Influence of the number and timing of malaria episodes during pregnancy on prematurity and small-for-gestational-age in an area of low transmission.
Influence of the number and timing of malaria episodes during pregnancy on prematurity and small-for-gestational-age in an area of low transmission.
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DOI：
10.1186/s12916-017-0877-6
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发表时间：
2017-06-21
期刊：
影响因子：
9.3
通讯作者：
McGready R
中科院分区：
文献类型：
--
作者：
Moore KA;Simpson JA;Wiladphaingern J;Min AM;Pimanpanarak M;Paw MK;Raksuansak J;Pukrittayakamee S;Fowkes FJI;White NJ;Nosten F;McGready R
大多数关于妊娠期疟疾与不良妊娠结局之间关系的证据都集中在出生时发现的恶性疟疾。我们评估了妊娠期小于胎龄儿（SGA）和早产期间恶性疟和间日疟发作次数和时间之间的关系。我们分析了从泰国-缅甸边境（1986-2015）的产前诊所收集的观察数据。我们评估了妊娠期疟疾发作总数对SGA的影响，以及妊娠期疟疾对SGA、极早产和晚期早产的影响，通过使用时间依赖性疟疾变量（每月间隔）的logistic回归模型进行疟疾检测和治疗时的孕龄。使用世界卫生组织对极早产（≥28周且<32周）和晚期早产（≥32周且<37周）的定义以及国际SGA标准。在50，060名孕妇中，8221名（16%）在怀孕期间患有疟疾。在50,060名新生儿中，10,005名（21%）为SGA，540名（1%）为极早产，4331名（9%）为晚期早产。恶性疟原虫和间日疟的发病率分别在妊娠6周和5周时最高。恶性疟和间日疟每次发作，SGA的几率分别线性增加1.13倍（95%置信区间：1.09，1.17）和1.27倍（1.21，1.33）。妊娠12-16周后的恶性疟和妊娠20-24周后的间日疟与SGA相关（恶性疟OR范围：1.15-1.63 [p范围：<0.001-0.094];间日疟OR范围：1.12-1.54 [p范围：<0.001-0.138]）。在24-28周后的任何妊娠期，恶性疟疾与极早或晚期早产相关（OR范围：1.44-2.53; p范围：<0.001-0.001）。24-28周的间日疟与极早产相关（OR：1.79 [1.11，2.90]），28-32周的间日疟与晚期早产相关（OR：1.23 [1.01，1.50]）。这些协会中有许多是为无症状疟疾设立的。应在怀孕期间尽早开始预防疟疾。在一般人群中控制和消除疟疾的努力可以避免与怀孕期间无症状疟疾治疗有关的不利后果。本文的在线版本（doi：10.1186/s12916-017-0877-6）包含补充材料，可供授权用户使用。
Most evidence on the association between malaria in pregnancy and adverse pregnancy outcomes focuses on falciparum malaria detected at birth. We assessed the association between the number and timing of falciparum and vivax malaria episodes during pregnancy on small-for-gestational-age (SGA) and preterm birth. We analysed observational data collected from antenatal clinics on the Thailand-Myanmar border (1986–2015). We assessed the effects of the total number of malaria episodes in pregnancy on SGA and the effects of malaria in pregnancy on SGA, very preterm birth, and late preterm birth, by the gestational age at malaria detection and treatment using logistic regression models with time-dependent malaria variables (monthly intervals). World Health Organisation definitions of very preterm birth (≥28 and <32 weeks) and late preterm birth (≥32 and <37 weeks) and international SGA standards were used. Of 50,060 pregnant women followed, 8221 (16%) had malaria during their pregnancy. Of the 50,060 newborns, 10,005 (21%) were SGA, 540 (1%) were very preterm, and 4331 (9%) were late preterm. The rates of falciparum and vivax malaria were highest at 6 and 5 weeks’ gestation, respectively. The odds of SGA increased linearly by 1.13-fold (95% confidence interval: 1.09, 1.17) and 1.27-fold (1.21, 1.33) per episode of falciparum and vivax malaria, respectively. Falciparum malaria at any gestation period after 12–16 weeks and vivax malaria after 20–24 weeks were associated with SGA (falciparum odds ratio, OR range: 1.15–1.63 [p range: <0.001–0.094]; vivax OR range: 1.12–1.54 [p range: <0.001–0.138]). Falciparum malaria at any gestation period after 24–28 weeks was associated with either very or late preterm birth (OR range: 1.44–2.53; p range: <0.001–0.001). Vivax malaria at 24–28 weeks was associated with very preterm birth (OR: 1.79 [1.11, 2.90]), and vivax malaria at 28–32 weeks was associated with late preterm birth (OR: 1.23 [1.01, 1.50]). Many of these associations held for asymptomatic malaria. Protection against malaria should be started as early as possible in pregnancy. Malaria control and elimination efforts in the general population can avert the adverse consequences associated with treated asymptomatic malaria in pregnancy. The online version of this article (doi:10.1186/s12916-017-0877-6) contains supplementary material, which is available to authorized users.