The effect of malaria and malaria prevention in pregnancy on offspring birthweight, prematurity, and intrauterine growth retardation in rural Malawi
The effect of malaria and malaria prevention in pregnancy on offspring birthweight, prematurity, and intrauterine growth retardation in rural Malawi
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DOI：
10.4269/ajtmh.1996.55.33
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发表时间：
1996-01-01
影响因子：
3.3
通讯作者：
Breman, JG
中科院分区：
文献类型：
--
作者：
Steketee, RW;Wirima, JJ;Breman, JG
虽然有广泛的证据表明妊娠期间感染恶性疟原虫会产生不利影响，而且世界卫生组织也建议采取预防战略，但在撒哈拉以南非洲，最广泛获得、负担得起和使用的抗疟药物-氯喹（CQ）-的疗效明显降低。在1987-1990年期间，我们研究了马拉维农村疟疾高发区的孕妇，以比较CQ的疗效（国家政策推荐的药物）与甲氟喹（MQ，一种相对较新且高效的抗疟药）预防早产和宫内生长导致的低出生体重（LBW）1，766名女性在妊娠最后6周内接受监测，观察到摄入其方案并顺利分娩活产单胎，其婴儿的平均+/- SD出生体重为2，905 +/- 461 gm和16.8%有LBW。在多因素分析中，与LBW显著相关的因素包括：第一胎（OR = 4.27）、女婴（OR = 2.92）、母体人类免疫缺陷病毒感染（OR = 2.66）、低体重（OR = 1.95）和胎盘血恶性疟原虫感染（OR = 1.71）。与IUGR-LBW显著相关的因素包括头胎、女婴、低体重母亲和胎盘疟疾。与早产儿低出生体重显著相关的因素包括母亲梅毒感染、脐带血疟疾、第一胎、母亲低体重和女婴。使用有效的抗疟药（MQ）通过其减少胎盘和脐带血疟疾感染的作用对LBW具有保护作用。MQ组妇女出生的LBW婴儿比例（12.5% [经产次调整的分娩妇女人口]）显著低于CQ组妇女出生的比例（15.5%; P = 0.05）。在疟疾流行的环境中有效预防孕妇的疟疾可将低出生体重的可能性降低5- 14%，并可将可预防的低出生体重的数量减少30%以上。在评估产前保健计划时，卫生政策制定者必须考虑提供有效的预防药物（MQ或其他研究中确定的其他药物，例如，磺胺乙胺嘧啶化合物）作为预防低出生体重及其后果的手段。
While there is broad evidence for the adverse effects of Plasmodium falciparum infection in pregnancy, and the World Health Organization recommends preventive strategies, there is markedly reduced efficacy in sub-Saharan Africa of the most widely available, affordable and used antimalarial drug for chemoprophylaxis-chloroquine (CQ). During 1987-1990, we studied pregnant women in an area of high malaria endemicity in rural Malawi to compare the efficacy of CQ (the drug recommended by national policy) with mefloquine (MQ, a relatively new and highly effective antimalarial) in preventing low birth weight (LBW) due to prematurity and intrauterine growth 1,766 women monitored during at least their last six weeks of pregnancy with observed ingestion of their regimen and facility delivery of a live born singleton, their babies had a mean +/- SD birth weight of 2,905 +/- 461 gm and 16.8% had LBW. In a multivariate analysis, factors significantly associated with LBW included: first birth (odds ratio [OR] = 4.27), female infant (OR = 2.92), maternal human immunodeficiency virus infection (OR = 2.66), low maternal weight (OR = 1.95), and placental blood P. falciparum infection (OR = 1.71). Factors significantly associated with IUGR-LBW included first birth, female infant, low maternal weight, and placental malaria. Factors significantly associated with preterm-LBW included maternal syphilis infection, umbilical cord blood malaria, first birth, low maternal weight, and female infant. Use of an effective antimalarial (MQ) was protective against LBW through its effect on reducing placental and umbilical cord blood malaria infection. The proportion of LBW babies born to women on MQ (12.5% [parity-adjusted for the population of delivering women]) was significantly lower than the proportion born to women on CQ (15.5%; P = 0.05). Effective prevention of malaria in pregnant women in malaria-endemic settings may reduce the likelihood of LBW by 5-14%, and may reduce the amount of preventable LBW by more than 30%. When evaluating antenatal care programs, health policy makers must consider providing an effective preventive drug (either MQ or other drugs identified in additional studies, e.g., sulfa-pyrimethamine compounds) as a means to prevent low birth weight and its consequences.