The association of parasitic infections in pregnancy and maternal and fetal anemia: a cohort study in coastal Kenya.
The association of parasitic infections in pregnancy and maternal and fetal anemia: a cohort study in coastal Kenya.
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DOI：
10.1371/journal.pntd.0002724
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发表时间：
2014-02
影响因子：
3.8
通讯作者：
Dent AE
中科院分区：
文献类型：
--
作者：
McClure EM;Meshnick SR;Mungai P;Malhotra I;King CL;Goldenberg RL;Hudgens MG;Siega-Riz AM;Dent AE
这些感染对妊娠期贫血的相对影响尚不确定。虽然保护孕妇免受疟疾侵害的措施不断扩大，但针对蠕虫的干预措施却受到的关注却少得多。在这项研究中，我们确定了蠕虫和疟疾对孕产妇贫血的相对影响。在肯尼亚沿海地区开展了一项前瞻性观察性研究，研究对象是在第一次产前护理 (ANC) 就诊时招募的一组孕妇，并在入组时进行了疟疾、钩虫和其他寄生虫感染和贫血检测。所有参与该研究的女性都接受了磺胺多辛-乙胺嘧啶、铁和多种维生素的推定治疗，诊断患有蠕虫感染的女性则接受了阿苯达唑治疗。足月活产的妇女还接受了母体贫血、胎儿贫血和分娩时感染情况的检测。在接受研究的 706 名女性中，在第一次 ANC 就诊时，27% 的女性患有中度/重度贫血，71% 的女性整体贫血。患病率最高的感染是钩虫病（24%）、泌尿生殖道血吸虫病（17%）、鞭虫病（10%）和疟疾（9%）。在调整和未经调整的分析中，首次 ANC 就诊时的中度/重度贫血与钩虫和恶性疟原虫镜检-疟疾感染的较高强度相关。分娩时，34%的妇女患有中度/重度贫血，18%的婴儿脐带血红蛋白与胎儿贫血一致。虽然没有任何母体感染与胎儿贫血显着相关，但中度/重度母体贫血与胎儿贫血相关。接受标准 ANC 联合 IPTp 治疗疟疾的女性中，超过四分之一的女性在妊娠期患有中度/重度贫血，并且寄生虫感染率较高。因此，需要解决钩虫等合并感染以及营养不良的作用及其对贫血的影响。国际指南建议在怀孕期间进行安全有效的常规预防和治疗，以减少生活在这些感染流行地区的孕妇的钩虫、疟疾和其他感染。尽管有效，但解决怀孕期间钩虫病、血吸虫病和疟疾等常见感染的计划尚未得到广泛采用。钩虫、疟疾和其他感染与儿童贫血有关，但有关这些感染对妊娠期贫血影响的研究尚不清楚。这项研究的目的是评估接受产前护理的妇女寄生虫感染的患病率，该护理为肯尼亚沿海地区提供了国家推荐的疟疾预防治疗计划。在第一次 ANC 就诊时，超过 70% 的女性患有贫血，近四分之一患有钩虫，约 10% 患有疟疾。钩虫或疟疾感染水平较高的女性有贫血的风险。
Relative contribution of these infections on anemia in pregnancy is not certain. While measures to protect pregnant women against malaria have been scaling up, interventions against helminthes have received much less attention. In this study, we determine the relative impact of helminthes and malaria on maternal anemia. A prospective observational study was conducted in coastal Kenya among a cohort of pregnant women who were recruited at their first antenatal care (ANC) visit and tested for malaria, hookworm, and other parasitic infections and anemia at enrollment. All women enrolled in the study received presumptive treatment with sulfadoxine-pyrimethamine, iron and multi-vitamins and women diagnosed with helminthic infections were treated with albendazole. Women delivering a live, term birth, were also tested for maternal anemia, fetal anemia and presence of infection at delivery. Of the 706 women studied, at the first ANC visit, 27% had moderate/severe anemia and 71% of women were anemic overall. The infections with highest prevalence were hookworm (24%), urogenital schistosomiasis (17%), trichuria (10%), and malaria (9%). In adjusted and unadjusted analyses, moderate/severe anemia at first ANC visit was associated with the higher intensities of hookworm and P. falciparum microscopy-malaria infections. At delivery, 34% of women had moderate/severe anemia and 18% of infants' cord hemoglobin was consistent with fetal anemia. While none of the maternal infections were significantly associated with fetal anemia, moderate/severe maternal anemia was associated with fetal anemia. More than one quarter of women receiving standard ANC with IPTp for malaria had moderate/severe anemia in pregnancy and high rates of parasitic infection. Thus, addressing the role of co-infections, such as hookworm, as well as under-nutrition, and their contribution to anemia is needed. International guidelines recommend routine prevention and treatments which are safe and effective during pregnancy to reduce hookworm, malaria and other infections among pregnant women living in geographic areas where these infections are prevalent. Despite their effectiveness, programs to address common infections such as hookworm, schistosomiasis and malaria during pregnancy have not been widely adopted. Hookworm, malaria and other infections have been associated with anemia in children, but the studies on the impact of these infections on anemia in pregnancy have not been as clear. This study was undertaken to evaluate the prevalence of parasitic infections among women attending antenatal care which provided the nationally recommended malaria preventive treatment program in coastal Kenya. At the first ANC visit, more than 70% of women were anemic, nearly one-fourth had hookworm and about 10% had malaria. Women with high levels of hookworm or malaria infections were at risk of anemia.
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DOI：
10.1111/j.1365-3156.2012.03001.x
发表时间：
2012-07
期刊：
Tropical medicine & international health : TM & IH
影响因子：
--
作者：
Gitonga CW;Edwards T;Karanja PN;Noor AM;Snow RW;Brooker SJ
通讯作者：
Brooker SJ
影响因子：
3.8
作者：
Khieu, Virak;Schaer, Fabian;Odermatt, Peter
通讯作者：
Odermatt, Peter
DOI：
10.4269/ajtmh.2012.12-0371
发表时间：
2013-01-01
影响因子：
3.3
作者：
Fairley, Jessica K.;Bisanzio, Donal;Malhotra, Indu
通讯作者：
Malhotra, Indu
影响因子：
7.2
作者：
Huchon, Cyrille;Dumont, Alexandre;Fournier, Pierre
通讯作者：
Fournier, Pierre
影响因子：
3.8
作者：
Gyorkos, Theresa W.;Gilbert, Nicolas L.;Montresor, Antonio
通讯作者：
Montresor, Antonio