Timing of Malaria Infection during Pregnancy Has Characteristic Maternal, Infant and Placental Outcomes
Timing of Malaria Infection during Pregnancy Has Characteristic Maternal, Infant and Placental Outcomes
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DOI：
10.1371/journal.pone.0074643
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发表时间：
2013-09-18
期刊：
影响因子：
3.7
通讯作者：
Laufer, Miriam K.
中科院分区：
文献类型：
--
作者：
Kalilani-Phiri, Linda;Thesing, Phillip C.;Laufer, Miriam K.
我们对马拉维布兰太尔的孕妇进行了一项临床研究，以确定妊娠期间疟疾感染的时间对孕产妇、婴儿和胎盘结局的影响。妇女在第一次或第二次怀孕的第一个或第二个三个月登记，每四周随访一次，直到分娩。给予三剂磺胺嘧啶-乙胺嘧啶进行疟疾间歇性预防治疗，并根据国家准则治疗所有寄生虫血症。在分娩时收集胎盘并通过组织学检查疟疾寄生虫和色素。在随访期间，孕妇每人每年有0.6次疟疾发作。几乎所有的疟疾发作都是在入组时检测到的，随访期间的疟疾感染很罕见。第一次产前检查时的疟疾和贫血与分娩时检测到的胎盘疟疾风险增加独立相关。当所有疟疾发作都用有效的抗疟药物治疗时，只有分娩时的外周疟疾感染与不利的母婴结局有关。四分之一的分析胎盘有疟疾感染的证据。胎盘组织学对妊娠期外周疟疾感染的敏感性为78%，特异性为89%。这项研究表明，在这种高抗叶酸药物耐药性的情况下，三种剂量的磺胺嘧啶-乙胺嘧啶在抑制显微镜下可检测到的寄生虫血症方面保持一定的疗效，尽管胎盘感染仍然频繁。即使在这种城市环境中，也有很大比例的妇女在第一次产前保健时就感染了疟疾。需要采取干预措施，及早控制疟疾，并积极发现病例，以限制与妊娠有关的疟疾的有害影响。
We conducted a clinical study of pregnant women in Blantyre, Malawi to determine the effect of the timing of malaria infection during pregnancy on maternal, infant and placental outcomes. Women were enrolled in their first or second trimester of their first or second pregnancy and followed every four weeks until delivery. Three doses of sulfadoxine-pyrimethamine were given for intermittent preventive treatment for malaria, and all episodes of parasitemia were treated according to the national guidelines. Placentas were collected at delivery and examined for malaria parasites and pigment by histology. Pregnant women had 0.6 episodes of malaria per person year of follow up. Almost all episodes of malaria were detected at enrollment and malaria infection during the follow up period was rare. Malaria and anemia at the first antenatal visit were independently associated with an increased risk of placental malaria detected at delivery. When all episodes of malaria were treated with effective antimalarial medication, only peripheral malaria infection at the time of delivery was associated with adverse maternal and infant outcomes. One quarter of the analyzed placentas had evidence of malaria infection. Placental histology was 78% sensitive and 89% specific for peripheral malaria infection during pregnancy. This study suggests that in this setting of high antifolate drug resistance, three doses of sulfadoxine-pyrimethamine maintain some efficacy in suppressing microscopically detectable parasitemia, although placental infection remains frequent. Even in this urban setting, a large proportion of women have malaria infection at the time of their first antenatal care visit. Interventions to control malaria early and aggressive case detection are required to limit the detrimental effects of pregnancy-associated malaria.