地区的妇女或前往疟疾流行地区的旅行者，感染与严重疾病与孕产妇和围产期死亡的高风险有关。妇女患脑型疟疾、低血糖、肺水肿和严重溶血性贫血的风险特别大。据记载，在无免疫力的疟疾妇女中，胎儿和围产期损失高达60-70%。长期居住在疟疾中度或高度传播地区的成年人，包括撒哈拉以南非洲的大部分地区，通常对疟疾有很高的免疫力。感染通常是无症状的，严重的疾病并不常见。在怀孕期间，这种对疟疾的免疫力发生了改变。感染仍然经常无症状，因此可能不被怀疑和未被发现，但与胎盘寄生有关。妊娠期疟疾是导致产妇严重厌气和婴儿出生体重低的常见原因，这些并发症在初产妇中比在多胎产妇中更为常见。预防战略包括定期化学预防、使用抗疟药和驱虫蚊帐进行间歇性预防治疗。
Malaria in pregnancy is one of the most important preventable causes of low birthweight deliveries worldwide. It is also a major cause of severe maternal anaemia contributing to maternal mortality. It is estimated that 40% of the world's pregnant women are exposed to malaria infection during pregnancy. The clinical features of Plasmodium falciparum malaria in pregnancy depend to a large extent on the immune status of the woman, which in turn is determined by her previous exposure to malaria. In pregnant women with little or no pre-existing immunity, such as women from non-endemic areas or travellers to malarious areas, infection is associated with high risks of severe disease with maternal and perinatal mortality. Women are at particular risk of cerebral malaria, hypoglycaemia, pulmonary oedema and severe haemolytic anaemia. Fetal and perinatal loss has been documented to be as high as 60-70% in non-immune women with malaria. Adults who are long-term residents of areas of moderate or high malaria transmission, including large parts of sub-Saharan Africa, usually have a high level of immunity to malaria. Infection is frequently asymptomatic and severe disease is uncommon. During pregnancy this immunity to malaria is altered. Infection is still frequently asymptomatic, so may go unsuspected and undetected, but is associated with placental parasitization. Malaria in pregnancy is a common cause of severe maternal anaernia and low birthweight babies, these complications being more common in primigravidae than multigravidae. Preventative strategies include regular chemoprophylaxis, intermittent preventative treatment with antimalarials and insecticide-treated bednets.