Effectiveness of Intermittent Preventive Treatment With Sulfadoxine-Pyrimethamine During Pregnancy on Maternal and Birth Outcomes in Machinga District, Malawi
Effectiveness of Intermittent Preventive Treatment With Sulfadoxine-Pyrimethamine During Pregnancy on Maternal and Birth Outcomes in Machinga District, Malawi
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DOI：
10.1093/infdis/jit276
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发表时间：
2013-09-15
影响因子：
6.4
通讯作者：
Skarbinski, Jacek
中科院分区：
文献类型：
--
作者：
Gutman, Julie;Mwandama, Dyson;Skarbinski, Jacek
背景妊娠期疟疾与出生体重低和围产期死亡率增加有关，特别是在孕妇中。尽管疟疾寄生虫对磺胺嘧啶-乙胺嘧啶（SP）的耐药性日益普遍，但SP仍然被推荐用于妊娠期间歇性预防治疗（IPTp）。无人类免疫缺陷病毒感染的妇女在分娩时入组。记录妊娠期间接受SP剂量的次数数据。主要结局是通过组织学分析证实的胎盘感染。次要结局包括分娩时疟疾寄生虫血症（外周血、胎盘、脐带血标本）和复合出生结局（小于胎龄、早产或低出生体重）。在入组的703名女性中，22%接受≥ 2次SP剂量对组织学证实的胎盘感染没有影响。IPTp-SP对妊娠妇女的复合出生结局具有剂量依赖性保护作用，校正患病率为0.50（95%置信区间[CI]，.30-.82），0.30（95%CI，0.19 - 0.48）和0.18（95%CI，0.05 - 0.61），分别为1，2和>= 3剂量与0剂量相比。IPTp-SP没有降低胎盘感染的频率，但与改善出生结局相关。很少有妇女没有接受过SP，所以IPTP-SP的真正效果可能被低估了。马拉维孕妇应继续接受IPTP-SP，但应调查怀孕期间预防疟疾的替代战略和抗疟药。
Background. Malaria during pregnancy is associated with low birth weight and increased perinatal mortality, especially among primigravidae. Despite increasing prevalence of malarial parasite resistance to sulfadoxine-pyrimethamine (SP), SP continues to be recommended for intermittent preventive treatment in pregnancy (IPTp).Methods. Women without human immunodeficiency virus infection were enrolled upon delivery. Data on the number of SP doses received during pregnancy were recorded. The primary outcome was placental infection demonstrated by histologic analysis. Secondary outcomes included malaria parasitemia (in peripheral, placental, cord blood specimens) at delivery and composite birth outcome (small for gestational age, preterm delivery, or low birth weight).Results. Of 703 women enrolled, 22% received = 2 SP doses had no impact on histologically confirmed placental infection. IPTp-SP was associated with a dose-dependent protective effect on composite birth outcome in primigravidae, with an adjusted prevalence ratio of 0.50 (95% confidence interval [CI], .30-.82), 0.30 (95% CI, .19-.48), and 0.18 (95% CI, .05-.61) for 1, 2, and >= 3 doses, respectively, compared with 0 doses.Conclusions. IPTp-SP did not reduce the frequency of placental infection but was associated with improved birth outcomes. Few women received no SP, so the true effect of IPTp-SP may be underestimated. Malawian pregnant women should continue to receive IPTp-SP, but alternative strategies and antimalarials for preventing malaria during pregnancy should be investigated.