Cot M, Deloron P
Institut de Recherche pour le Développement, UR 010, Paris, France.
Br Med Bull. 2003;67:137-48. doi: 10.1093/bmb/ldg003.
Acute and severe consequences of pregnancy-associated malaria (PAM), such as materno-fetal death or cerebral malaria, seem limited to unstable malaria areas. In areas of stable endemicity, the main consequences are maternal anaemia and low birth weight (LBW) babies, particularly in primigravidae. Placental malaria seems more frequent and its consequences more severe in HIV-infected women. Since 1964, several chemoprophylaxis controlled trials have been undertaken, mainly in Tropical Africa where malaria is stable. Most showed an increase in mean birth weight in the prophylaxis group, especially among primigravidae. Similar findings were made with anaemia. Prophylaxis seems less effective in the case of HIV-malaria co-infection, which may require an increase in the number of doses. At present, intermittent treatment with sulfadoxine-pyrimethamine given twice or thrice during pregnancy in antenatal clinics seems the best policy for preventing PAM. Such effective prophylaxis should be integrated with other antenatal clinic services. Recently identified molecular receptors involved in cytoadherence of parasitized erythrocytes to placenta could yield new therapeutic or vaccine approaches, specifically targeted to pregnant women.
妊娠相关疟疾（PAM）的急性和严重后果，如母婴死亡或脑型疟疾，似乎仅限于疟疾不稳定地区。在疟疾稳定流行地区，主要后果是孕妇贫血和低体重（LBW）儿，尤其是初产妇。胎盘疟疾在感染艾滋病毒的妇女中似乎更常见，其后果也更严重。自1964年以来，已经进行了几项化学预防对照试验，主要在疟疾稳定的热带非洲地区。大多数试验表明，预防组的平均出生体重有所增加，尤其是初产妇。贫血方面也有类似的发现。在艾滋病毒与疟疾合并感染的情况下，预防似乎效果较差，这可能需要增加用药剂量。目前，在产前诊所孕期给予两次或三次磺胺多辛-乙胺嘧啶间歇治疗似乎是预防PAM的最佳策略。这种有效的预防措施应与其他产前诊所服务相结合。最近发现的参与被寄生红细胞与胎盘细胞粘附的分子受体可能会产生新的治疗或疫苗方法，专门针对孕妇。
