Preventing Pregnancy Malaria: Maternal-Infant Outcomes

预防妊娠疟疾：母婴结局

• 批准号: 6960211
• 负责人: PATRICK E DUFFY
• 金额: $ 109.45万
• 依托单位: SEATTLE BIOMEDICAL RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-09-02 至 2010-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6960211
• 关键词: Africa; antimalarial agents; chemoprevention; clinical research; cooperative study; human therapy evaluation; longitudinal human study; malaria; microorganism disease chemotherapy; pregnancy infection; women' s health

DESCRIPTION (provided by applicant): Malaria during pregnancy kills thousands of mothers and hundreds of thousands of infants each year, so prevention is essential, but current regimens are losing efficacy to drug-resistant parasites. Scientists submitting this grant application have been conducting longitudinal studies and interventional trials of antimalarial drugs in pregnant women and young children in Tanzania. These studies indicate that placental malaria is common despite widespread delivery of Intermittent Presumptive Treatment to Pregnant women (IPTp) in Tanzania. In these studies, placental malaria increases the frequency of parasitemia and increases the frequency of all-cause hospitalization during infancy and early childhood, and retards weight gain during infancy. Taken together, the results indicate a public health crisis for Tanzanian mothers and their newborns who urgently require information on new malaria preventative regimens during pregnancy. In the studies proposed here, three new IPTp regimens (chlorproguanil-dapsone (LapDap); mefloquine; sulfadoxine-pyrimethamine (SP) + azithromycin) will be compared to the currently recommended regimen (SP alone) for their efficacy and safety, including longterm effects on neurodevelopmental outcomes of offspring. Regimens will also be compared for their effect on protective antibody levels, placental inflammation, infant development, and infant susceptibility to malaria infection and disease. The scientists submitting this grant application are uniquely qualified to carry out the research. This proposed program is based on the following hypotheses: IPTp with new regimens will be safe for mothers and their offspring, and will improve pregnancy outcomes among malaria-exposed women; effective IPTp regimens will delay the acquisition of protective antibodies against placental parasites, but will also prevent placental inflammation; effective IPTp will reduce susceptibility to malaria infection and disease during early life, and will improve measures of infant development; a center of excellence can be developed in Tanzania that is focused on malaria interventional studies for pregnant women and children. The Program will be organized as three discrete but inter-related projects, supported by a Data and Biostatistics Core. Our broad, long-term objectives are to identify more effective treatments to prevent malaria infection and disease in pregnant women, and to understand the long-term impact of malaria prevention on the acquisition of protective immunity and malaria susceptibility in pregnant women and their infants. We will also establish a center of excellence for future research on antimalarial interventions in Tanzania.

描述（由申请人提供）：每年有数千名母亲和数十万婴儿死于妊娠期疟疾，因此预防至关重要，但目前的治疗方案对耐药寄生虫正在失去疗效。提交这一赠款申请的科学家一直在坦桑尼亚对孕妇和幼儿进行抗疟药物的纵向研究和干预试验。这些研究表明，尽管在坦桑尼亚对孕妇进行了广泛的间歇性假定治疗，但胎盘疟疾仍很常见。在这些研究中，胎盘疟疾增加了寄生虫血症的频率，增加了婴儿期和幼儿期全因住院的频率，并延缓了婴儿期的体重增加。总的来说，这些结果表明坦桑尼亚母亲及其新生儿面临公共卫生危机，他们迫切需要有关怀孕期间新的疟疾预防方案的信息。在这里提出的研究中，三种新的IPTp方案（氯丙胍-氨苯砜（LapDap）;甲氟喹;磺胺嘧啶-乙胺嘧啶（SP）+阿奇霉素）将与目前推荐的方案（SP单独）进行疗效和安全性比较，包括对后代神经发育结局的长期影响。还将比较方案对保护性抗体水平、胎盘炎症、婴儿发育和婴儿对疟疾感染和疾病的易感性的影响。提交这项资助申请的科学家是唯一有资格进行这项研究的人。该计划基于以下假设：新方案的IPTp对母亲及其后代安全，并将改善疟疾暴露妇女的妊娠结局;有效的IPTp方案将延迟获得针对胎盘寄生虫的保护性抗体，但也将预防胎盘炎症;有效的国际预防性治疗方案将减少生命早期对疟疾感染和疾病的易感性，并将改善婴儿发育的衡量标准;可以在坦桑尼亚建立一个卓越中心，重点为孕妇和儿童开展疟疾干预研究。该计划将被组织为三个独立但相互关联的项目，由数据和生物统计核心支持。我们广泛的长期目标是确定更有效的治疗方法，以预防孕妇感染疟疾和疾病，并了解疟疾预防对孕妇及其婴儿获得保护性免疫力和疟疾易感性的长期影响。我们还将在坦桑尼亚建立一个卓越中心，用于未来的抗疟干预研究。