The Association between Malaria and Iron Status or Supplementation in Pregnancy: A Systematic Review and Meta-Analysis
The Association between Malaria and Iron Status or Supplementation in Pregnancy: A Systematic Review and Meta-Analysis
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DOI：
10.1371/journal.pone.0087743
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发表时间：
2014-02-14
期刊：
影响因子：
3.7
通讯作者：
Stergachis, Andy
中科院分区：
文献类型：
--
作者：
Sangare, Laura;van Eijk, Anna Maria;Stergachis, Andy
疟疾预防和铁补充与改善孕产妇和婴儿结局相关。然而，来自儿童研究的证据表明，铁可能会对疟疾的风险产生不利影响。我们回顾了妊娠期间疟疾与铁状态标记物、铁补充或肠外治疗之间的关联。方法和发现：我们检索了MEDLINE、EMBASE、Cochrane中央对照试验登记、全球卫生图书馆和妊娠期疟疾图书馆，以确定研究铁状态、铁治疗或补充与妊娠期疟疾之间关系的研究。31项研究对分析做出了贡献；3项实验研究和28项观察性研究。在非洲，补充铁与妊娠或分娩期间恶性疟原虫疟疾风险增加无关（总相对危险度= 0.89,95%可信区间（CI） 0.66-1.20, I-2 = 78.8%， 5项研究）。亚洲的一项研究报告补充铁后30天内间日疟原虫的风险增加（例如，1-15天调整后的风险比= 1.75,95% CI 1.14-2.70），但60天后没有增加。缺铁（基于铁蛋白和c反应蛋白）与疟疾感染几率较低相关（总比值比= 0.35,0.24-0.51,I-2 = 59.2%， 5项研究）。除了急性期蛋白铁蛋白外，缺铁的生物标志物通常与疟疾感染无关。结论：补充铁与间日疟原虫的时间增加有关，但与恶性疟原虫的风险增加无关；然而，数据不足以排除恶性疟原虫风险增加的可能性。只有在用铁蛋白测量时，缺铁才与妊娠期疟疾风险降低有关。在有更多证据之前，谨慎的做法是在怀孕期间结合提供铁和预防疟疾。
Introduction: Malaria prevention and iron supplementation are associated with improved maternal and infant outcomes. However, evidence from studies in children suggests iron may adversely modify the risk of malaria. We reviewed the evidence in pregnancy of the association between malaria and markers of iron status, iron supplementation or parenteral treatment.Methods and Findings: We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, the Global Health Library, and the Malaria in Pregnancy library to identify studies that investigated the association between iron status, iron treatment or supplementation during pregnancy and malaria. Thirty one studies contributed to the analysis; 3 experimental and 28 observational studies. Iron supplementation was not associated with an increased risk of P. falciparum malaria during pregnancy or delivery in Africa (summary Relative Risk = 0.89, 95% Confidence Interval (CI) 0.66-1.20, I-2 = 78.8%, 5 studies). One study in Asia reported an increased risk of P. vivax within 30 days of iron supplementation (e. g. adjusted Hazard Ratio = 1.75, 95% CI 1.14-2.70 for 1-15 days), but not after 60 days. Iron deficiency (based on ferritin and C-reactive protein) was associated with lower odds for malaria infection (summary Odds Ratio = 0.35, 0.24-0.51, I-2 = 59.2%, 5 studies). With the exception of the acute phase protein ferritin, biomarkers of iron deficiency were generally not associated with malaria infection.Conclusions: Iron supplementation was associated with a temporal increase in P vivax, but not with an increased risk of P. falciparum; however, data are insufficient to rule out the potential for an increased risk of P. falciparum. Iron deficiency was associated with a decreased malaria risk in pregnancy only when measured with ferritin. Until there is more evidence, it is prudent to provide iron in combination with malaria prevention during pregnancy.