EFFECT OF MALARIA ON FETAL DEVELOPMENT

如果妇女在怀孕期间感染了恶性疟原虫， 她的健康以及胎儿和新生儿的健康都有危险。 在 1986年，世界卫生组织建议孕妇使用氯喹 化学预防作为预防疟疾副作用的一种手段。 今天，氯喹抗药性很普遍，疟疾学家 试图生产一种保护孕妇的疫苗。 不幸的是，很少有人知道为什么有些妇女会经历严重的 疟疾在怀孕期间和其他人没有，或者为什么发病率 自然流产、死产、早产和低 出生体重的婴儿因感染疟疾而增加。 很可能 胎盘内发生的变化导致胎儿发育迟缓 发展 在本文所述的研究中，我们建议测试 假设1）高寄生虫血症之间存在关系， 胎盘和胎儿发育改变的风险增加; 2）， 高寄生虫血症发生在胎盘，因为它是一个专门的 寄生虫特异性免疫反应 3）或者，怀孕失败的妇女 感染的疟疾病毒比那些 成功怀孕; 4）胎盘内的寄生虫诱导 肿瘤坏死因子（TNF）的合成改变抗原性 合胞体滋养细胞的表达导致胎儿滞留减少; 和5）胎盘中隔离的寄生虫的存在可以被 在血涂片阴性的妇女中通过检测可溶性 血清或尿液中的疟疾抗原。 基本信息来自 拟议的研究应该有助于开发一种疫苗， 胎儿和婴儿死亡率，以及确定一种方法， 诊断孕妇的疟疾

If a woman becomes infected with Plasmodium falciparum during pregnancy, her health and that of the fetus and newborn infant are at risk. In 1986, the WHO recommended that pregnant women use chloroquine chemoprophylaxis as a means of preventing the adverse effects of malaria. Today chloroquine resistance is widespread, and malariologists are attempting to produce a vaccine that will protect pregnant women. Unfortunately, little is known about why some women experience severe malaria during pregnancy and others do not, or why the incidence of spontaneous abortions, stillbirths, premature deliveries and low birthweight babies are increased by malaria infection. It is likely that changes within the placenta occur that contribute to retarded fetal development. In the studies described herein, we propose to test the hypotheses 1) that there is a relationship between high parasitemias in the placenta and increased risk of altered fetal development; 2) that high parasitemias occur in the placenta because it is a specialized immunologic environment where parasite-specific immune responses are suppressed; 3) alternatively, that women with unsuccessful pregnancies are infected with a more virulent strain of malaria than those with successful pregnancies; 4) that within the placenta parasites induce the synthesis of tumor necrosis factor (TNF) which alters antigenic expression of syncytiotrophoblasts resulting in reduced fetal retention; and 5) that the presence of parasites sequestered in the placenta can be detected in women who are blood-smear negative by detecting soluble malarial antigens in their serum or urine. Basic information from the proposed studies should help in the development of a vaccine that reduces fetal and infant mortality, as well as identify a method for accurately diagnosing malaria in pregnant women.