Adverse effects of falciparum and vivax malaria and the safety of antimalarial treatment in early pregnancy: a population-based study
Adverse effects of falciparum and vivax malaria and the safety of antimalarial treatment in early pregnancy: a population-based study
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DOI：
10.1016/s1473-3099(11)70339-5
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发表时间：
2012-05-01
影响因子：
56.3
通讯作者：
Nosten, F. H.
中科院分区：
文献类型：
--
作者：
McGready, R.;Lee, S. J.;Nosten, F. H.
背景疟疾的影响及其在怀孕头三个月的治疗仍然是一个令人关注的领域。我们的目的是评估结果的疟疾暴露和疟疾未暴露的头三个月的妇女从泰缅边境怀孕，并比较结果后，氯喹为基础的，奎宁为基础的，或青蒿素为基础的treatment.Methods我们分析了所有的产前记录的妇女在怀孕的头三个月参加Shoklo疟疾研究单位产前诊所从1986年5月12日，2010年10月31日。将妊娠期未患疟疾的妇女与妊娠前三个月患过一次疟疾的妇女进行比较。疟疾和流产之间的关联估计使用多变量logistic regression.Findings的48 426名孕妇，17 613（36%）符合纳入标准：16 668（95%）没有疟疾在怀孕期间和945（5%）有一个单一的发作在头三个月。无症状性疟疾（调整后的比值比为2.70，95% CI为2.04-3.59）和有症状性疟疾（3.99，3.10-5.13）患者的流产几率增加，恶性疟原虫和间日疟原虫的流产几率相似。流产的其他危险因素包括吸烟、母亲年龄、既往流产史和非疟疾发热性疾病。在患有疟疾的女性中，流产的其他风险因素包括重度或高寄生虫血症性疟疾（调整后的比值比为3.63，95% CI为1.15-11.46）和寄生虫血症（寄生虫血症每增加10倍为1.49，1.25-1-78）。感染时较高的胎龄是保护性的（校正比值比0.86，95%CI 0.81 -0.91）。接受氯喹（354例中92例[26%]）、奎宁（355例中95例[27%]）或青蒿琥酯（64例中20例[31%]; p=0.71）治疗的妇女流产风险相似。与抗疟治疗有关的不良反应没有观察到。解释一个单一的恶性疟原虫或间日疟发作在怀孕的头三个月可能会导致流产。没有额外的毒性作用与青蒿琥酯治疗发生在怀孕早期。现在应该进行前瞻性研究，以评估青蒿素联合治疗在早孕期的安全性和有效性。
Background The effects of malaria and its treatment in the first trimester of pregnancy remain an area of concern. We aimed to assess the outcome of malaria-exposed and malaria-unexposed first-trimester pregnancies of women from the Thai Burmese border and compare outcomes after chloroquine-based, quinine-based, or artemisinin-based treatments.Methods We analysed all antenatal records of women in the first trimester of pregnancy attending Shoklo Malaria Research Unit antenatal clinics from May 12, 1986, to Oct 31, 2010. Women without malaria in pregnancy were compared with those who had a single episode of malaria in the first trimester. The association between malaria and miscarriage was estimated using multivariable logistic regression.Findings Of 48 426 pregnant women, 17 613 (36%) met the inclusion criteria: 16 668 (95%) had no malaria during the pregnancy and 945 (5%) had a single episode in the first trimester. The odds of miscarriage increased in women with asymptomatic malaria (adjusted odds ratio 2.70, 95% CI 2.04-3.59) and symptomatic malaria (3.99, 3.10-5.13), and were similar for Plasmodium falciparum and Plasmodium vivax. Other risk factors for miscarriage included smoking, maternal age, previous miscarriage, and non-malaria febrile illness. In women with malaria, additional risk factors for miscarriage included severe or hyperparasitaemic malaria (adjusted odds ratio 3.63, 95% CI 1.15-11.46) and parasitaemia (1.49, 1.25-1-78 for each ten-fold increase in parasitaemia). Higher gestational age at the time of infection was protective (adjusted odds ratio 0.86, 95% CI 0 81-0.91). The risk of miscarriage was similar for women treated with chloroquine (92 [26%] of 354), quinine (95 [27%) of 355), or artesunate (20 [31%] of 64; p=0.71). Adverse effects related to antimalarial treatment were not observed.Interpretation A single episode of falciparum or vivax malaria in the first trimester of pregnancy can cause miscarriage. No additional toxic effects associated with artesunate treatment occurred in early pregnancy. Prospective studies should now be done to assess the safety and efficacy of artemisinin combination treatments in early pregnancy.Funding Wellcome Trust and Bill & Melinda Gates Foundation.